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Erdem H, Ankarali H, Al-Tawfiq JA, Angamuthu K, Piljic D, Umihanic A, Dayyab F, Karamanlioğlu D, Pekok AU, Cagla-Sonmezer M, El-Kholy A, Gad MA, Velicki L, Akyildiz O, Altindis M, Başkol-Elik D, Erturk-Sengel B, Kara İ, Kahraman U, Özdemir M, Caskurlu H, Cag Y, Al-Khalifa A, Hakamifard A, Batinjan MKG, Tahir M, Tukenmez-Tigen E, Zajkowska J, ElKholy J, Gašparović H, Filiz M, Gul O, Tehrani HA, Doyuk-Kartal E, Aybar-Bilir Y, Kahraman H, Mikulić H, Dayan S, Cascio A, Yurdakul ES, Colkesen F, Karahangil K, Espinosa A, Rahimi BA, Vangel Z, Fasciana T, Giammanco A. Mortality Associated with Surgical Site Infections Following Cardiac Surgery: Insights from the International ID-IRI Study. IJID REGIONS 2025; 14:100566. [PMID: 39931188 PMCID: PMC11808521 DOI: 10.1016/j.ijregi.2025.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/02/2025] [Accepted: 01/03/2025] [Indexed: 02/13/2025]
Abstract
Objectives Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.
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Affiliation(s)
- Hakan Erdem
- Turkish Health Sciences University, Gülhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, USA
| | - Kumar Angamuthu
- Department of Infectious Diseases, Almana General Hospitals, Dammam, Saudi Arabia
| | - Dragan Piljic
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Ajdin Umihanic
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Farouq Dayyab
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Dilek Karamanlioğlu
- Etlik City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Abdullah Umut Pekok
- Department of Infectious Diseases, VM Medical Park, Pendik Hospital, Istanbul, Türkiye
| | - Meliha Cagla-Sonmezer
- Hacettepe University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Amani El-Kholy
- Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
| | - Maha Ali Gad
- Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Institute of Cardiovascular Disease Vojvodina, Sremska Kamenica, Serbia
| | - Ozay Akyildiz
- Acibadem Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Türkiye
| | - Mustafa Altindis
- Sakarya University, Faculty of Medicine, Department of Microbiology, Sakarya, Türkiye
| | - Dilşah Başkol-Elik
- Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Türkiye
| | - Buket Erturk-Sengel
- Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - İbrahim Kara
- Sakarya University, Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Türkiye
| | - Umit Kahraman
- Ege University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Türkiye
| | - Mehmet Özdemir
- Necmettin Erbakan University, Faculty of Medicine, Department of Microbiology, Konya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Abdulwahab Al-Khalifa
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marina Kljaković-Gašpić Batinjan
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Institute of Cardiovascular Disease Vojvodina, Sremska Kamenica, Serbia
| | - Muhammad Tahir
- Department of Medicine, Federal General Hospital, Islamabad, Pakistan
| | - Elif Tukenmez-Tigen
- Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Joanna Zajkowska
- Medical University in Bialystok, Department of Infectious Diseases and Neuroinfections, Bialystok, Poland
| | - Jehan ElKholy
- Cairo University Hospital, Department of Anesthesia, Pain Management, Cairo, Egypt
| | - Hrvoje Gašparović
- University Hospital Centre Zagreb, University of Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
| | - Mine Filiz
- Turkish Health Sciences University, Gülhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Ozlem Gul
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Hamed Azhdari Tehrani
- Shahid Beheshti University of Medical Sciences, Department of Hematology and Medical Oncology, Tehran, Iran
| | - Elif Doyuk-Kartal
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Türkiye
| | - Yesim Aybar-Bilir
- Etlik City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Hasip Kahraman
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Türkiye
| | - Hrvoje Mikulić
- SKB Mostar, Department of Cardiac Surgery, Mostar, Bosnia and Herzegovina
| | - Saim Dayan
- Dicle University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Eray Serdar Yurdakul
- Turkish Health Sciences University, Gulhane School of Medicine, Department of Medical History and Ethics, Ankara, Türkiye
| | - Fatma Colkesen
- Turkish Health Sciences University, Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology Konya, Türkiye
| | - Kadriye Karahangil
- Istanbul Medipol University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Angel Espinosa
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Bilal Ahmad Rahimi
- Kandahar University Faculty of Medicine, Department of Pediatrics, Kandahar, Afghanistan
| | - Zdraveski Vangel
- PHI UC State Cardiac Surgery, Department of Cardiac Surgery, Skopje, North Macedonia
| | - Teresa Fasciana
- Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Anna Giammanco
- Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D'Alessandro, University of Palermo, Palermo, Italy
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Kodde C, Bonsignore M, Köhler J, Schwegmann K, Nachtigall I. Males are at higher risk of colonization and infection with multi-drug-resistant organisms than females. J Hosp Infect 2025; 155:88-94. [PMID: 39395464 DOI: 10.1016/j.jhin.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND The global rise in multi-drug-resistant organisms (MDROs) is alarming, and antimicrobial resistance poses a significant public health threat globally. Although certain risk factors are known, including recent antimicrobial therapy, inappropriate use and hospitalization, the focus on gender-specific aspects in MDROs is scarce. The aim of this study was to show gender-specific differences in colonization and infection of multiple MDROs and their detection sites. METHODS For this multi-centre, retrospective cohort study, surveillance data were collected between 2015 and 2020 from 86 hospitals from Helios Kliniken, Germany. The following multi-drug-resistant bacteria were analysed by sample site: meticillin-resistant Staphylococcus aureus (MRSA); Enterococcus spp.; Escherichia coli; Klebsiella pneumoniae; Pseudomonas aeruginosa; and Acinetobacter baumannii. RESULTS Of the 7,081,708 cases in the database, 187,656 patients were found to be colonized with MDROs (2.65%). A documented infection with an MDRO was identified in 33,023 patients (0.466%), with the origin of infection known in 24,231 cases. Male gender was a risk factor for both infection and colonization with any MDRO (P<0.001). Males exhibited a higher likelihood of MDRO detection in superficial skin/soft tissue, blood cultures (P<0.001) and respiratory samples (P=0.002). Additionally, gender-specific differences in MDRO detection site and pathogens were found, with a slightly higher proportion of MRSA infections in deep skin/soft tissue and respiratory samples for females. CONCLUSIONS This study reinforces the existing hypothesis that male gender is a risk factor for colonization and infection with MDROs, supported by a large dataset. This highlights the need to acknowledge gender-specific MDRO susceptibility in clinical practice.
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Affiliation(s)
- C Kodde
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Respiratory Diseases 'Heckeshorn', Helios Hospital Emil-von-Behring, Berlin, Germany.
| | - M Bonsignore
- Department of Infectious Diseases and Prevention, Helios Hospitals Duisburg, Duisburg, Germany; Centre for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - J Köhler
- Institute of Public Health, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - K Schwegmann
- Department of Hygiene, Helios Kliniken, Hildesheim, Germany
| | - I Nachtigall
- Division of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, Berlin, Germany; Medical School Berlin, Berlin, Germany
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Candel FJ, Salavert M, Cantón R, Del Pozo JL, Galán-Sánchez F, Navarro D, Rodríguez A, Rodríguez JC, Rodríguez-Aguirregabiria M, Suberviola B, Zaragoza R. The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document. Crit Care 2024; 28:440. [PMID: 39736683 DOI: 10.1186/s13054-024-05224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 12/19/2024] [Indexed: 01/01/2025] Open
Abstract
Rapid multiplex molecular syndromic panels (RMMSP) (3 or more pathogens and time-to-results < 6 h) allow simultaneous detection of multiple pathogens and genotypic resistance markers. Their implementation has revolutionized the clinical landscape by significantly enhancing diagnostic accuracy and reducing time-to-results in different critical conditions. The current revision is a comprehensive but not systematic review of the literature. We conducted electronic searches of the PubMed, Medline, Embase, and Google Scholar databases to identify studies assessing the clinical performance of RMMSP in critically ill patients until July 30, 2024. A multidisciplinary group of 11 Spanish specialists developed clinical questions pertaining to the indications and limitations of these diagnostic tools in daily practice in different clinical scenarios. The topics covered included pneumonia, sepsis/septic shock, candidemia, meningitis/encephalitis, and off-label uses of these RMMSP. These tools reduced the time-to-diagnosis (and therefore the time-to-appropriate treatment), reduced inappropriate empiric treatment and the length of antibiotic therapy (which has a positive impact on antimicrobial stewardship and might be associated with lower in-hospital mortality), may reduce the length of hospital stay, which could potentially lead to cost savings. Despite their advantages, these RMMSP have limitations that should be known, including limited availability, missed diagnoses if the causative agent or resistance determinants are not included in the panel, false positives, and codetections. Overall, the implementation of RMMSP represents a significant advancement in infectious disease diagnostics, enabling more precise and timely interventions. This document addresses relevant issues related to the use of RMMSP on different critically ill patient profiles, to standardize procedures, assist in making management decisions and help specialists to obtain optimal outcomes.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology and Infectious Diseases, Hospital Clínico Universitario San Carlos, IdISSC & IML Health Research Institutes, 28040, Madrid, Spain.
| | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Cantón
- Microbiology Department, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, , Madrid, Spain
| | - José Luis Del Pozo
- Infectious Diseases Unit, Microbiology Department, Clínica Universidad de Navarra, Navarra, Spain
- IdiSNA: Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Fátima Galán-Sánchez
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación Biomédica de Cádiz (INIBICA), Cádiz, Spain
| | - David Navarro
- Microbiology Department, INCLIVA Health Research Institute, Clinic University Hospital, Valencia, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Alejandro Rodríguez
- Intensive Care Medicine Department, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira I Virgili, CIBER Enfermedades Respiratorias, d'investigacio Sanitaria Pere Virgili, Tarragona, Spain
| | - Juan Carlos Rodríguez
- Microbiology Department, Dr. Balmis University General Hospital, Alicante, Spain
- Department of Microbiology, Institute for Health and Biomedical Research (ISABIAL), Miguel Hernández University, Alicante, Spain
| | | | - Borja Suberviola
- Intensive Care Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rafael Zaragoza
- Critical Care Department, Hospital Universitario Dr. Peset, Valencia, Spain
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Beig M, Parvizi E, Navidifar T, Bostanghadiri N, Mofid M, Golab N, Sholeh M. Geographical mapping and temporal trends of Acinetobacter baumannii carbapenem resistance: A comprehensive meta-analysis. PLoS One 2024; 19:e0311124. [PMID: 39680587 PMCID: PMC11649148 DOI: 10.1371/journal.pone.0311124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/04/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) is of critical concern in healthcare settings, leading to limited treatment options. In this study, we conducted a comprehensive meta-analysis to assess the prevalence of CRAB by examining temporal, geographic, and bias-related variations. METHODS We systematically searched prominent databases, including Scopus, PubMed, Web of Science, and EMBASE. Quality assessment was performed using the JBI checklist. Subgroup analyses were performed based on the COVID-19 timeframes, years, countries, continents, and bias levels, antimicrobial susceptivity test method and guidelines. RESULTS Our comprehensive meta-analysis, which included 795 studies across 80 countries from 1995 to 2023, revealed a surge in carbapenem resistance among A. baumannii, imipenem (76.1%), meropenem (73.5%), doripenem (73.0%), ertapenem (83.7%), and carbapenems (74.3%). Temporally, 2020-2023 witnessed significant peaks, particularly in carbapenems (81.0%) and meropenem (80.7%), as confirmed by meta-regression, indicating a steady upward trend. CONCLUSION This meta-analysis revealed an alarmingly high resistance rate to CRAB as a global challenge, emphasizing the urgent need for tailored interventions. Transparency, standardized methodologies, and collaboration are crucial for the accurate assessment and maintenance of carbapenem efficacy.
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Affiliation(s)
- Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Elnaz Parvizi
- Department of Microbiology, Science and Research Branch, Islamic Azad University, Fars, Iran
| | - Tahereh Navidifar
- Shoushtar Faculty of Medical Sciences, Department of Basic Sciences, Shoushtar, Iran
| | - Narjes Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mofid
- School of Medicine, Hamadan University of Medical Science, Hamadan, Iran
| | - Narges Golab
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sholeh
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
- Student Research Committee, Pasteur Institute of Iran, Tehran, Iran
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Añón-Hidalgo J, Garrido-Rodríguez M, González-Abad MJ, Cuervas-Mons Vendrell M, García-Ascaso MT, Díaz Pérez D, García-Salido A. Cefiderocol as rescue therapy in a cancer immunosuppressed critically ill child: Case description and literature review. Diagn Microbiol Infect Dis 2024; 110:116539. [PMID: 39298932 DOI: 10.1016/j.diagmicrobio.2024.116539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 09/12/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
Severe infections caused by multidrug-resistant bacteria have underscored the urgent need for innovative treatment approaches. Novel antimicrobials like cefiderocol have emerged as effective options, but their use in children remains largely unexplored. In this brief report, we describe a severe case of sepsis in a child with an oncohematological disease, caused by a highly drug-resistant strain of Klebsiella pneumoniae. The addition of cefiderocol to other therapies resulted in a successful outcome. Additionally, we provide a literature review of previously published cases involving children treated with this new antibiotic. In our patient, cefiderocol was both safe and effective in combating the multidrug-resistant pathogen. However, further research is needed to better define the indications and safety profile of this novel antibiotic.
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Affiliation(s)
- Juan Añón-Hidalgo
- Pediatric Oncology Department, Hospital Infantil Universitario Niño Jesús, Spain
| | - María Garrido-Rodríguez
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain
| | | | | | | | - David Díaz Pérez
- Pediatric Oncology Department, Hospital Infantil Universitario Niño Jesús, Spain
| | - Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo 65, Madrid, Spain.
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Abdelsalam NA, ElBanna SA, Mouftah SF, Cobo-Díaz JF, Shata AH, Shawky SM, Atteya R, Elhadidy M. Genomic dynamics of high-risk carbapenem-resistant klebsiella pneumoniae clones carrying hypervirulence determinants in Egyptian clinical settings. BMC Infect Dis 2024; 24:1193. [PMID: 39438795 PMCID: PMC11515790 DOI: 10.1186/s12879-024-10056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 10/03/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Ongoing studies have revealed the global prevalence of severe infections caused by the hypervirulent strains of Klebsiella pneumoniae (K. pneumoniae). Meanwhile, the World Health Organization and the Centers for Disease Control declared carbapenem-resistant K. pneumoniae as an urgent public health threat, requiring swift and effective action to mitigate its spread. Low- and middle-income countries are severely impacted by such devastating infectious diseases owing to the ill implementation of antimicrobial practices and infection control policies. Having both hypervirulence and carbapenemase gene determinants, the emergence of convergent hypervirulent carbapenem-resistant K. pneumoniae is now being reported worldwide. METHODS In this study, we sequenced 19 carbapenemase-producing K. pneumoniae strains recovered from various clinical specimens. Additionally, we evaluated the phenotypic antimicrobial susceptibility to multiple antimicrobial classes using the VITEK2 automated system. Utilizing the sequencing data, we characterized the sequence types, serotypes, pangenome, resistance profiles, virulence profiles, and mobile genetic elements of the examined isolates. We highlighted the emergence of high-risk clones carrying hypervirulence genetic determinants among the screened isolates. RESULTS Our findings revealed that all carbapenem-resistant isolates exhibited either extensive- or pan-drug resistance and harbored multiple variants of resistance genes spanning nearly all the antimicrobial classes. The most prevalent carbapenemase genes detected within the isolates were blaNDM-5 and blaOXA-48. We identified high-risk clones, such as ST383-K30, ST147-K64, ST11-K15, and ST14-K2, which may have evolved into putative convergent strains by acquiring the full set of hypervirulence-associated genetic determinants (iucABCD, rmpA and/ or rmpA2, putative transporter peg-344). Additionally, this study identified ST709-K9 as a high-risk clone for the first time and uncovered that capsule types K15 and K9 carried hypervirulence genetic determinants. The most frequent Inc types found in these isolates were Col440I, IncHI1B, and Inc FII(K). CONCLUSION This study highlights the emergence of high-risk, extensively carbapenem-resistant K. pneumoniae strains co-carrying hypervirulence determinants in Egyptian clinical settings. This poses an imminent threat not only to Egypt but also to the global community, underscoring the urgent need for enhanced surveillance and control strategies to combat this pathogen.
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Affiliation(s)
- Nehal Adel Abdelsalam
- Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Shahira A ElBanna
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Shaimaa F Mouftah
- Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt
| | - José F Cobo-Díaz
- Department of Food Hygiene and Technology, Institute of Food Science and Technology, Universidad de León, León, Spain
| | - Ahmed H Shata
- Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Reham Atteya
- Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt
| | - Mohamed Elhadidy
- Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt.
- Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt.
- Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
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7
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Duhaniuc A, Păduraru D, Nastase EV, Trofin F, Iancu LS, Sima CM, Dorneanu OS. Multidrug-Resistant Bacteria in Immunocompromised Patients. Pharmaceuticals (Basel) 2024; 17:1151. [PMID: 39338313 PMCID: PMC11434862 DOI: 10.3390/ph17091151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
The increasing incidence of antibiotic resistance in bacteria is a major problem in terms of therapeutic options, especially in immunocompromised patients, such as patients from intensive care units (ICUs), HIV-positive patients, patients with malignancies or transplant patients. Commensal bacteria, especially anaerobes, serve to maintain microbial stability by preventing overpopulation with pathogenic bacteria. In immunocompromised patients, microbiota imbalance caused by antibiotic therapy and decreased host immunity favors intestinal overpopulation with pathogenic species, leading to increased bacterial translocation and susceptibility to systemic infections. Infections with multidrug-resistant (MDR) bacteria pose major challenges to the establishment of appropriate treatment and lead to increased mortality. Asymptomatic colonization with MDR bacteria usually precedes infection and tends to persist for long periods of time, and in immunocompromised patients, colonization with MDR bacteria is a risk factor for systemic infections. This review aims to assess the relation between colonization and infection with MDR bacteria in immunocompromised patients such as ICU patients, HIV-positive patients and cancer patients and to identify the prevalence and patterns of MDR bacterial colonization and infection in this category of patients.
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Affiliation(s)
- Alexandru Duhaniuc
- Department of Preventive Medicine and Interdisciplinarity-Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- National Institute of Public Health-Regional Center of Public Health, 700465 Iasi, Romania
| | - Diana Păduraru
- "Dr. C.I. Parhon" Clinical Hospital, 700503 Iasi, Romania
| | - Eduard-Vasile Nastase
- Department of Internal Medicine II-Infectious Diseases, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Clinical Hospital of Infectious Diseases "Sf. Parascheva", 700116 Iasi, Romania
| | - Felicia Trofin
- Department of Preventive Medicine and Interdisciplinarity-Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Luminița-Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity-Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- National Institute of Public Health-Regional Center of Public Health, 700465 Iasi, Romania
| | - Cristina-Mihaela Sima
- Department of Preventive Medicine and Interdisciplinarity-Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Clinical Hospital of Infectious Diseases "Sf. Parascheva", 700116 Iasi, Romania
| | - Olivia-Simona Dorneanu
- Department of Preventive Medicine and Interdisciplinarity-Microbiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Clinical Hospital of Infectious Diseases "Sf. Parascheva", 700116 Iasi, Romania
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Tićac M, Grubić Kezele T, Bubonja Šonje M. Impact of Appropriate Empirical Antibiotic Treatment on the Clinical Response of Septic Patients in Intensive Care Unit: A Single-Center Observational Study. Antibiotics (Basel) 2024; 13:569. [PMID: 38927235 PMCID: PMC11201024 DOI: 10.3390/antibiotics13060569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
The appropriate antibiotic treatment of patients with bacterial sepsis in the intensive care unit (ICU) remains a challenge. Considering that current international guidelines recommend 7 days of antibiotic therapy as sufficient for most severe infections, our primary outcome was a comparison of clinical response to initial empirical therapy on day 7 and mortality between two groups of septic patients-with appropriate (AEAT) and inappropriate (IEAT) empirical antibiotic therapy according to the in vitro sensitivity of bacteria detected in a blood culture (BC). Adult patients admitted to the ICU between 2020 and 2023, who were diagnosed with sepsis according to the Sequential Organ Failure Assessment (SOFA) score ≥ 2 in association with a suspected or documented infection, were selected for the study. Of the 418 patients, 149 (35.6%) died within 7 days. Although the AEAT group had a lower mortality rate (30.3% vs. 34.2%) and better clinical improvement (52.8% vs. 47.4%) on day 7 after starting empirical antibiotic therapy, there was no significant difference. A causative organism was isolated from BCs in 30% of septic patients, with gram-negative bacteria (GNB) predominating in 60% of cases, and multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria predominantly detected in the BCs of the IEAT group. Although the AEAT group had slightly worse clinical characteristics at the onset of sepsis than the IEAT group, the AEAT group showed faster improvement on days 7 and 14 of sepsis. In this retrospective cross-sectional study, the AEAT group was associated with better clinical response at day 7 after sepsis onset and lower mortality, but without a significant difference. Comorbidities and the type of bacterial pathogen should also be taken into account as they can also contribute to the prediction of the final outcome. These results demonstrate the importance of daily assessment of clinical factors to more accurately predict the clinical outcome of a septic patient.
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Affiliation(s)
- Mateo Tićac
- Department of Anesthesiology and Intensive Care, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
- Department of Anesthesiology, Reanimatology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Tanja Grubić Kezele
- Department of Clinical Microbiology, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
- Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Marina Bubonja Šonje
- Department of Clinical Microbiology, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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9
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Miftode IL, Vâță A, Miftode RȘ, Parângă T, Luca MC, Manciuc C, Țimpău AS, Radu V, Roșu MF, Stămăteanu LO, Leca D, Anton-Păduraru DT, Miftode EG. The Impact of Urinary Catheterization on the Antibiotic Susceptibility of ESBL-Producing Enterobacterales: A Challenging Duo. Antibiotics (Basel) 2024; 13:462. [PMID: 38786190 PMCID: PMC11117663 DOI: 10.3390/antibiotics13050462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. RESULTS We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). MATERIALS AND METHODS We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. CONCLUSIONS The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Andrei Vâță
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Radu-Ștefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Tudorița Parângă
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Mihaela Cătălina Luca
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Carmen Manciuc
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Amalia Stefana Țimpău
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Viorel Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Manuel Florin Roșu
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
- Department of Intensive Care Unit, Infectious Diseases Clinical Hospital, 700115 Iasi, Romania
| | - Lidia Oana Stămăteanu
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Daniela Leca
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Dana Teodora Anton-Păduraru
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
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10
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Stămăteanu LO, Pleşca CE, Miftode IL, Bădescu AC, Manciuc DC, Hurmuzache ME, Roșu MF, Miftode RȘ, Obreja M, Miftode EG. " Primum, non nocere": The Epidemiology of Toxigenic Clostridioides difficile Strains in the Antibiotic Era-Insights from a Prospective Study at a Regional Infectious Diseases Hospital in Eastern Europe. Antibiotics (Basel) 2024; 13:461. [PMID: 38786189 PMCID: PMC11117487 DOI: 10.3390/antibiotics13050461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Clostridioides difficile infection (CDI), though identified nearly five decades ago, still remains a major challenge, being associated with significant mortality rates. The strains classified as hypervirulent, notably 027/NAP1/BI, have garnered substantial attention from researchers and clinicians due to their direct correlation with the severity of the disease. Our study aims to elucidate the significance of toxigenic Clostridioides difficile (CD) strains in the clinical and therapeutic aspects of managing patients diagnosed with CDI. We conducted a single-center prospective study, including patients with CDI from north-eastern Romania. We subsequently conducted molecular biology testing to ascertain the prevalence of the presumptive 027/NAP1/BI strain within aforementioned geographic region. The patients were systematically compared and assessed both clinically and biologically, employing standardized and comparative methodologies. The study enrolled fifty patients with CDI admitted between January 2020 and June 2020. Among the investigated patients, 43 (86%) exhibited infection with toxigenic CD strains positive for toxin B genes (tcdB), binary toxin genes (cdtA and cdtB), and deletion 117 in regulatory genes (tcdC), while the remaining 7 (14%) tested negative for binary toxin genes (cdtA and cdtB) and deletion 117 in tcdC. The presence of the presumptive 027/NAP1/BI strains was linked to a higher recurrence rate (35.56%, p = 0.025), cardiovascular comorbidities (65.1% vs. 14.2%, p = 0.016), and vancomycin treatment (55.8% vs. 14.3%, p = 0.049). The findings of our investigation revealed an elevated incidence of colitis attributed to presumptive 027/NAP1/BI. Despite the prevalence of the presumptive 027 strain and its associated heightened inflammation among the patients studied, no significant differences were observed regarding the clinical course or mortality outcomes.
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Affiliation(s)
- Lidia Oana Stămăteanu
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Claudia Elena Pleşca
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Ionela Larisa Miftode
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Aida Corina Bădescu
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Doina Carmen Manciuc
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Mihnea Eudoxiu Hurmuzache
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Manuel Florin Roșu
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
- Surgical (Dentoalveolar and Maxillofacial Surgery) Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Radu Ștefan Miftode
- Department of Internal Medicine I (Cardiology), “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Maria Obreja
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.O.S.); (D.C.M.); (M.E.H.); (M.O.); (E.G.M.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (A.C.B.); (M.F.R.)
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11
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Munro C, Zilberberg MD, Shorr AF. Bloodstream Infection in the Intensive Care Unit: Evolving Epidemiology and Microbiology. Antibiotics (Basel) 2024; 13:123. [PMID: 38391509 PMCID: PMC10886070 DOI: 10.3390/antibiotics13020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Bloodstream infections (BSIs) arising in the intensive care unit (ICUs) present a significant challenge and we completed a narrative review of the emerging literature on this issue. Multiple reports document that these infections are associated with substantial morbidity and mortality. Also, they can be caused by a variety of pathogens. Generally classified as either community or hospital in onset, or as either primary or secondary in origin, the microbiology of ICU BSIs varies across the globe. Gram-positive pathogens predominate in certain regions such as the United States while Gram-negative organisms occur more frequently in Europe, Asia, and Latin America. The incidence of ICU BSIs climbed during the recent pandemic. BSIs complicating the care of persons suffering from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection significantly heighten the risk for death compared to patients who develop ICU BSIs but who are not infected with SARS-CoV-2. Furthermore, rates of antimicrobial resistance are generally increasing in ICU BSIs. This fact complicates attempts to ensure that the patient receives initially appropriate antimicrobial therapy and is of particular concern in Methicillin-resistant Staphylococcus aureus, Carbapenem-resistant Enterobacterales, and Acinetobacter baumannii. Fortunately, with respect to clinical application, preventive measures exist, and recent analyses suggest that increased collaboration between infectious disease specialists and intensivists can improve patient outcomes.
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Affiliation(s)
- Carly Munro
- Medstar Washington Hospital Center, Washington, DC 20010, USA
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12
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Musuroi SI, Voinescu A, Musuroi C, Baditoiu LM, Muntean D, Izmendi O, Jumanca R, Licker M. The Challenges of The Diagnostic and Therapeutic Approach of Patients with Infectious Pathology in Emergency Medicine. J Pers Med 2023; 14:46. [PMID: 38248747 PMCID: PMC10821085 DOI: 10.3390/jpm14010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
The emergency department (ED) represents an important setting for addressing inappropriate antimicrobial prescribing practices because of the time constraints and the duration of microbiological diagnosis. The purpose of this study is to evaluate the etiology and antimicrobial resistance (AMR) pattern of the community-acquired pathogens, as well as the epidemiological characteristics of patients admitted through the ED, in order to guide appropriate antibiotic therapy. METHODS A retrospective observational study was performed on 657 patients, from whom clinical samples (urine, purulent secretions, blood cultures, etc.) were collected for microbiological diagnosis in the first 3 days after presentation in the ED. The identification of pathogens and the antimicrobial susceptibility testing with minimum inhibitory concentration determination were carried out according to the laboratory protocols. RESULTS From the 767 biological samples analyzed, 903 microbial isolates were identified. E. coli was most frequently isolated (24.25%), followed by Klebsiella spp., S. aureus (SA), and non-fermentative Gram-negative bacilli. E. coli strains maintained their natural susceptibility to most antibiotics tested. In the case of Pseudomonas spp. and Acinetobacter spp., increased rates of AMR were identified. Also, 32.3% of SA strains were community-acquired MRSA. CONCLUSIONS The introduction of rapid microbiological diagnostic methods in emergency medicine is imperative in order to timely identify AMR strains and improve therapeutic protocols.
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Affiliation(s)
- Silvia Ioana Musuroi
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Internal Medicine Department, Municipal Emergency Clinical Hospital, 300254 Timisoara, Romania
| | - Adela Voinescu
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Corina Musuroi
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Luminita Mirela Baditoiu
- Epidemiology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Delia Muntean
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Oana Izmendi
- Doctoral School, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.I.M.)
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Romanita Jumanca
- Romanian and Foreign Languages Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Monica Licker
- Microbiology Department, Multidisciplinary Research Center of Antimicrobial Resistance, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.M.); (M.L.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
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13
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Erdem H, Kocoglu E, Ankarali H, El-Sokkary R, Hakamifard A, Karaali R, Kulzhanova S, El-Kholy A, Tehrani HA, Khedr R, Kaya-Kalem A, Pandak N, Cagla-Sonmezer M, Nizamuddin S, Berk-Cam H, Guner R, Elkholy JA, Llopis F, Marino A, Stebel R, Szabo BG, Belitova M, Fadel E, Yetisyigit T, Cag Y, Alkan S, Kayaaslan B, Oncu S, Ozdemir M, Yilmaz M, Isik AC, Başkol D, Sincan G, Cascio A, Ozer-Balin S, Korkmaz N, Ripon RK, Abbas S, Dumitru IM, Eser-Karlidag G, Lanzafame M, Rafey A, Raza A, Sipahi OR, Darazam IA, Elbahr U, Erdem I, Ergen P, Bilir C, Caskurlu H, Erdem A, Makek MJ, Altindis M, Lakatos B, Luca CM, Yilmaz EM, Nsutebu E, Cakmak R, Sirmatel F. Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study. Int J Antimicrob Agents 2023; 62:106919. [PMID: 37423582 DOI: 10.1016/j.ijantimicag.2023.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain; Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Türkiye.
| | - Esra Kocoglu
- Department of Microbiology and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ridvan Karaali
- Department of Infectious Diseases & Clinical Microbiology, Cerrahpaşa School of Medicine, Istanbul, Türkiye
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hamed Azhdari Tehrani
- Department of Haematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reham Khedr
- Department of Paediatric Oncology, National Cancer Institute-Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Ayşe Kaya-Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | | | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Summiya Nizamuddin
- Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Hande Berk-Cam
- Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Türkiye
| | - Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Jehan Ali Elkholy
- Department of Anaesthesia, Pain Management, Cairo University Hospital, Cairo, Egypt
| | - Ferran Llopis
- Emergency Department, Bellvitge University Hospital, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Maya Belitova
- Medical University-Sofia, Department of Anaesthesiology and Intensive Care, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Elias Fadel
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Türkiye
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Türkiye
| | - Mehmet Ozdemir
- Department of Medical Microbiology, Necmettin Erbakan University, Konya, Türkiye
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Arzu Cennet Isik
- Department of Internal Medicine, Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Dilşah Başkol
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Gulden Sincan
- Department of Haematology, School of Medicine, Ataturk University, Erzurum, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Italy
| | - Safak Ozer-Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, School of Medicine, Elazig, Türkiye
| | - Nesibe Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yıldirim Beyazit Education and Research Hospital, Ankara, Türkiye
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Salma Abbas
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | | | - Abdur Rafey
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aun Raza
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
| | - Ilknur Erdem
- Namık Kemal University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Tekirdağ, Türkiye
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Cemil Bilir
- Department of Oncology, Istinye University, VMMedical Park Pendik Hospital, Istanbul, Türkiye; Sakarya University Faculty of Medicine Department of Medical Oncology, Sakarya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mustafa Altindis
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | | | - Esmeray Mutlu Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Rumeysa Cakmak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Fatma Sirmatel
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Türkiye
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14
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Ture Z, Güner R, Alp E. Antimicrobial stewardship in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2023; 3:244-253. [PMID: 37533805 PMCID: PMC10391567 DOI: 10.1016/j.jointm.2022.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 08/04/2023]
Abstract
High resistance rates to antimicrobials continue to be a global health threat. The incidence of multidrug-resistant (MDR) microorganisms in intensive care units (ICUs) is quite high compared to in the community and other units in the hospital because ICU patients are generally older, have higher numbers of co-morbidities and immune-suppressed; moreover, the typically high rates of invasive procedures performed in the ICU increase the risk of infection by MDR microorganisms. Antimicrobial stewardship (AMS) refers to the implementation of coordinated interventions to improve and track the appropriate use of antibiotics while offering the best possible antibiotic prescription (according to dose, duration, and route of administration). Broad-spectrum antibiotics are frequently preferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms. For this reason, a number of studies on AMS in ICUs have increased in recent years. Reducing the use of broad-spectrum antibiotics forms the basis of AMS. For this purpose, parameters such as establishing an AMS team, limiting the use of broad-spectrum antimicrobials, terminating treatments early, using early warning systems, pursuing infection control, and providing education and feedback are used. In this review, current AMS practices in ICUs are discussed.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri 38039,Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım Beyazıt University, Ankara 06800, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Yıldırım Beyazıt University, Ankara 06800, Turkey
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15
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Hadi HA, Al-Hail H, Aboidris LE, Al-Orphaly M, Ahmed MAS, Samuel BG, Mohamed HA, Sultan AA, Skariah S. Prevalence and genetic characterization of clinically relevant extended-spectrum β-lactamase-producing Enterobacterales in the Gulf Cooperation Council countries. FRONTIERS IN ANTIBIOTICS 2023; 2:1177954. [PMID: 39816644 PMCID: PMC11732020 DOI: 10.3389/frabi.2023.1177954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 01/03/2025]
Abstract
Introduction Among Gram-negative bacteria (GNB), Enterobacterales (Enterobacterales), such as Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), are the most clinically relevant pathogens in healthcare settings. Infections secondary to these pathogens are widely common but multidrug resistance (MDR) in Enterobacterales has become a significant challenge with increased morbidity, mortality, and cost of management. The escalating global prevalence of MDR in Enterobacterales has led to limited treatment options, raising an urgent need for novel antimicrobial therapy(s) and detailed studies exploring underlying resistance mechanisms. In Enterobacterales, the prime antimicrobial resistance mechanism against β-lactam antibiotics is mainly the production of β-lactamases, particularly extended-spectrum β-lactamases (ESBLs). Although the Gulf region is witnessing major challenges from infections secondary to MDR GNB, the extent of the problem has not been fully evaluated. Therefore, this review aims to address the prevalence and genetic characterization of ESBL-producing Enterobacterales in the Gulf Cooperation Council (GCC) countries. Methods PubMed® (National Library of Medicine, Bethesda, MD, USA) search was conducted, which looked for academic articles discussing the epidemiology of MDR Enterobacterales in the GCC countries, published in the last 5 years. Results and conclusions In GCC countries there is a high prevalence rate of MDR Enterobacterales, particularly ESBLs. Prevalence rates of ESBL-producing Enterobacterales among the Enterobacterales in general clinical samples in the GCC region is 21.6%-29.3%, with a slightly higher prevalence rate in intensive care unit patients (17.3-31.3%) and in patients with urinary tract infections (25.2%-31.7%). ESBL carriers have also been noted in the general community. ESBL-producing Enterobacterales from the GCC region show high levels of resistance to ampicillin, aztreonam, third-/fourth-generation cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Intermediate resistance rates are observed against nitrofurantoin, piperacillin/tazobactam, and gentamicin, with increasing resistance observed against tigecycline. The isolates demonstrate low-level resistance to carbapenems, fosfomycin, colistin, and amikacin. Enterobacterales isolates that are concomitant ESBL producers and are carbapenem resistant have been increasingly reported and demonstrate alarmingly increased antibiotic resistance patterns compared with ESBL Enterobacterales. The most prevalent genes for ESBL resistance in the Enterobacterales isolates in the GCC region are: bla CTX-M (subtype group 1) followed by/co-dominated by bla TEM and bla SHV, whereas the most common carbapenem-resistant genes are bla OXA-48 and bla NDM-1.
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Affiliation(s)
- Hamad A. Hadi
- Department of Infectious Diseases, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hissa Al-Hail
- Department of Medical Education, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Leena Elsheikh Aboidris
- Department of Medical Education, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Mahmood Al-Orphaly
- Department of Medical Education, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Mazen A. Sid Ahmed
- Laboratory Services, Philadelphia Department of Public Health, Philadelphia, PA, United States
- The Life Science Centre, School of Science and Technology, Örebro University, Örebro, Sweden
| | - Bincy Gladson Samuel
- Department of Microbiology and Immunology, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Hana Adam Mohamed
- Department of Microbiology and Immunology, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Ali A. Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Sini Skariah
- Department of Microbiology and Immunology, Weill Cornell Medicine – Qatar, Education City, Qatar Foundation, Doha, Qatar
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16
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Adukauskiene D, Ciginskiene A, Adukauskaite A, Koulenti D, Rello J. Clinical Features and Outcomes of VAP Due to Multidrug-Resistant Klebsiella spp.: A Retrospective Study Comparing Monobacterial and Polybacterial Episodes. Antibiotics (Basel) 2023; 12:1056. [PMID: 37370375 DOI: 10.3390/antibiotics12061056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
VAP due to multidrug-resistant (MDR) bacteria is a frequent infection among patients in ICUs. Patient characteristics and mortality in mono- and polybacterial cases of VAP may differ. A single-centre, retrospective 3-year study was conducted in the four ICUs of a Lithuanian referral university hospital, aiming to compare both the clinical features and the 60-day ICU all-cause mortality of monobacterial and polybacterial MDR Klebsiella spp. VAP episodes. Of the 86 MDR Klebsiella spp. VAP episodes analyzed, 50 (58.1%) were polybacterial. The 60-day mortality was higher (p < 0.05) in polybacterial episodes: overall (50.0 vs. 27.8%), in the sub-group with less-severe disease (SOFA < 8) at VAP onset (45.5 vs. 15.0%), even with appropriate treatment (41.7 vs. 12.5%), and the sub-group of extended drug-resistant (XDR) Klebsiella spp. (46.4 vs. 17.6%). The ICU mortality (44.0 vs. 22.5%) was also higher in the polybacterial episodes. The monobacterial MDR Klebsiella spp. VAP was associated (p < 0.05) with prior hospitalization (61.1 vs. 40.0%), diabetes mellitus (30.6 vs. 5.8%), obesity (30.6 vs. 4.7%), prior antibiotic therapy (77.8 vs. 52.0%), prior treatment with cephalosporins (66.7 vs. 36.0%), and SOFA cardiovascular ≥ 3 (44.4 vs. 10.0%) at VAP onset. Patients with polybacterial VAP were more likely (p < 0.05) to be comatose (22.2 vs. 52.0%) and had a higher SAPS II score (median [IQR] 45.0 [35.25-51.1] vs. 50.0 [40.5-60.75]) at VAP onset. Polybacterial MDR Klebsiella spp. VAP had distinct demographic and clinical characteristics compared to monobacterial, and was associated with poorer outcomes.
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Affiliation(s)
- Dalia Adukauskiene
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ausra Ciginskiene
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Agne Adukauskaite
- Department of Cardiology and Angiology, University Hospital of Innsbruck, 6020 Innsbruck, Austria
| | - Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, 12462 Athens, Greece
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The Univesrity of Queensland, 4029 Brisbane, Australia
| | - Jordi Rello
- Vall d'Hebron Institute of Research, Vall d'Hebron Campus Hospital, 08035 Barcelona, Spain
- Clinical Research, CHU Nîmes, 30900 Nîmes, France
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17
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Marino A, Calvo M, Trovato L, Scalia G, Gussio M, Consoli U, Ceccarelli M, Nunnari G, Cacopardo B. Mucorales/ Fusarium Mixed Infection in Hematologic Patient with COVID-19 Complications: An Unfortunate Combination. Pathogens 2023; 12:pathogens12020304. [PMID: 36839576 PMCID: PMC9964160 DOI: 10.3390/pathogens12020304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Hematological diseases, especially those causing severe neutropenia, represent the main factor in the development of invasive fungal infections (IFIs). Furthermore, COVID-19 has been considerably associated with IFIs due to immunological dysregulation, prolonged hospitalization in intensive care units, and immunomodulatory therapies. Opportunistic molds are correlated with elevated morbidity and mortality rates in these patients, due to immune impairment, diagnostic complexity, and therapeutic challenges. Among opportunistic fungal infections, the Mucorales and Fusarium species are considered particularly aggressive, especially during severe neutropenia. A mixed Mucorales/Fusarium infection has been rarely described in scientific literature. Herein, we report a case of Mucorales and Fusarium co-infection in a patient with acute leukemia whose clinical history was also complicated by COVID-19. Herein, we report a challenging case in order to encourage the clinical suspicion of combined fungal infections in immunosuppressed patients, performing a punctual microbiological diagnosis, and promptly administering the correct empiric and targeted antifungal therapy.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Maddalena Calvo
- U.O.C. Laboratory Analysis Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Via S. Sofia 78, 95123 Catania, Italy
- Correspondence:
| | - Laura Trovato
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Via S. Sofia 78, 95123 Catania, Italy
| | - Guido Scalia
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- U.O.C. Laboratory Analysis Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Via S. Sofia 78, 95123 Catania, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Ugo Consoli
- Unità Operativa Complessa (UOC) di Ematologia, ARNAS Garibaldi Hospital, 95122 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95122 Catania, Italy
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The Clash of the Titans: COVID-19, Carbapenem-Resistant Enterobacterales, and First mcr-1-Mediated Colistin Resistance in Humans in Romania. Antibiotics (Basel) 2023; 12:antibiotics12020324. [PMID: 36830235 PMCID: PMC9952164 DOI: 10.3390/antibiotics12020324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
(1) Background: Antibiotic resistance and coronavirus disease-19 (COVID-19) represent a dual challenge in daily clinical practice, inducing a high burden on public health systems. Hence, we aimed to dynamically evaluate the impact of COVID-19 on patients with carbapenem-resistant Enterobacterales (CRE) urinary tract infections (UTIs), as well as the antibiotic resistance trends after the onset of the pandemic. (2) Methods: We conducted a prospective study including patients with CRE UTIs who were enrolled both pre- and during the pandemic from 2019 to 2022. We further performed a standardized and comparative clinical, paraclinical, and microbiological assessment between patients with and without COVID-19. (3) Results: A total of 87 patients with CRE UTIs were included in this study (46 pre-pandemic and 41 during the pandemic, of which 21 had associated Severe Acute Respiratory Syndrome Coronavirus-2 infection). Klebsiella pneumoniae was the main etiological agent of the UTIs, with the majority of strains (82.7%) being carbapenemase producers (mainly OXA-48 producers), while five of the 34 colistin-resistant isolates were harboring the mobile colistin resistance-1 (mcr-1) gene. COVID-19 patients presented a significantly worse outcome with higher rates of intensive care unit (ICU) admissions (66.7% for COVID patients vs. 18.2% for non-COVID patients, p < 0.001), while the fatality rates were also considerably higher among patients with concomitant viral infection (33.3% vs. 12.1%, p < 0.001). Besides COVID-19, additional risk factors associated with increased mortality were urinary catheterization, sepsis with K. pneumoniae, impaired liver and kidney function, and an inappropriate initial empiric antibiotic therapy. (4) Conclusions: COVID-19 showed a pronounced negative impact on patients with CRE UTIs, with significantly longer hospitalizations and higher ICU admissions and mortality rates.
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19
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A Review of Potential Therapeutic Strategies for COVID-19. Viruses 2022; 14:v14112346. [PMID: 36366444 PMCID: PMC9696587 DOI: 10.3390/v14112346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 02/01/2023] Open
Abstract
Coronavirus disease 2019 is a rather heterogeneous disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The ongoing pandemic is a global threat with increasing death tolls worldwide. SARS-CoV-2 belongs to lineage B β-CoV, a subgroup of Sarbecovirus. These enveloped, large, positive-sense single-stranded RNA viruses are easily spread among individuals, mainly via the respiratory system and droplets. Although the disease has been gradually controlled in many countries, once social restrictions are relaxed the virus may rebound, leading to a more severe and uncontrollable situation again, as occurred in Shanghai, China, in 2022. The current global health threat calls for the urgent development of effective therapeutic options for the treatment and prevention of SARS-CoV-2 infection. This systematic overview of possible SARS-CoV-2 therapeutic strategies from 2019 to 2022 indicates three potential targets: virus entry, virus replication, and the immune system. The information provided in this review will aid the development of more potent and specific antiviral compounds.
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20
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Novel biosynthesis of tellurium nanoparticles and investigation of their activity against common pathogenic bacteria. J Taibah Univ Med Sci 2022; 18:400-412. [PMID: 37102074 PMCID: PMC10124139 DOI: 10.1016/j.jtumed.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/17/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Tellurium has received substantial attention for its remarkable properties. This study performed in vitro and in vivo testing of the antibacterial action of tellurium nanoparticles biosynthesized in actinomycetes against methicillin-resistant Staphylococcus aureus (MRSA), a common blood bacterial pathogen. Methods Nine actinomycete isolates were tested for their potential to reduce potassium tellurite (K2TeO3) and form tellurium nanoparticles (TeNPs). The most efficient actinomycete isolate in producing Tellerium nanoparticles was identified through molecular protocols. The generated TeNPs were characterized using UV, TEM, EDX, XRD and FTIR. The bacterial species implicated in bloodstream infections were detected at El Hussein Hospital. Bacterial identification and antibiotic susceptibility testing were performed using Vitek 2. An animal infection model was used to test the efficacy of the produced TeNPs against the most commonly isolated methicillin-resistant S. aureus using survival assays, colony counting, cytokine assessment and biochemical testing. Results The most efficient actinomycete isolate was identified as Streptomyces graminisoli and given the accession number (OL773539). The mean particle size of the produced TeNPs was 21.4 nm, and rods and rosette forms were observed. Methicillin-resistant S. aureus (MRSA) was the main bacterium (60%) causing blood stream infections, and was followed by Escherichia coli (25%) and Klebsiella pneumoniae (15%). The produced TeNPs were tested against MRSA, the bacterium most frequently isolated from blood, and showed a promising action inhibition zone of 24 ± 0.7 mm and an MIC of 50 μg/ml. An animal infection model indicated the promise of TeNPs alone or in combination with standard drugs to combat MRSA in a rat intravenous infection model. Conclusion TeNPs combined with vancomycin have successive impact to combat bacteremia for further verification of results.
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21
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Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey. J Infect Public Health 2022; 15:950-954. [DOI: 10.1016/j.jiph.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
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22
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Oral Fosfomycin Formulation in Bacterial Prostatitis: New Role for an Old Molecule-Brief Literature Review and Clinical Considerations. Infect Dis Rep 2022; 14:621-634. [PMID: 36005269 PMCID: PMC9408554 DOI: 10.3390/idr14040067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Bacterial prostatitis infections are described as infections that are difficult-to-treat, due to prostate anatomic characteristics along with clinical difficulty in terms of diagnosis and management. Furthermore, the emergence of multidrug resistant (MDR) bacteria, such as extended-spectrum beta-lactamase (ESBL) producer Escherichia coli, also representing the main causative pathogen in prostatitis, poses major problems in terms of antibiotic management and favorable clinical outcome. Oral fosfomycin, an antibiotic commonly used for the treatment of uncomplicated urinary tract infections (UTIs), has been recently evaluated for the treatment of bacterial prostatitis due to its favorable pharmacokinetic profile, its activity against MDR gram-positive and gram-negative bacteria, safety profile, and multiple synergic effect with other antibiotics as well as the low resistance rate. This review addresses fosfomycin pharmacokinetics and pharmacodynamics and discusses the latest clinical evidence on its clinical use to treat acute and chronic bacterial prostatitis in hospitalized patients and in outpatients. As described in several reports, oral fosfomycin may represent a valid therapeutic option to treat susceptible germs commonly causing prostatitis, such as E. coli and other Enterobacterales as well as Enterococcus faecium, even as a first-line regimen in particular clinical settings (patients with previous treatment failure, with allergies or outpatients). Stronger data from further studies, including randomized controlled trials, would be helpful to establish the proper dosage and specific indications.
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23
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Moscatt V, Marino A, Ceccarelli M, Cosentino F, Zagami A, Celesia B, Nunnari G, Cacopardo B. Possible role of low dose dexamethasone administration in listeria monocytogenes meningoencephalitis: A case series. Biomed Rep 2022; 17:73. [PMID: 35950097 PMCID: PMC9353624 DOI: 10.3892/br.2022.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/20/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vittoria Moscatt
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95122 Catania, Italy
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Aldo Zagami
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Benedetto Celesia
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Sicily
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, I-95122 Catania, Italy
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The Production of Antibiotics Must Be Reoriented: Repositioning Old Narrow-Spectrum Antibiotics, Developing New Microbiome-Sparing Antibiotics. Antibiotics (Basel) 2022; 11:antibiotics11070924. [PMID: 35884178 PMCID: PMC9311687 DOI: 10.3390/antibiotics11070924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
The development of broad-spectrum antibiotics to control multidrug-resistant bacteria is an outdated business model. This strategy has led to the introduction of highly effective antibiotics, but their widespread use has contributed to the emergence of even broader antibiotic resistance. In a strategy to combat antimicrobial resistance, we believe that the use of narrow-spectrum antibiotics should be promoted. This should involve both the repositioning of old antibiotics and the reorientation of research and development towards new narrow-spectrum antibiotics with a low ecological impact. These antibiotics could be prescribed for common conditions such as sore throats and cystitis, which account for the bulk of antibiotic use in humans. Narrow-spectrum, targeted, microbiome-sparing antibiotics could help control antibiotic resistance while being economically sustainable. Their development and production should be supported by governments, which would ultimately benefit from reduced health care costs.
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Alsaedi AA, El-Saed A, Althaqafi A, Bhutta MJ, Abukhzam B, Alshamrani M. Antimicrobial therapy, resistance, and appropriateness in healthcare-associated and community-associated infections; a point prevalence survey. J Infect Chemother 2022; 28:1358-1363. [PMID: 35760663 DOI: 10.1016/j.jiac.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Data examining differences in antimicrobial therapy and its appropriateness between healthcare-associated infections (HAIs) and community-associated infections (CAIs) are limited. The objective was to compare antimicrobial therapy, resistance, and appropriateness between CAIs and HAIs. METHODS One-day point prevalence survey targeting admitted patients with active infections was conducted in six tertiary care hospitals. Antimicrobial appropriateness was decided based on hospital antimicrobial guidelines, clinical assessment, culture results, and other relevant investigations. RESULTS Out of 1666 patient records reviewed, 240 (14.4%) infection events were identified. Prevalence of infections treated with antimicrobials were 6.5% for HAIs and 7.1% for CAIs. The most commonly prescribed antimicrobials were carbapenems (19.6%), cephalosporins (14.8%), and vancomycin (13.2%), with some differences between HAIs and CAIs. The overall contribution of MDR pathogens to both HAIs and CAIs was similar (34.0% versus 34.3%, p = 0.969). ESBL was significantly associated with CAIs while other gram-negative MDR pathogens significantly associated with HAIs. Overall appropriateness of antimicrobial therapy was similar in HAI and CAI events (64.2% versus 64.7%, p = 0.934). However, it was highest in aminoglycosides (78.6%) and lowest in vancomycin (40.8%). It was lowest in bloodstream infections than other infections (48.5% versus 61% to 78%, p = 0.044). CONCLUSION Although the overall burden of MDR pathogens and appropriateness of antimicrobial therapy were similar in HAI and CAI events, there were some differences related to the type of MDR, type of antimicrobials, and type of infection. The current finding can guide training and educational activities of local antimicrobial stewardship initiatives aiming to improve antimicrobial therapy in hospital setting.
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Affiliation(s)
- Asim A Alsaedi
- Infection Prevention and Control Department, Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Aiman El-Saed
- Infection Prevention and Control Department, MNGHA, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Muhammad Javid Bhutta
- Infection Prevention and Control Department, Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia
| | - Bassem Abukhzam
- Infection Prevention and Control Department, MNGHA, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- Infection Prevention and Control Department, MNGHA, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Marino A, Campanella E, Stracquadanio S, Ceccarelli M, Zagami A, Nunnari G, Cacopardo B. Corynebacterium striatum Bacteremia during SARS-CoV2 Infection: Case Report, Literature Review, and Clinical Considerations. Infect Dis Rep 2022; 14:383-390. [PMID: 35645221 PMCID: PMC9149851 DOI: 10.3390/idr14030042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Bacterial infections, especially those in hospital settings, represent a major complication of COVID-19 patients, complicating management and worsening clinical outcomes. Corynebacterium striatum is a non-diphtheric actinobacterium that has been reported as being the causative agent of several different infections, affecting both immunocompetent and immunocompromised patients. Recently, C. striatum has been recognized as a nosocomial pathogen that is responsible for severe infection in critical patients, as well as in fragile and immunocompromised subjects. C. striatum has been described as the etiological agent of bacteremia, central line infections, and endocarditis. We report a case of a 91-year-old woman who was hospitalized due to SARS-CoV-2 infection, who developed C. striatum bacteremia and died despite antimicrobial therapy and clinical efforts. Furthermore, we discuss C. striatum diagnosis and treatment based on evidence from the scientific literature.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Edoardo Campanella
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, 98124 Messina, Italy; (E.C.); (G.N.)
| | - Stefano Stracquadanio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Aldo Zagami
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, 98124 Messina, Italy; (E.C.); (G.N.)
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
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Ceccarelli M, Marino A, Pulvirenti S, Coco V, Busà B, Nunnari G, Cacopardo BS. Bacterial and Fungal Co-Infections and Superinfections in a Cohort of COVID-19 Patients: Real-Life Data from an Italian Third Level Hospital. Infect Dis Rep 2022; 14:372-382. [PMID: 35645220 PMCID: PMC9149992 DOI: 10.3390/idr14030041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
The use of immune suppressive drugs combined with the natural immune suppression caused by SARS-CoV-2 can lead to a surge of secondary bacterial and fungal infections. The aim of this study was to estimate the incidence of superinfections in hospitalized subjects with COVID-19. We carried out an observational retrospective single center cohort study. We enrolled patients admitted at the "Garibaldi" hospital for ≥72 h, with a confirmed diagnosis of COVID-19. All patients were routinely investigated for bacterial, viral, and fungal pathogens. A total of 589 adults with COVID-19 were included. A total of 88 infections were documented in different sites among 74 patients (12.6%). As for the etiology, 84 isolates were bacterial (95.5%), while only 4 were fungal (4.5%). A total of 51 episodes of hospital-acquired infections (HAI) were found in 43 patients, with a bacterial etiology in 47 cases (92.2%). Community-acquired infections (CAIs) are more frequently caused by Streptococcus pneumoniae, while HAIs are mostly associated with Pseudomonas aeruginosa. A high rate of CAIs and HAIs due to the use of high-dose corticosteroids and long hospital stays can be suspected. COVID-19 patients should be routinely evaluated for infection and colonization. More data about antimicrobial resistance and its correlation with antibiotic misuse in COVID-19 patients are required.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, I-95122 Catania, Italy;
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
- Unit of Infectious Diseases, ARNAS “Garibaldi”, “Nesima” Hospital, I-95122 Catania, Italy; (A.M.); (S.P.)
| | - Andrea Marino
- Unit of Infectious Diseases, ARNAS “Garibaldi”, “Nesima” Hospital, I-95122 Catania, Italy; (A.M.); (S.P.)
- Department of Biomedical and Biotechnological Sciences, Unit of Infectious Diseases, University of Catania, I-95123 Catania, Italy
| | - Sarah Pulvirenti
- Unit of Infectious Diseases, ARNAS “Garibaldi”, “Nesima” Hospital, I-95122 Catania, Italy; (A.M.); (S.P.)
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy;
| | - Viviana Coco
- Unit of Hospital Pharmacy, ARNAS “Garibaldi”, “Garibaldi” Hospital, I-95124 Catania, Italy; (V.C.); (B.B.)
| | - Barbara Busà
- Unit of Hospital Pharmacy, ARNAS “Garibaldi”, “Garibaldi” Hospital, I-95124 Catania, Italy; (V.C.); (B.B.)
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy;
| | - Bruno Santi Cacopardo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, I-95122 Catania, Italy;
- Unit of Infectious Diseases, ARNAS “Garibaldi”, “Nesima” Hospital, I-95122 Catania, Italy; (A.M.); (S.P.)
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Marino A, Munafò A, Augello E, Bellanca CM, Bonomo C, Ceccarelli M, Musso N, Cantarella G, Cacopardo B, Bernardini R. Sarilumab Administration in COVID-19 Patients: Literature Review and Considerations. Infect Dis Rep 2022; 14:360-371. [PMID: 35645219 PMCID: PMC9149900 DOI: 10.3390/idr14030040] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Two years have passed since WHO declared a pandemic state for SARS-CoV-2 infection. COVID-19 pathogenesis consists of a first viral phase responsible for early symptoms followed by an inflammatory phase, cytokine-mediated, responsible for late-onset manifestations up to ARDS. The dysregulated immune response has an outstanding role in the progression of pulmonary damage in COVID-19. IL-6, through the induction of pro-inflammatory chemokines and cytokines, plays a key role in the development and maintenance of inflammation, acting as a pioneer of the hyperinflammatory condition and cytokine storm in severe COVID-19. Therefore, drugs targeting both IL-6 and IL-6 receptors have been evaluated in order to blunt the abnormal SARS-CoV-2-induced cytokine release. Sarilumab, a high-affinity anti-IL-6 receptor antibody, may represent a promising weapon to treat the fearsome hyperinflammatory phase by improving the outcome of patients with moderate-to-severe COVID-19 pneumonia. Further prospective and well-designed clinical studies with larger sample sizes and long-term follow-up are needed to assess the efficacy and the safety of this therapeutic approach to achieve improved outcomes in COVID-19.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Science (BIOMETEC), University of Catania, 95123 Catania, Italy; (A.M.); (C.B.); (N.M.)
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (M.C.); (B.C.)
| | - Antonio Munafò
- Department of Biomedical and Biotechnological Science, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (E.A.); (C.M.B.); (G.C.); (R.B.)
| | - Egle Augello
- Department of Biomedical and Biotechnological Science, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (E.A.); (C.M.B.); (G.C.); (R.B.)
| | - Carlo Maria Bellanca
- Department of Biomedical and Biotechnological Science, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (E.A.); (C.M.B.); (G.C.); (R.B.)
| | - Carmelo Bonomo
- Department of Biomedical and Biotechnological Science (BIOMETEC), University of Catania, 95123 Catania, Italy; (A.M.); (C.B.); (N.M.)
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (M.C.); (B.C.)
| | - Nicolò Musso
- Department of Biomedical and Biotechnological Science (BIOMETEC), University of Catania, 95123 Catania, Italy; (A.M.); (C.B.); (N.M.)
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Science, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (E.A.); (C.M.B.); (G.C.); (R.B.)
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy; (M.C.); (B.C.)
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Science, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (E.A.); (C.M.B.); (G.C.); (R.B.)
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
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Miftode IL, Pasare MA, Miftode RS, Nastase E, Plesca CE, Lunca C, Miftode EG, Timpau AS, Iancu LS, Dorneanu OS. What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe. Antibiotics (Basel) 2022; 11:antibiotics11050548. [PMID: 35625192 PMCID: PMC9137815 DOI: 10.3390/antibiotics11050548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with Enterobacterales urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was Escherichia coli, representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay (p = 0.0001), Charlson comorbidity index ≥ 3 (p = 0.02), urinary catheterization (p = 0.001), associated respiratory pathologies (p = 0.004), obesity (p = 0.047), a history of previous hospitalizations (p = 0.007), inappropriate empiric antibiotic regimen (p = 0.001), or hyper inflammatory status (p = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R2 = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Maria-Antoanela Pasare
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Eduard Nastase
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Claudia Elena Plesca
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Catalina Lunca
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Egidia-Gabriela Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Amalia-Stefana Timpau
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
| | - Luminita Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Olivia Simona Dorneanu
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
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Marino A, Campanella E, Ceccarelli M, Bonomo C, Gussio M, Micali C, Celesia BM, Nunnari G, Cacopardo B. Severe Neutropenia after Sarilumab Administration in Two COVID-19 Patients: Case Reports and Literature Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Two years have passed since the WHO declared a pandemic state for SARS-CoV2 infection. COVID-19 pathogenesis consists of a first viral phase responsible for early symptoms followed by an inflammatory phase, which is cytokine-mediated, responsible for late-onset signs up to acute respiratory distress syndrome. Considering that interleukin (IL)6 plays a key role in the development and maintenance of inflammation, drugs targeting both IL6 and IL6 receptors have been evaluated.
CASE REPORTS: The present study reports the cases of two hospitalized patients with severe respiratory COVID-19 treated with a single dose of intravenous sarilumab, a monoclonal anti-IL6 antibody, along with standard of care medications and high-flow oxygen therapy. Although a few days following sarilumab administration, clinical and biochemical conditions started ameliorating, these patients developed severe and self-limiting neutropenia.
CONCLUSION: Sarilumab may represent a promising weapon to treat the fearsome hyperinflammatory phase; however, more trials are needed to decide whether to use it in combination with other drugs or alone, and to better understand pharmacokinetics and side effects.
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Tosto F, Marino A, Moscatt V, Cosentino F, Campanella E, Micali C, Russotto Y, Caci G, Rullo E, Nunnari G, Cacopardo B. Methicillin‑sensitive Staphylococcus aureus prosthetic vascular graft infection after a Fontan procedure in an adult patient: A case report. WORLD ACADEMY OF SCIENCES JOURNAL 2022; 4:19. [DOI: 10.3892/wasj.2022.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Fabio Tosto
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, Unit of Infectious Diseases, University of Catania, I-95122 Catania, Italy
| | - Vittoria Moscatt
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Edoardo Campanella
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Cristina Micali
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Ylenia Russotto
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Grazia Caci
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Emmanuele Rullo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, I-98124 Messina, Italy
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Catania, I-95122 Catania, Italy
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Marino A, Munafò A, Zagami A, Ceccarelli M, Campanella E, Cosentino F, Moscatt V, Cantarella G, Di Mauro R, Bernardini R, Nunnari G, Cacopardo B. Ampicillin plus ceftriaxone therapy against Enterococcus faecalis endocarditis: A case report, guidelines considerations, and literature review. IDCases 2022; 28:e01462. [PMID: 35265458 PMCID: PMC8899221 DOI: 10.1016/j.idcr.2022.e01462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Enterococcus faecalis infective endocarditis (EFIE) continues to be a very serious disease, showing considerable morbidity and mortality rates which are influenced by the spread of multi-drug resistant strains occurred in the last decades. Although aminoglycosides were considered the treatment of choice of EIFE, in recent years several studies have investigated alternative therapeutic approaches, including combinations of beta-lactams, mainly because of the aminoglycoside-renowned nephrotoxicity and the widespread development of high-level aminoglycosides resistance (HLAR). In this scenario, we reported a case involving a prosthetic valve infective endocarditis caused by an aminoglycoside-resistant E. faecalis strain which was successfully treated with ampicillin plus ceftriaxone despite the presence of artificial heart valve and the patient’s severe clinical conditions.
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Affiliation(s)
- Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Correspondence to: ARNAS Garibaldi Hospital, Via Palermo, 636, 95122 Catania, Italy.
| | - Antonio Munafò
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Aldo Zagami
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Edoardo Campanella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
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