Dataset Information

Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia.

ABSTRACT: Introduction:Information on microbiological and susceptibility profiles of clinical isolates in Mongolia is scarce, hampering infection control and clinical care. Methods:Species and resistance profiles of 6334 clinical gram negative isolates, collected at Mongolia's National Center for Maternal and Child Health between 2014 and 2017 were analyzed. Results:Annual proportion of multidrug-resistance among E. coli and Enterobacter isolates increased from 2.8% to 16.6% and 3.5% to 22.6% respectively; Klebsiella isolates exhibiting susceptibilities suggestive of extended spectrum beta-lactamase (ESBL) production from 73% to 94%. By 2017, 60.6% of Klebsiella isolates were multidrug-resistant, most originated from intensive care wards. Enterobacteriaceae exhibiting susceptibility patterns suggestive of ESBL production and multidrug-resistant organisms were common and their incidence increased rapidly. Conclusion:These findings will serve to build strategies to strengthen microbiological surveillance, diagnostics and infection control; and to develop empiric therapy and stewardship recommendations for Mongolia's largest Children's and Maternity hospital.

SUBMITTER: Felsenstein S

PROVIDER: S-EPMC7538878 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia.

Felsenstein Susanna S Bira Sarantsetseg S Altanmircheg Narangerel N Shonkhuuz Enkhtur E Ochirpurev Ariuntuya A Warburton David D

Central Asian journal of global health 20200427 1

<h4>Introduction</h4>Information on microbiological and susceptibility profiles of clinical isolates in Mongolia is scarce, hampering infection control and clinical care.<h4>Methods</h4>Species and resistance profiles of 6334 clinical gram negative isolates, collected at Mongolia's National Center for Maternal and Child Health between 2014 and 2017 were analyzed.<h4>Results</h4>Annual proportion of multidrug-resistance among <i>E. coli</i> and <i>Enterobacter</i> isolates increased from 2.8% to ...[more]

PMID: 33062401

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Project description:Gram-negative multidrug-resistant organisms (GN-MDRO) producing β-lactamases (ESBL, plasmid-mediated AmpC β-lactamases and carbapenemases) are increasingly reported throughout Asia. The aim of this surveillance study was to determine the rate of bacterial colonization in patients from two hospitals in the Mongolian capital Ulaanbaatar. Rectal swabs were obtained from patients referred to the National Traumatology and Orthopaedics Research Centre (NTORC) or the Burn Treatment Centre (BTC) between July and September 2014, on admission and again after 14 days. Bacteria growing on selective chromogenic media (CHROMagar ESBL/KPC) were identified by MALDI-ToF MS. We performed susceptibility testing by disk diffusion and PCR (blaIMP-1, blaVIM, blaGES, blaNDM, blaKPC, blaOXA-48, blaGIM-1, blaOXA-23, blaOXA-24/40, blaOXA-51, blaOXA-58, blaOXA-143, blaOXA-235, blaCTX-M, blaSHV blaTEM and plasmid-mediated blaAmpC). Carbapenemase-producing isolates were additionally genotyped by PFGE and MLST. During the study period 985 patients in the NTORC and 65 patients in the BTC were screened on admission. The prevalence of GN-MDRO-carriage was 42.4% and 69.2% respectively (p<0.001). Due to the different medical specialities the two study populations differed significantly in age (p<0.029) and gender (p<0.001) with younger and more female patients in the burn centre (BTC). We did not observe a significant difference in colonization rate in the respective age groups in the total study population. In both centres most carriers were colonized with CTX-M-producing E. coli, followed by CTX-M-producing K. pneumoniae and CTX-M-producing E. cloacae. 158 patients from the NTORC were re-screened after 14 days of whom 99 had acquired a new GN-MDRO (p<0.001). Carbapenemases were detected in both centres in four OXA-58-producing A. baumannii isolates (ST642) and six VIM-2-producing P. aeruginosa isolates (ST235). This study shows a high overall prevalence of GN-MDRO in the study population and highlights the importance of routine surveillance, appropriate infection control practice and antibiotic prescribing policies to prevent further spread especially of carbapenemases.

Project description:Multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) is a major bacterial pathogen responsible for hospital outbreaks worldwide, mainly via the spread of high-risk clones and epidemic resistance plasmids. In this study, we evaluated the molecular epidemiology and β-lactam resistance mechanisms of MDR-Kp strains isolated in a Brazilian academic care hospital. We used whole-genome sequencing to study drug resistance mechanisms and their relationships with a K. pneumoniae carbapenemase-producing (KPC) Kp outbreak. Forty-three Kp strains were collected between 2003 and 2012. Antimicrobial susceptibility testing was performed for 15 antimicrobial agents, and polymerase chain reaction (PCR) was used to detect 32 resistance genes. Mutations in ompk35, ompk36, and ompk37 were evaluated by PCR and DNA sequencing. Pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were carried out to differentiate the strains. Based on distinct epidemiological periods, six Kp strains were subjected to whole-genome sequencing. β-lactamase coding genes were widely distributed among isolates. Almost all isolates had mutations in porin genes, particularly ompk35. The presence of bla KPC promoted a very high increase in carbapenem minimum inhibitory concentration only when ompk35 and ompk36 were interrupted by insertion sequences. A major cluster was identified by PFGE analysis and all isolates from this cluster belonged to clonal group (CG) 258. We have also identified a large repertoire of resistance genes in the sequenced isolates. A bla KPC-2-bearing plasmid (pUFPRA2) was also identified, which was very similar to a plasmid previously described in the first Brazilian KPC-Kp (2005). We found high-risk clones (CG258) and an epidemic resistance plasmid throughout the duration of the study (2003 to 2012), emphasizing a persistent presence of MDR-Kp strains in the hospital setting. Finally, we found that horizontal transfer of resistance genes between clones may have played a key role in the evolution of the outbreak.

Dataset Information

Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia.

Publications

Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia.

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