Mechanisms of Resistance and Molecular Epidemiology of Commonly Encountered Multi-Resistant Bacteria

The following variables will be followed: time and location of positive cultures, underlying
diseases and severity of illness, recent immunomodulative therapies, physical exam findings,
laboratory and radiographical data, antimicrobial usage of onset of infection,
microbiological data and resistance patterns, choice of antibiotics once organism
identified, suspected source of infection, bacteriological outcomes, laboratory results,
demographic information, medications, clinical outcome gender, height, weight, ethnicity,
and past medical history. The following variables will be followed: time and location of
positive cultures, underlying diseases and severity of illness, recent immunomodulative
therapies, physical exam findings, laboratory and radiographical data, antimicrobial usage
of onset of infection, microbiological data and resistance patterns, choice of antibiotics
once organism identified, suspected source of infection, bacteriological outcomes,
laboratory results, demographic information, medications, clinical outcome gender, height,
weight, ethnicity, and past medical history. The bacteria in the patient's cultures will be
subcultured (after the diagnosis has been obtained since the microbiology lab would
otherwise destroy the culture) and provided to the honest broker who will deidentify the
specimen and link it to the medical information collected (which will also be deidentified
by the honest broker). Patient data will be entered into a database by the honest brokers
using an excel program for electronic data capture and reporting system. The honest brokers
will have access to the database to ensure data integrity and perform data analyses. In
addition, the Honest Broker will obtain information from the medical record as well as
information about the specimens. The research team will have access to the database that is
deidentified. The following evaluation will be performed on the bacteria. The minimal
inhibitory concentration of the antibiotic used in treatment will be performed by the E-Test
method (AB Biodisk, Solna, Sweden). Specific mechanisms of antimicrobial resistance will be
studied with emphasis on the molecular mechanisms of antibiotic resistance such as
production of beta-lactamases. This evaluation will be performed by analytical isoelectric
focusing techniques as well as PCR and gene sequencing analysis to determine genes encoding
beta-lactamases. Biologic samples will be under the control of the principal investigator of
this research project. All samples provided to the investigators are deidentified by the
honest broker and will be coded with numbers. The information linking these code numbers to
the corresponding subjects' identities will be kept in a separate, secure location that only
the honest broker has access to. The investigators on this study will keep the samples
indefinitely. Samples will be kept in the investigator's laboratory located in Scaife Hall,
room 812, 3500 Terrace Street. At no time will the research investigators have access to any
patient identifiers.

Inclusion Criteria:

- bacteria resistant to commonly used antibiotics