Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 10 (2024)

Quantifying aminoglycoside resistance in extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales clinical isolates: a retrospective cohort study

DOI
https://doi.org/10.57187/s.3904
Cite this as:
Swiss Med Wkly. 2024;154:3904
Published
09.10.2024

Summary

AIMS: Aminoglycoside resistance is frequently detected in extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE), questioning the appropriateness of aminoglycosides as empiric therapy in patients with suspected ESBL-PE infections. Therefore, we aimed to evaluate the frequency of aminoglycoside resistance in patients harbouring ESBL-PE and identify patient-related risk factors associated with aminoglycoside resistance to facilitate early detection of at-risk patients.

METHODS: This retrospective single-centre cohort study included hospitalised patients aged ≥18 years with an ESBL-PE-positive sample between January 2016 and December 2018. Aminoglycoside resistance was defined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints for Enterobacterales for the current year of testing.

RESULTS: Five hundred forty-four patients met the eligibility criteria, of which 240 (44.1%) harboured aminoglycoside-resistant ESBL strains. Identification of ESBL-Klebsiella pneumoniae was significantly associated with aminoglycoside resistance (odds ratio [OR] = 2.64, 95% confidence interval [CI] = 1.65–4.21, p <0.001) and an international travel history within the past 12 months was marginally associated with aminoglycoside resistance (OR = 1.51, 95% CI = 0.95–2.42, p = 0.084).

CONCLUSIONS: In a low ESBL endemicity setting, aminoglycoside resistance in patients harbouring ESBL-PE is common, especially ESBL-K. pneumoniae, and needs to be considered in clinicians’ decision-making regarding empiric therapy regimens.

References

  1. Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, et al.; ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013 Dec;98(12):1826–35. doi: https://doi.org/10.3324/haematol.2013.091025 DOI: https://doi.org/10.3324/haematol.2013.091025
  2. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al.; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb;52(4):e56–93. doi: https://doi.org/10.1093/cid/cir073 DOI: https://doi.org/10.1093/cid/cir073
  3. Isendahl J, Giske CG, Tegmark Wisell K, Ternhag A, Nauclér P. Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case-control study. Clin Microbiol Infect. 2019 Nov;25(11):1408–14. doi: https://doi.org/10.1016/j.cmi.2019.04.002 DOI: https://doi.org/10.1016/j.cmi.2019.04.002
  4. Vock I, Aguilar-Bultet L, Egli A, Tamma PD, Tschudin-Sutter S. Infections in Patients Colonized With Extended-spectrum Beta-Lactamase-Producing Enterobacterales: A Retrospective Cohort Study. Clin Infect Dis. 2021 Apr;72(8):1440–3. doi: https://doi.org/10.1093/cid/ciaa895 DOI: https://doi.org/10.1093/cid/ciaa895
  5. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: https://doi.org/10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
  6. Centers for Disease Control and Prevention. CDC/NHSN Surveillance Definitions for Specific Types of Infections. 2022. Available from https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf
  7. Albasanz-Puig A, Gudiol C, Puerta-Alcalde P, Ayaz CM, Machado M, Herrera F, et al. Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study). Antimicrob Agents Chemother. 2021 Jul;65(8):e0004521. doi: https://doi.org/10.1128/AAC.00045-21 DOI: https://doi.org/10.1128/AAC.00045-21
  8. Ma L, Lin CJ, Chen JH, Fung CP, Chang FY, Lai YK, et al.; Taiwan Surveillance of Antimicrobial Resistance Project. Widespread dissemination of aminoglycoside resistance genes armA and rmtB in Klebsiella pneumoniae isolates in Taiwan producing CTX-M-type extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 2009 Jan;53(1):104–11. doi: https://doi.org/10.1128/AAC.00852-08 DOI: https://doi.org/10.1128/AAC.00852-08
  9. Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol Rev. 2017 May;41(3):252–75. doi: https://doi.org/10.1093/femsre/fux013 DOI: https://doi.org/10.1093/femsre/fux013
  10. Kennedy K, Collignon P. Colonisation with Escherichia coli resistant to “critically important” antibiotics: a high risk for international travellers. Eur J Clin Microbiol Infect Dis. 2010 Dec;29(12):1501–6. doi: https://doi.org/10.1007/s10096-010-1031-y DOI: https://doi.org/10.1007/s10096-010-1031-y
  11. Karlowsky JA, Zelenitsky SA, Zhanel GG. Aminoglycoside adaptive resistance. Pharmacotherapy. 1997;17(3):549–55. doi: https://doi.org/10.1002/j.1875-9114.1997.tb03063.x DOI: https://doi.org/10.1002/j.1875-9114.1997.tb03063.x
  12. Vock I, Aguilar-Bultet L, Egli A, Tamma PD, Tschudin-Sutter S. Independent, external validation of clinical prediction rules for the identification of extended-spectrum β-lactamase-producing Enterobacterales, University Hospital Basel, Switzerland, January 2010 to December 2016. Euro Surveill. 2020 Jul;25(26):1900317. doi: https://doi.org/10.2807/1560-7917.ES.2020.25.26.1900317 DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.26.1900317

Most read articles by the same author(s)

<< < 1 2