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Hocking L, Ali GC, d’Angelo C, Deshpande A, Stevenson C, Virdee M, Guthrie S. A rapid evidence assessment exploring whether antimicrobial resistance complicates non-infectious health conditions and healthcare services, 2010-20. JAC Antimicrob Resist 2021; 3:dlab171. [PMID: 34806009 PMCID: PMC8599069 DOI: 10.1093/jacamr/dlab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.
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Affiliation(s)
- Lucy Hocking
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
- Corresponding author. E-mail:
| | | | | | | | | | - Mann Virdee
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
| | - Susan Guthrie
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
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Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011-2019. Antibiotics (Basel) 2020; 9:antibiotics9090630. [PMID: 32971752 PMCID: PMC7559630 DOI: 10.3390/antibiotics9090630] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022] Open
Abstract
Monitoring of pathogen resistance profiles is necessary to guide empirical antibiotic therapy before culture and sensitivity results become available. The aim of this study was to describe current antibiotic resistance patterns of five most frequent causative uropathogens in a Department of Urology of a tertiary referral centre in Central Europe over a period of nine years. The Hospital Department of Clinical Microbiology database was used to extract data on all positive urine samples from inpatients in the Department of Urology between 2011 and 2019. Numbers of susceptible and resistant isolates per year were calculated for five most frequent uropathogens: Escherichia coli, Enterococcus spp., Klebsiella spp., Pseudomonas aeruginosa, and Proteus spp. Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin, colistin, and vancomycin. High resistance rates of Gram-negative uropathogens were demonstrated to most common antimicrobials, with statistically significant increasing or decreasing trends in some cases. No carbapenem-resistant Enterobacteriaceae were isolated. Vancomycin-resistant Enterococcus spp. strains were rare in our population.
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Ang H, Sun X. Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: A meta-analysis. Int J Nurs Pract 2018; 24:e12644. [PMID: 29575345 DOI: 10.1111/ijn.12644] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/09/2018] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
AIMS To identify the risk factors for multidrug-resistant Gram-negative bacteria systematically and provide suggestions and an evidence-base for clinical measures. BACKGROUND With the increase in the social population, changes in human behaviour and ecosystems, as well as economic development, bacteria have gradually produced drug resistance genes. These have swept through intensive care units causing high mortality. METHODS Relevant literature which included case-control and cohort studies published from January 1999 to March 2017 were searched in the Cochrane Library, PubMed, Web of Science, and Medline. Meta-analysis was performed by using StataSE version 12.0 software. RESULTS Eighteen studies of 235 publications were eligible. Male gender (OR 1.40, 95%CI 1.09, 1.80), having an operative procedure (OR 1.31, 95%CI 1.10, 1.56), a central venous catheter (OR 1.22, 95%CI 1.01, 1.48), mechanical ventilation (OR 1.25, 95%CI 1.07, 1.46), previous antibiotic therapy (OR 1.66, 95%CI 1.41, 1.96), length of ICU stay (weighted mean difference 8.18, 95%CI 0.27, 16.10), and types of health-associated infections were the identified risk factors for multidrug-resistant Gram-negative bacterial infection in intensive care units; moreover, diabetes mellitus was not. CONCLUSION Six risk factors were associated with multidrug-resistant Gram-negative bacterial infection in intensive care units. Antimicrobial stewardship, infection control, and medical staff prevention care are needed.
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Affiliation(s)
- Hui Ang
- Medical School, Yangtze University, Jingzhou, Hubei, China
| | - Xuan Sun
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Murri R, Fiori B, Spanu T, Mastrorosa I, Giovannenze F, Taccari F, Palazzolo C, Scoppettuolo G, Ventura G, Sanguinetti M, Cauda R, Fantoni M. Trimethoprim-sulfamethoxazole therapy for patients with carbapenemase-producing Klebsiella pneumoniae infections: retrospective single-center case series. Infection 2017; 45:209-213. [PMID: 28185222 DOI: 10.1007/s15010-016-0968-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate the efficacy and tolerability of trimethoprim-sulfamethoxazole (also known as co-trimoxazole, TMPS) to treat Klebsiella pneumoniae (Kp)-K. pneumoniae carbapenemase (KPC) infections. METHODS Clinical data of patients with a TMPS-susceptible Kp-KPC infection were collected as a case series. RESULTS We report clinical outcomes and tolerability for 14 patients infected by Kp-KPC strains susceptible to TMPS, including three bloodstream infections. In ten cases (71.4%), TMPS was administered as monotherapy. In all but one case, Kp-KPC infection was cured. In the remaining patient, therapy was discontinued because of an adverse event. CONCLUSIONS The use of TMPS to treat TMPS-susceptible Kp-KPC infections seems promising.
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Affiliation(s)
- Rita Murri
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy.
| | - Barbara Fiori
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Teresa Spanu
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Ilaria Mastrorosa
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Francesca Giovannenze
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Francesco Taccari
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Claudia Palazzolo
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Giulio Ventura
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Maurizio Sanguinetti
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Roberto Cauda
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Department of Microbiology, Catholic University of Rome, Rome, Italy
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El Maaroufi H, Goubard A, Redjoul R, Legrand P, Pautas C, Mikdame M, Doghmi K, Toma A, Maury S, Schwarzinger M, Cordonnier C. Risk factors and scoring system for predicting bacterial resistance to cefepime as used empirically in haematology wards. BIOMED RESEARCH INTERNATIONAL 2015; 2015:945769. [PMID: 26075276 PMCID: PMC4436445 DOI: 10.1155/2015/945769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 04/04/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Bacterial resistance is of growing concern in haematology wards. As the inappropriate administration of empirical antibacterial may alter survival, we studied risk factors for resistance to our usual empirical first-line antibacterial therapy, cefepime. METHODS We retrospectively studied 103 first episodes of bacteraemia recorded in our haematology department over 2.5 years. Risk factors for cefepime-resistance were identified by multivariate logistic regression with backward selection (P < 0.05). A scoring system for predicting cefepime-resistance was built on independent factor, with an internal validation by the bootstrap resampling technique. RESULTS 38 (37%) episodes were due to Gram-negative bacteria. Fifty (49%) were due to bacteria resistant to cefepime. Cefepime resistance was significantly associated with a decreased survival at day 30 (P < 0.05). Three risk factors were independently associated with cefepime-resistance: acute lymphoblastic leukaemia; ≥18 days since hospital admission; and receipt of any β-lactam in the last month. Patients with ≥2 of these risk factors had a probability of 86% (CI 95%, 25 to 100%) to carry a cefepime-resistant strain. CONCLUSION Using our scoring system should reduce the indication of very broad antibacterial regimens in the empirical, first-line treatment of febrile hematology patients in more than 80% of the cases.
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Affiliation(s)
- Hicham El Maaroufi
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
- Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco
| | - Agathe Goubard
- Microbiology Laboratory, Henri Mondor Hospital, 94000 Créteil, France
| | - Rabah Redjoul
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
| | - Patrick Legrand
- Microbiology Laboratory, Henri Mondor Hospital, 94000 Créteil, France
| | - Cécile Pautas
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
| | - Mohamed Mikdame
- Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco
| | - Kamal Doghmi
- Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco
| | - Andréa Toma
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
| | - Sébastien Maury
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
| | - Michael Schwarzinger
- Equipe ATIP/AVENIR, INSERM, UMR 738, 75018 Paris, France
- University Paris Diderot, Sorbonne Paris Cité, UMR 738, 75018 Paris, France
| | - Catherine Cordonnier
- Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France
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Zhong HQ, Zhang S, Pan H, Cai T. Influence of induced ciprofloxacin resistance on efflux pump activity of Klebsiella pneumoniae. J Zhejiang Univ Sci B 2014; 14:837-43. [PMID: 24009204 DOI: 10.1631/jzus.b1200221] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The efflux pump (EP) is one of the major mechanisms of antibiotic resistance in Klebsiella pneumoniae. However, there are few reports on the effect of the abuse of antibiotic use on the activity of EPs. To determine whether the use of low efficacy antibiotics has any effect on the activity of EPs and induces drug resistance in K. pneumoniae, we investigated the effect of ciprofloxacin on the activity of EPs in K. pneumoniae strains. METHODS Sixteen susceptible K. pneumoniae strains were isolated from patients and their minimum inhibitory concentrations (MICs) of ciprofloxacin were measured in the absence and presence of the pump inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP). The strains were then induced with a gradient of ciprofloxacin until the MICs of the strains showed no further increase, to obtain induced resistant strains. The EP activities of the strains before and after induction were compared using EP inhibition and ethidium bromide (EtBr) accumulation assays. RESULTS The MIC values of the strains were 16‒256 times higher after induction than before induction. In the presence of CCCP, the MIC values of 50% of the induced strains were 2‒4-fold lower than that in the absence of this inhibitor. The EtBr accumulation assay showed that the fluorescence of EtBr in the induced cells was lower than that in the cells before induction. CONCLUSIONS EPs are widespread in susceptible and drug-resistant K. pneumoniae strains. Induction with ciprofloxacin may increase the activity of EPs in K. pneumoniae. The EtBr accumulation assay is more sensitive than the EP inhibition assay in evaluating the activity of EPs in K. pneumoniae.
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Affiliation(s)
- Hai-qin Zhong
- Department of Internal Medicine, School of Medicine, Ningbo University, Ningbo 315211, China; Stem Cell Laboratory, Ningbo No. 2 Hospital, Ningbo 315010, China; Clinical Laboratory, Ningbo No. 2 Hospital, Ningbo 315010, China; Emergency Department, Ningbo No. 2 Hospital, Ningbo 315010, China
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Meyer E, Gastmeier P, Deja M, Schwab F. Antibiotic consumption and resistance: Data from Europe and Germany. Int J Med Microbiol 2013; 303:388-95. [DOI: 10.1016/j.ijmm.2013.04.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wallace CC, Yund PO, Ford TE, Matassa KA, Bass AL. Increase in antimicrobial resistance in bacteria isolated from stranded marine mammals of the Northwest Atlantic. ECOHEALTH 2013; 10:201-10. [PMID: 23636484 DOI: 10.1007/s10393-013-0842-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 05/21/2023]
Abstract
Studies on marine mammals can inform our understanding of the environmental health of the ocean. To evaluate the potential for changes in antimicrobial resistance, we analyzed a database spanning 2004-2010 that consisted of bacterial isolate identity and antimicrobial sensitivity for stranded pinnipeds in the Northwest Atlantic. Samples (n = 170) from treated animals yielded 310 bacterial isolates representing 24 taxa. We evaluated changes in antimicrobial class resistance from 2004 to 2010 for eight taxa. Escherichia coli displayed a significant increase in resistance to several antimicrobial classes. Other taxa displayed significant increases in resistance to aminoglycosides, and/or fluoroquinolones. In addition, we observed a significant increase in multiple antimicrobial resistance in cultures from untreated animals. These results demonstrate an increase in resistance among common bacterial pathogens of marine mammals over a time span of 6 years.
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Affiliation(s)
- Courtney C Wallace
- Center for Land-Sea Interactions, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA
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Wang F, Wu K, Sun J, Wang Q, Chen Q, Yu S, Rui Y. Novel ISCR1-linked resistance genes found in multidrug-resistant Gram-negative bacteria in southern China. Int J Antimicrob Agents 2012; 40:404-8. [DOI: 10.1016/j.ijantimicag.2012.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/12/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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van der Donk CFM, van de Bovenkamp JHB, De Brauwer EIGB, De Mol P, Feldhoff KH, Kalka-Moll WM, Nys S, Thoelen I, Trienekens TAM, Stobberingh EE. Antimicrobial resistance and spread of multi drug resistant Escherichia coli isolates collected from nine urology services in the Euregion Meuse-Rhine. PLoS One 2012; 7:e47707. [PMID: 23082197 PMCID: PMC3474752 DOI: 10.1371/journal.pone.0047707] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/14/2012] [Indexed: 12/01/2022] Open
Abstract
We determined the prevalence and spread of antibiotic resistance and the characteristics of ESBL producing and/or multi drug resistant (MDR) Escherichia coli isolates collected from urine samples from urology services in the Euregio Meuse-Rhine, the border region of the Netherlands (n = 176), Belgium (n = 126) and Germay (n = 119). Significant differences in resistance between the three regions were observed. Amoxicillin-clavulanic acid resistance ranged from 24% in the Netherlands to 39% in Belgium (p = 0.018), from 20% to 40% (p<0.004) for the fluoroquinolones and from 20% to 40% (p = 0.018) for the folate antagonists. Resistance to nitrofurantoin was less than 5%. The prevalence of ESBL producing isolates varied from 2% among the Dutch isolates to 8% among the German ones (p = 0.012) and were mainly CTX-M 15. The prevalence of MDR isolates among the Dutch, German and Belgian isolates was 11%, 17% and 27%, respectively (p< = 0.001 for the Belgian compared with the Dutch isolates). The majority of the MDR and ESBL producing isolates belonged to ST131. This study indicates that most antibiotics used as first choice oral empiric treatment for UTIs (amoxicillin-clavulanic acid, fluoroquinolones and folate antagonists) are not appropriate for this purpose and that MDR strains such as CTX-M producing ST131 have spread in the entire Euregion. Our data stress the importance of ward specific surveillance to optimize empiric treatment. Also, prudent use of antibiotics and further research to alternative agents are warranted.
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Affiliation(s)
- Christina F. M. van der Donk
- Maastricht University Medical Centre, Department of Medical Microbiology, Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | | | | | - Patrick De Mol
- Centre Hospitalier Universitaire de Liège, Laboratoire de Microbiologie, Liège, Belgium
| | | | | | - Sita Nys
- Jessa Hospital, Campus Virga Jesse, Department of Clinical Biology, Hasselt, Belgium
| | - Inge Thoelen
- General Hospital Vesalius, Department of Clinical Biology, Tongeren, Belgium
| | | | - Ellen E. Stobberingh
- Maastricht University Medical Centre, Department of Medical Microbiology, Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- * E-mail:
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Resistance drives antibacterial drug development. Curr Opin Pharmacol 2011; 11:433-8. [DOI: 10.1016/j.coph.2011.07.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/16/2011] [Accepted: 07/26/2011] [Indexed: 12/24/2022]
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