Infection With Beta-lactam Resistance in Enterobacteriaceae Clinical Trial
— CARBAFRESTOfficial title:
Prevalence of Enterobacteriaceae With Decreased Susceptibility to Carbapenems in Eastern Inter- Region
| Verified date | June 2016 |
| Source | CHU de Reims |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | France: Commission nationale de l'informatique et des libertés |
| Study type | Observational |
Upon penicillins' introduction, inactivation of beta- lactam antibiotics by enzymes produced
by bacteria was demonstrated. Until recently, carbapenems were a relatively spared subclass
by these enzymes which makes the molecules of last resort in serious infection. Recently the
prevalence of enzymes hydrolysing carbapenem, the carbapenemases, was increasing in some
countries. But these carbapenemases are not the only mechanism involved in a decreased
susceptibility to carbapenems which is sometimes linked to the conjunction of several
resistance mechanisms. Data available on the epidemic situation of this new resistance are
essential for improving their detection, the management of infections in patients and
prevent the occurrence of epidemic. In this context, the investigators propose a study in
the North-East inter-region to estimate the prevalence of Enterobacteriaceae with decrease
susceptibility to carbapenems and look for risk factors for infection with this type of
bacteria. The study is conducted in five teaching hospitals (Besançon, Dijon, Nancy, Reims
and Strasbourg) and two general hospitals (Colmar and Troyes) in North-Eastern France. For
one year, all the Enterobacteriaceae isolates with a decreased susceptibility to carbapenems
(CDSE) according to the 2012 Antibiogram Comity of the French Microbiology Society (CA-SFM)
(MIC of ertapenem > 0.5 μg/mL) are collected and sent to the bacteriology laboratory of the
Reims University Hospital. Among these strains 105 are randomly selected. The clinical study
is conducted as follow: for each patient with CDSE isolate included in a center, 2 control
patients are selected. They are the patients having the 2 Enterobacteriaceae isolates, with
no reduced susceptibility to carbapenems and following the CDSE isolate in the same center.
Microbiological study : identification of isolates is performed using MALDI-TOF (Bruker
Daltonics, Bremen, Germany). Antibiotic susceptibilities is determined by the disc diffusion
method according to European Committee on Antimicrobial Susceptibility Testing (EUCAST)
guidelines (www.EUCAST.org) and extended-spectrum beta-lactamase (ESBLs) are detected by the
double-disc synergy test and carbapenem minimal inhibitory concentrations (MICs to Imipenem,
Ertapenem, Doripenem and Meropenem) determined using E-test® strips. Metallo-β-lactamase
production was screened with the MβL Etest (bioMérieux, Marcy l'Etoile, France).
Beta-lactamases detected using polymerase chain reaction (PCR). Carbapenemase-encoding genes
(blaKPC, blaVIM, blaIMP, blaNDM, blaOXA-23-like, blaOXA-24-like, blaOXA-58-like and
blaOXA-48-like) were screened using multiplex PCRs and blaIMI and blaGES with simplex PCRs.
All the blaOXA-48-like detected were subsequently sequenced. Genes blaTEM, blaSHV, blaCTX-M
and blaOXA were detected by PCR using specific primers. Plasmid-mediated AmpC-type genes
blaACC, blaFOX, blaMOX, blaDHA, blaCMY and blaMIR were screened using multiplex PCRs. All
the beta-lactamases are sequenced. Mutations in the quinolone resistance determining region
(QRDR) are identified by PCR and sequencing in the gyrA, gyrB, parC and parE genes. Qnr and
qepA genes are detected by real-time PCR, aac(6')-Ib-cr by pyrosequencing and oqxAB by
conventional PCR. Genotyping is performed with pulsed-field gel electrophoresis (PFGE) and
multilocus sequence typing (MLST).
Statistical analysis : qualitative variables are analysed with the Chi2 test and the
two-tailed Fisher exact test. Quantitative variables are compared using the Mann-Whitney
test. Then, a multivariate analysis is conducted: logistic regression with stepwise factors
as explanatory variables with p <0.20 in the univariate analysis as input threshold and
output set at 0.20.The results are considered statistically significant when P < 0.05.
Expected results : this study will give the proportion of the different species involved, of
the carbapenemase in comparison to the other mechanisms, the level of resistance in MIC.
Risk factors such as previous antibiotic treatment, underlying disease severity or clonal
strain transmission will be evidenced, allowing to identify prevention control measure to
implement.
| Status | Active, not recruiting |
| Enrollment | 315 |
| Est. completion date | December 2016 |
| Est. primary completion date | December 2012 |
| Accepts healthy volunteers | No |
| Gender | Both |
| Age group | 18 Years and older |
| Eligibility |
Inclusion Criteria: - Cases: patients (infected or colonized) with an Enterobacteriaceae isolate with decreased susceptibility to carbapenems - Controls: patients (infected or colonized) with an Enterobacteriaceae isolate not having reduced susceptibility to carbapenems and for which the strain was isolated following an Enterobacteriaceae isolate with decreased susceptibility to carbapenems (2 controls per case). Exclusion Criteria: - <18yo |
Observational Model: Case Control
| Country | Name | City | State |
|---|---|---|---|
| France | Chu Reims | Reims |
| Lead Sponsor | Collaborator |
|---|---|
| CHU de Reims |
France,
Guillard T, Cholley P, Limelette A, Hocquet D, Matton L, Guyeux C, Lebreil AL, Bajolet O, Brasme L, Madoux J, Vernet-Garnier V, Barbe C, Bertrand X, de Champs On Behalf Of CarbaFrEst Group C. Fluoroquinolone Resistance Mechanisms and population structure — View Citation
Liapis E, Pantel A, Robert J, Nicolas-Chanoine MH, Cavalié L, van der Mee-Marquet N, de Champs C, Aissa N, Eloy C, Blanc V, Guyeux C, Hocquet D, Lavigne JP, Bertrand X; ONERBA. Molecular epidemiology of OXA-48-producing Klebsiella pneumoniae in France. Cl — View Citation
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Antibiotic susceptibilities by the disc diffusion method | 12 months | No |