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Doyle D.,Calgary Laboratory Services | Peirano G.,Calgary Laboratory Services | Peirano G.,University of Calgary | Lascols C.,International Health Management Associates Inc. | And 5 more authors.
Journal of Clinical Microbiology | Year: 2012

A study was designed to evaluate the modified Hodge test (MHT), Mastdiscs ID inhibitor combination disks (MDI), Rosco Diagnostica Neo-Sensitabs (RDS), metallo-β-lactamase (MBL) Etest, and in-house multiplex PCR for the detection of well-characterized carbapenemase-producing Enterobacteriaceae. One hundred forty-two nonrepeat clinical isolates of carbapenemase-producing Enterobacteriaceae (including Klebsiella spp., Escherichia coli, Citrobacter freundii, and Enterobacter spp.) obtained from the SMART worldwide surveillance program during 2008 to 2009 were included. These included 49 KPC-, 27 NDM-, 19 VIM-, 14 OXA-48-like enzyme-, and 5 IMP-producing isolates and 28 carbapenem-resistant, carbapenemase-negative isolates. The manufacturer's instructions were followed for MDI, RDS, and MBL Etest and CLSI guidelines for MHT. A multiplex PCR was designed to detect KPC, NDM, VIM, IMP, and OXA-48-like carbapenemases. Overall, the sensitivity and specificity were 78% and 93% for MDI, 80% and 93% for RDS, 58% and 93% for MHT, and 55% and 100% for MBL Etest, respectively. The PCR had 100% sensitivity and specificity. MDI and RDS performed well for the detection of KPCs and NDMs but poorly for VIMs, IMPs, and OXA-48-like enzymes. MHT performed well for KPCs and OXA-48-like enzymes but poorly for NDMs, VIMs, and IMPs. MDI and RDS were easy to perform and interpret but lacked sensitivity for OXA-48-like enzymes, VIMs, and IMPs. MHT and MBL Etest were often difficult to interpret. We recommend using molecular tests for the optimal detection of carbapenemase-producing Enterobacteriaceae. Copyright © 2012, American Society for Microbiology. All Rights Reserved. Source


Lascols C.,International Health Management Associates Inc. | Peirano G.,University of Calgary | Hackel M.,International Health Management Associates Inc. | Laupland K.B.,University of Calgary | Pitout J.D.D.,University of Calgary
Antimicrobial Agents and Chemotherapy | Year: 2013

A study was designed to characterize nonrepeat isolates of carbapenemase-producing K. pneumoniae obtained from the SMART worldwide surveillance program during 2008 and 2009. Characterization was done by PCR and sequencing for blaVIM, blaIMP, blaNDM, bla OXA, blaKPC, and plasmid-mediated quinolone resistance and virulence factors (VFs). Genetic relatedness was determined with pulsed-field gel electrophoresis (PFGE) using XbaI and multilocus sequence typing. A total of 110 isolates were included; 47 possess genes that encode K. pneumoniae carbapenemases (KPCs), 26 NDMs, 19 VIMs, 13 OXA-48-like, and 5 imipenems (IMPs). We identified 3 different major sequence types (STs) among 65% of the isolates (i.e., ST11 [ n = 11], ST147 [n = 23], and ST258 [n = 38]). ST11 and ST147, producing OXA-48-like and NDMs, were found in Argentina, Turkey, Greece, Italy, and India; ST258, producing KPCs, was present in the United States, Israel, Greece, and Puerto Rico. The major STs consisted of up to 4 different pulsotypes, and each pulsotype had a specific geographical distribution. A new ST, named ST903, with blaIMP-26, was identified in the Philippines, while two blaOXA-48-positive isolates were detected in the United States. There were no significant differences in the distribution of the VFs between the isolates; all were positive for fimH, mrkD, wabG, and ureA. This is the first report of OXA-48-like enzymes in North America. Our study highlights the importance of surveillance programs using molecular techniques as powerful tools to identify the importance of international sequence types. Copyright © 2013, American Society for Microbiology. All Rights Reserved. Source


Hoban D.J.,International Health Management Associates Inc. | Nicolle L.E.,University of Manitoba | Hawser S.,IHMA Europe Sarl | Bouchillon S.,International Health Management Associates Inc. | Badal R.,International Health Management Associates Inc.
Diagnostic Microbiology and Infectious Disease | Year: 2011

Escherichia coli is the most important uropathogen. The Study for Monitoring Antimicrobial Resistance Trends program collected 1643 E. coli isolates in 2009-2010 from urinary tract infection (UTI) specimens of hospitalized patients in countries worldwide. Ertapenem and imipenem were the most active agents tested, inhibiting >98% of all E. coli phenotypes. Overall, 17.9% of isolates were extended-spectrum beta-lactamase (ESBL) producers. The highest ESBL rate was from the Asia/Pacific region (27.7%). Amikacin and piperacillin-tazobactam achieved 90% inhibition levels only for ESBL-negative isolates. Ciprofloxacin and levofloxacin were not effective for ESBL-positive isolates, with only 14.6% and 15.9% susceptible, respectively. These observations highlight the need for continued monitoring of susceptibility of E. coli isolated from hospitalized patients with UTIs. © 2011 Elsevier Inc. Source


Peirano G.,University of Calgary | Lascols C.,International Health Management Associates Inc. | Hackel M.,International Health Management Associates Inc. | Hoban D.J.,International Health Management Associates Inc. | And 2 more authors.
Diagnostic Microbiology and Infectious Disease | Year: 2014

A study was designed to characterize 35 non-repeat isolates of VIM- and IMP-producing Enterobacteriaceae obtained from the SMART surveillance program. Characterization was done by polymerase chain reaction, sequencing, and multi-locus sequencing. The VIM-1, -2, -5, -26, -27, -33, and IMP-1 and -26-producing Enterobacteriaceae were obtained from Greece, Italy, Spain, Philippines, Turkey, Australia, Mexico, USA, and India. Plasmids varied in size from 60 to 300 kb and belonged to IncA/C, IncF, IncHI1, IncL/M, IncN, and IncK incompatibility groups. The most common gene cassettes consisted of blaIMP-26, qacG, aacA4 and blaVIM, aacA7, dhfrI, and aadA1. Intercountry, interhospital, intrahospital, interspecies, and intraclonal spread of blaVIM and blaIMP containing plasmids and sequence types (STs) occurred in Greece, Italy, Spain, and Philippines. ST147 with IncA/C and IncF plasmids is an important drug-resistant ST among Klebsiella pneumoniae with VIMs. Our study highlights the importance of surveillance programs using molecular techniques as powerful tools to identify the transmission of STs with their respective plasmids. © 2014 Elsevier Inc. Source


Bouchillon S.K.,International Health Management Associates Inc. | Badal R.E.,International Health Management Associates Inc. | Hoban D.J.,International Health Management Associates Inc. | Hawser S.P.,IHMA Europe Sarl
Clinical Therapeutics | Year: 2013

Background: The Study for Monitoring Antimicrobial Resistance Trends is an ongoing global surveillance program that has monitored the susceptibilities of Gram-negative bacilli from inpatient urinary tract infections (UTIs) since late 2009. Objective: This analysis reports on the in vitro susceptibility of 2,135 isolates collected by 24 US sites from hospitalized patients with UTIs between 2009 and 2011. Methods: Minimum inhibitory concentrations and susceptibility were determined according to the guidelines of the Clinical and Laboratory Standards Institute. Results: Of the isolates collected, 88.6% (1,892) were Enterobacteriaceae, which included 48.9% (n = 1,045) Escherichia coli, 14.5% (n = 310) Klebsiella pneumoniae, 6.4% (n = 136) Proteus mirabilis, 2.5% (n = 54) Klebsiella oxytoca, and 16.3% (n = 347) other Enterobacteriaceae species. Overall, 6.8% of E coli, 10.3% of K pneumoniae, 3.7% of P mirabilis, and 11.1% of K oxytoca isolates were extended-spectrum β-lactamase-producing strains. Of the Enterobacteriaceae isolates, 67.5% were community associated and 26.9% were hospital associated (5.7% had no demographics). Highest overall rates of activity for the study period were seen with amikacin, ertapenem, and imipenem. The least active antimicrobials tested were ampicillin-sulbactam, ciprofloxacin, and levofloxacin. Conclusions: Ertapenem, imipenem, and amikacin were the most active study drugs against extended-spectrum β-lactamase-producing strains, although the activity against extended-spectrum β-lactamase-producing K pneumoniae did not exceed 69% throughout the study period. The results of the Study for Monitoring Antimicrobial Resistance Trends surveillance study document the rates of antimicrobial resistance in UTI pathogens in the United States, which can assist health care practitioners in selecting the appropriate treatment for UTIs. © 2013. Source

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