1
|
Lee EH, Lee SK, Cheon JH, Koh H, Lee JA, Kim CH, Kim JN, Lee KH, Lee SJ, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yong DE, Yoon SS, Yeom JS, Choi JY. Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube. J Hosp Infect 2023; 131:234-243. [PMID: 36414164 DOI: 10.1016/j.jhin.2022.11.007] [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: 07/28/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonizing MDRO. AIM To compare the efficacy of different FMT methods to optimize the success rate of decolonization in patients with MDRO carriage. METHODS This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube. FINDINGS A total of 57 patients underwent FMT for MDRO decolonization. The colonoscopy group required the shortest time for decolonization, whereas the EGD group required the longest (24.9 vs 190.4 days, P = 0.022). The decolonization rate in the oral capsule group was comparable to that in the EGD group (84.6% vs 85.7%, P = 0.730). An important clinical factor associated with decolonization failure was antibiotic use after FMT (odds ratio = 6.810, P = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT. CONCLUSION Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonization.
Collapse
Affiliation(s)
- E H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Cheon
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - H Koh
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - C H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J N Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K H Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Lee
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J H Kim
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - D E Yong
- Division of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - S S Yoon
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, South Korea
| | - J S Yeom
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
2
|
Modelling of the transmission dynamics of carbapenem-resistant Klebsiella pneumoniae in hospitals and design of control strategies. Sci Rep 2022; 12:3805. [PMID: 35264643 PMCID: PMC8907197 DOI: 10.1038/s41598-022-07728-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/21/2022] [Indexed: 01/13/2023] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a major threat to global public health. Epidemiological and infection controls associated with CRKP are challenging because of several potential elements involved in a complicated cycle of transmission. Here, we proposed a comprehensive mathematical model to investigate the transmission dynamics of CRKP, determine factors affecting the prevalence, and evaluate the impact of interventions on transmission. The model includes the essential compartments, which are uncolonized, asymptomatic colonized, symptomatic colonized, and relapsed patients. Additionally, symptomatic colonized and relapsed patients were further classified into subpopulations according to their number of treatment failures or relapses. We found that the admission of colonized patients and use of antibiotics significantly impacted the endemic transmission in health care units. Thus, we introduced the treatment efficacy, defined by combining the treatment duration and probability of successful treatment, to characterize and describe the effects of antibiotic treatment on transmission. We showed that a high antibiotic treatment efficacy results in a significantly reduced likelihood of patient readmission in the health care unit. Additionally, our findings demonstrate that CRKP transmission with different epidemiological characteristics must be controlled using distinct interventions.
Collapse
|
3
|
An animal model of limitation of gut colonization by carbapenemase-producing Klebsiella pneumoniae using rifaximin. Sci Rep 2022; 12:3789. [PMID: 35260705 PMCID: PMC8904601 DOI: 10.1038/s41598-022-07827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Current knowledge suggests that infection by carbapenem-resistant enterobacteria is preceded by gut colonization. It is hypothesized that colonization is eradicated by non-absorbable antibiotics like rifaximin. We investigated the effect of rifaximin against carbapenem-resistant Klebsiella pneumoniae (CRKP) in vitro and in a mouse model. We studied the in vitro efficacy of rifaximin against 257 CRKP clinical isolates, 188 KPC producers and 69 OXA-48 producers, by minimum inhibitory concentration and time-kill assays. We then developed a model of gut colonization by feeding 30 C57Bl6 mice with 108 cfu of one KPC-KP isolate for 7 days; mice were pre-treated orally with saline, omeprazole or ampicillin. Then, another 60 mice with established KPC-2 gut colonization received orally for 7 consecutive days rifaximin 180 mg/kg dissolved in ethanol and 4% bile or vehicle. On days 0, 3 and 7 stool samples were collected; mice were sacrificed for determination of tissue outgrowth. At a concentration of 1000 μg/ml rifaximin inhibited 84.8% of CRKP isolates. Α 3 × log10 decrease of the starting inoculum was achieved by 100, 250 and 500 μg/ml of rifaximin after 24 h against 25, 55 and 55% of isolates. Pre-treatment with ampicillin was necessary for gut colonization by KPC-KP. Treatment with rifaximin succeeded in reducing KPC-KP load in stool and in the intestine. Rifaximin inhibits at clinically meaningful gut concentrations the majority of CRKP isolates and is efficient against gut colonization by KPC-KP.
Collapse
|
4
|
Effectiveness of selective digestive decolonization therapy using oral gentamicin for eradication of carbapenem-resistant Enterobacteriaceae carriage. Infect Control Hosp Epidemiol 2022; 43:1580-1585. [DOI: 10.1017/ice.2021.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objectives:
To evaluate the efficacy of selective digestive decolonization (SDD) therapy using oral gentamicin against carbapenem-resistant Enterobacteriaceae (CRE) colonization and to compare the incidence of novel gentamicin resistance between SDD and non-SDD patient groups.
Design:
Retrospective cohort study.
Setting:
Acute-care referral center hospital in South Korea.
Methods:
Adults aged ≥20 years identified as rectal CRE carriers hospitalized between October 2019 and June 2020 were enrolled. Patients with a <30-day follow-up were excluded. Among CRE carriers, those who received 80 mg oral gentamicin sulfate (Shin Poong Pharmaceutical, Seoul, South Korea) 4 times daily comprised the SDD group and those who did not receive SDD therapy comprised the non-SDD group. CRE decolonization was compared between groups within 15 days, and new gentamicin resistance was assessed.
Results:
In total, 73 rectal CRE carriers were identified; 11 patients were lost to follow-up within 30 days and were excluded. Oral gentamicin was administered to 20 of 62 patients. We detected no differences in the basic demographic features between groups. The rate of decolonization within 15 days was higher in the SDD group than in the non-SDD group (70.0% vs 23.8%; P = .001). The time to decolonization was significantly shorter in the SDD group. We detected no difference in acquisition of new gentamicin resistance between the groups. No serious adverse events due to oral gentamicin SDD therapy were reported.
Conclusions:
SDD therapy using oral gentamicin for CRE-colonized patients may be effective for the decolonization of gut CRE and for the prevention of transmission and subsequent CRE infection.
Collapse
|
5
|
Lin Q, Wang Y, Yu J, Li S, Zhang Y, Wang H, Lai X, Liu D, Mao L, Luo Y, Tang G, Chen Z, Sun Z. Bacterial characteristics of carbapenem-resistant Enterobacteriaceae (CRE) colonized strains and their correlation with subsequent infection. BMC Infect Dis 2021; 21:638. [PMID: 34215214 PMCID: PMC8254368 DOI: 10.1186/s12879-021-06315-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Searching the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection is important in clinical practice. In the present study, we aim to investigate bacterial characteristics of colonizing strains and their correlation with subsequent CRE infection. METHODS Between May 2018 and January 2019, patients hospitalized in the department of haematology and intensive care unit (ICU) were screened for CRE by rectal swabs and monitored for the outcome of infection. We identified the species and carbapenemase-encoding genes of colonizing strains and performed antimicrobial susceptibility tests and multilocus sequence typing (MLST). Risk factors for subsequent CRE infections were ascertained by univariate and multivariable analysis. RESULTS We collected a total of 219 colonizing strains from 153 patients. Klebsiella pneumoniae was the most abundant species, and MLST analysis showed rich diversity. K. pneumoniae carbapenemase (KPC) was predominant in the infection group (72.4%). In the non-infection group, 35.4% of strains were non-carbapenemase-producing CRE (NCP-CRE), and New Delhi metallo-β-lactamase (NDM) was predominant (42.2%). The rate of high-level carbapenem resistance (minimum inhibitory concentration [MIC] ≥ 64 mg/L for meropenem and ertapenem, ≥ 32 mg/L for imipenem) was remarkably higher in the infection group than in the non-infection group (P < 0.001). Univariate analysis showed that K. pneumoniae, high-level carbapenem resistance, CP-CRE and KPC-CRE were infection risk factors after CRE colonization. On multivariable analysis with different carbapenemase dichotomizations, KPC-CRE (adjusted odds ratio [aOR], 4.507; 95% confidence interval [CI], 1.339-15.171; P = 0.015) or imipenem MIC ≥ 32 mg/L (aOR, 9.515; 95% CI, 1.617-55.977; P = 0.013) were respectively identified as independent risk factors for subsequent infection. CONCLUSIONS Patients colonized with KPC-CRE or strains with an imipenem MIC ≥ 32 mg/L were at particularly high risk of subsequent CRE infections during their hospital stay.
Collapse
Affiliation(s)
- Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yu
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shusheng Li
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yicheng Zhang
- Department of Haematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoquan Lai
- Department of Nosocomial Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, TongjiMedical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhongju Chen
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
6
|
Gałązka P, Styczyński J, Czyżewski K, Salamonowicz-Bodzioch M, Frączkiewicz J, Zając-Spychała O, Zaucha-Prażmo A, Goździk J, Biliński J, Basak GW. Impact of decontamination therapy on gastrointestinal acute graft-versus-host disease after allogeneic hematopoietic cell transplantation in children: Decontamination therapy in allo-HCT. Curr Res Transl Med 2021; 69:103298. [PMID: 34144374 DOI: 10.1016/j.retram.2021.103298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Gut colonization with antibiotic-resistant bacteria (ARB) is associated with a significantly decreased overall survival in adult patients undergoing allo-HCT because of an increased treatment-related mortality. OBJECTIVE The objective of this multicenter study was the analysis of impact of gut colonization status and the use of antibiotics on development of gastro-intestinal (GI) graft-versus-host disease (GVHD) of allo-HCT in children. METHODS All consecutive patients who underwent allo-HCT over a period of three years in all pediatric HCT centers in Poland were analyzed for the impact of gut colonization on GI GVHD, with respect to standard of care including prophylaxis of infections and supportive therapy. RESULTS At the time of allo-HCT, 44.2% of pediatric patients were colonized by ARB. Decontamination therapy with antibiotics was applied in 78% of children. Gut decontamination prophylactic therapy with antibiotics decreased the risk of acute GI GVHD. The use of gentamicin contributed to decreased rate of GVHD, while the use of ciprofloxacin and colistin contributed to increased incidence of GVHD after allo-HCT in children. Sepsis with ARB and non-MFD transplant contributed significantly to worse survival, while neither colonization nor gut decontamination had an impact on overall survival. CONCLUSIONS Gut decontamination therapy contributed to lower incidence of acute GI GVHD in children undergoing allo-HCT, and the use of specific antibiotics might be responsible for this effect.
Collapse
Affiliation(s)
- Przemysław Gałązka
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | | | - Jowita Frączkiewicz
- Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jolanta Goździk
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Jaroslaw Biliński
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warszawa, Warszawa, Poland
| | - Grzegorz W Basak
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warszawa, Warszawa, Poland
| |
Collapse
|
7
|
Sato S, Shimizu E, He J, Ogawa M, Asai K, Yazu H, Rusch R, Yamane M, Yang F, Fukuda S, Kawakami Y, Tsubota K, Ogawa Y. Positive Effects of Oral Antibiotic Administration in Murine Chronic Graft-Versus-Host Disease. Int J Mol Sci 2021; 22:3745. [PMID: 33916809 PMCID: PMC8038334 DOI: 10.3390/ijms22073745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic graft-versus-host disease (cGVHD) is one of the most frequent complications experienced after allogeneic hematopoietic stem cell transplantation. Reportedly, dysbiosis and severe damage to the microbiome are also closely associated with GVHD. Herein, we aimed to elucidate the positive and negative effects of the administration of various antibiotics in a murine model of cGVHD. For allogeneic bone marrow transplantation (allo-BMT), bone marrow from B10.D2 mice were transplanted in BALB/c mice to induce cGVHD. The cGVHD mice were orally administered ampicillin, gentamicin (GM), fradiomycin, vancomycin, or the solvent vehicle (control group). Among the antibiotic-treated mice, the systemic cGVHD phenotypes and ocular cGVHD manifestations were suppressed significantly in GM-treated mice compared to that in control mice. Inflammatory cell infiltration and fibrosis in cGVHD-targeted organs were significantly attenuated in GM-treated mice. Although regulatory T cells were retained at greater levels in GM-treated mice, there were significantly fewer Th17 cells and interleukin (IL)-6-producing macrophages in cGVHD-targeted organs in these mice. Collectively, our results revealed that orally administered GM may exert positive effects in a cGVHD mouse model.
Collapse
Affiliation(s)
- Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Jingliang He
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
- Aier Eye school of Ophthalmology, Central South University, Changsha 410083, China
| | - Mamoru Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Kazuki Asai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-0063, Japan
| | - Robert Rusch
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Mio Yamane
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Fan Yang
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
- Aier Eye school of Ophthalmology, Central South University, Changsha 410083, China
| | - Shinji Fukuda
- Institute for Advanced Biosciences, Keio University, Yamagata 997-0052, Japan
- Transborder Medical Research Center, University of Tsukuba, Ibaraki 305-8575, Japan
- Intestinal Microbiota Project, Kanagawa Institute of Industrial Science and Technology, Kanagawa 210-0821, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo 160-8582, Japan;
- International University of Health and Welfare School of Medicine, Chiba 286-0048, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (S.S.); (J.H.); (M.O.); (K.A.); (H.Y.); (R.R.); (M.Y.); (F.Y.); (Y.O.)
| |
Collapse
|
8
|
Ramstad SN, Taxt AM, Naseer U, Wasteson Y, Bjørnholt JV, Brandal LT. Effects of antimicrobials on Shiga toxin production in high-virulent Shiga toxin-producing Escherichia coli. Microb Pathog 2020; 152:104636. [PMID: 33242644 DOI: 10.1016/j.micpath.2020.104636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Antimicrobial treatment of Shiga toxin-producing Escherichia coli (STEC) infections is controversial because antimicrobials may stimulate Shiga toxin (Stx) production, and thereby increase the risk of developing haemolytic uremic syndrome (HUS). Previous in vitro studies have shown this mainly in infections caused by STEC serotype O157:H7. The aim of this study was to investigate induction of Stx transcription and production in different serotypes of STEC isolated from severely ill patients, following their exposure in vitro to six different classes of antimicrobials. METHODS We investigated Stx transcription and production in 12 high-virulent STEC strains, all carrying the stx2a gene, of six different serotypes following their exposure to six classes of antimicrobials. Liquid cultures of the STEC strains were incubated with sub-inhibitory concentrations of the antimicrobials. We used reverse-transcription quantitative PCR to measure the relative expression of Stx2a mRNA and an enzyme-linked immunosorbent assay to quantify Stx production. RESULTS In general the antibiotics tested showed only minor effects on transcriptional levels of Stx2a. Ciprofloxacin caused an increase of Stx production in all but two strains, while gentamicin, meropenem and azithromycin did not induce Stx production in any of the STEC strains examined. STEC O104:H4 was the serotype that in greatest extent responded to antimicrobial exposure with an increase of stx2a transcription and Stx production. CONCLUSION Gentamicin, meropenem and azithromycin exposure did not result in elevated Stx production. We recommend that this finding is investigated further in the search for candidates for future antimicrobial treatment of STEC.
Collapse
Affiliation(s)
- Silje N Ramstad
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, PB 4956 Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Arne M Taxt
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, PB 4956 Nydalen, 0424, Oslo, Norway
| | - Umaer Naseer
- Department of Infectious Diseases and Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Yngvild Wasteson
- Department of Paraclinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Jørgen V Bjørnholt
- Department of Microbiology, Division of Laboratory Medicine, Oslo University Hospital, PB 4956 Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lin T Brandal
- Department of Infectious Diseases and Prevention, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
9
|
Zollner-Schwetz I, Scarpatetti M, Pichler G, Pux C, Klymiuk I, Trajanoski S, Krause R. Effect of a Multispecies Probiotic on Intestinal and Skin Colonization by Multidrug-Resistant Gram-Negative Bacteria in Patients in a Long-Term Care Facility: A Pilot Study. Nutrients 2020; 12:nu12061586. [PMID: 32481668 PMCID: PMC7352861 DOI: 10.3390/nu12061586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023] Open
Abstract
Residents in long-term care facilities (LTCFs) are frequently colonized by multidrug-resistant Gram-negative bacteria, putting them at risk for subsequent infections. We aimed to evaluate the effect of the multispecies probiotic Omnibiotic10AAD® on the intestinal and inguinal skin colonization of patients by multidrug-resistant Gram-negative bacteria in LTCFs. Patients colonized by multidrug-resistant Gram-negative bacteria received a 12 week oral course of Omnibiotic10AAD®. Inguinal swabs and stool samples were collected during and after treatment for microbiological and microbiome analysis. The median age of patients was 76 years. Twelve patients completed the pilot study. Intestinal colonization was reduced to 42% of patients 8 weeks after the end of treatment, but increased to 66% 24 weeks after the end of probiotic treatment. Colonization of inguinal skin was lowest during probiotic treatment and increased thereafter. Fecal microbiome analysis revealed statistically significant increases of the genus Enterococcus comparing start and end of probiotic treatment. In conclusion, a 12 week course of a multispecies probiotic led to a transient reduction of intestinal colonization 8 weeks after the end of treatment. The findings of our pilot study warrant further research in the area of probiotics and intestinal colonization by multidrug-resistant bacteria.
Collapse
Affiliation(s)
- Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
- Correspondence:
| | - Monika Scarpatetti
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Gerald Pichler
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Christian Pux
- Geriatric Health Centres of the City of Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria; (M.S.); (G.P.); (C.P.)
| | - Ingeborg Klymiuk
- Core Facility Molecular Biology, Centre for Medical Research, Medical University of Graz, Stiftingtalstraße 24/1, 8010 Graz, Austria; (I.K.); (S.T.)
| | - Slave Trajanoski
- Core Facility Molecular Biology, Centre for Medical Research, Medical University of Graz, Stiftingtalstraße 24/1, 8010 Graz, Austria; (I.K.); (S.T.)
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| |
Collapse
|
10
|
Bassetti M, Peghin M. How to manage KPC infections. Ther Adv Infect Dis 2020; 7:2049936120912049. [PMID: 32489663 PMCID: PMC7238785 DOI: 10.1177/2049936120912049] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
Carbapenemase-producing Enterobacteriaceae represent an increasing global threat worldwide and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas. Risk stratification and rapid diagnostics laboratory workflows are of paramount importance and indication for therapy of KPC-KP infection must be individualized according to the baseline characteristics of the patient and severity of infection. The optimal treatment of infection because of KPC-KP organisms is uncertain and antibiotic options are limited. The knowledge of the patient's pathophysiology, infection site, and application of the pharmacokinetic/pharmacodynamic principles on the basis of minimum inhibitory concentration (MIC) has progressively gained major relevance. Combination therapies including high-dose meropenem, colistin, fosfomycin, tigecycline, and aminoglycosides are widely used, with suboptimal results. In the past few years, new antimicrobials targeting KPC-KP have been developed and are now at various stages of clinical research. However, their optimal use should be guaranteed in the long term for delaying, as much as possible, the emergence of resistance. Strict infection control measures remain necessary. The aim of this review is to discuss the challenges in the management and treatment of patients with infections because KPC-KP and provide an expert opinion.
Collapse
Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Piazzale S. Maria della Misericordia, n. 15, Udine, 33100, Italy
| | - Maddalena Peghin
- Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria, Integrata di Udine, Udine, Italy
| |
Collapse
|
11
|
Hurley JC. Structural equation modeling the "control of gut overgrowth" in the prevention of ICU-acquired Gram-negative infection. Crit Care 2020; 24:189. [PMID: 32366267 PMCID: PMC7199305 DOI: 10.1186/s13054-020-02906-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptually, the "control of gut overgrowth" (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the other SDD components, enteral and protocolized parenteral antibiotic prophylaxis, versus other methods of infection prevention and versus other contextual exposures cannot be resolved within individual studies. METHODS Seven candidate generalized structural equation models founded on COGO concepts were confronted with Pseudomonas and Acinetobacter bacteremia as well as ventilator-associated pneumonia data derived from > 200 infection prevention studies. The following group-level exposures were included in the models: use and mode of antibiotic prophylaxis, anti-septic and non-decontamination methods of infection prevention; proportion receiving mechanical ventilation; trauma ICU; mean length of ICU stay; and concurrency versus non-concurrency of topical antibiotic prophylaxis study control groups. RESULTS In modeling Pseudomonas and Acinetobacter gut overgrowth as latent variables, anti-septic interventions had the strongest negative effect against Pseudomonas gut overgrowth but no intervention was significantly negative against Acinetobacter gut overgrowth. Strikingly, protocolized parenteral antibiotic prophylaxis and concurrency each have positive effects in the model, enteral antibiotic prophylaxis is neutral, and Acinetobacter bacteremia incidences are high within topical antibiotic prophylaxis studies, moreso with protocolized parenteral antibiotic prophylaxis exposure. Paradoxically, topical antibiotic prophylaxis (moreso with protocolized parenteral antibiotic prophylaxis) appears to provide the strongest summary prevention effects against overall bacteremia and overall VAP. CONCLUSIONS Structural equation modeling of published Gram-negative bacillus infection data enables a test of the COGO concept. Paradoxically, Acinetobacter and Pseudomonas bacteremia incidences are unusually high among studies of topical antibiotic prophylaxis.
Collapse
Affiliation(s)
- James C Hurley
- Melbourne Medical School, University of Melbourne, Melbourne, Australia.
- Internal Medicine Service, Ballarat Health Services, PO Box 577, Ballarat, Victoria, 3353, Australia.
| |
Collapse
|
12
|
Dietl B, Martínez LM, Calbo E, Garau J. Update on the role of ceftazidime-avibactam in the management of carbapenemase-producing Enterobacterales. Future Microbiol 2020; 15:473-484. [DOI: 10.2217/fmb-2020-0012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Ceftazidime-avibactam is a novel combination of a known cephalosporin and a non-β-lactam/β-lactamase inhibitor that has been approved for the treatment of complicated intra-abdominal and urinary tract infections, hospital-acquired pneumonia as well as Gram-negative infections with limited treatment options in Europe. Since its approval, it has been used in patients with infections due to carbapenem-resistant bacteria, in many occasions as off-label indication or salvage therapy, with promising clinical and microbiological cure rates. Emergence of resistance during therapy to this new combination has already been described, which is a matter of concern. A rational use of these new therapeutic options is critical in the multidrug resistance era. The current review focuses on the clinical experience in real life of ceftazidime-avibactam use in the treatment of carbapenemase-producing Enterobacterales.
Collapse
Affiliation(s)
- Beatriz Dietl
- Infectious Diseases Unit. Internal Medicine Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Laura M Martínez
- Pharmacy Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Esther Calbo
- Infectious Diseases Unit. Internal Medicine Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
- Department of Medicine, Faculty of Medicine & Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Javier Garau
- Head of Internal Medicine Department, Clinica Rotger, Palma de Mallorca Spain
| |
Collapse
|
13
|
Dan M, Parizade M. Chronic high-level multidrug-resistant Campylobacter coli enterocolitis in an agammaglobulinemia patient: Oral gentamicin efficacy. Med Mal Infect 2020; 50:525-527. [PMID: 32353415 DOI: 10.1016/j.medmal.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/10/2019] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Campylobacter is the most common cause of infectious diarrhea in agammaglobulinemia patients. These infections can be severe, prolonged, and recurrent in such patients. PATIENT AND METHODS We report a 29-year-old male patient with X-linked agammaglobulinemia with Campylobacter coli enterocolitis that persisted for nine months despite multiple 10- to 14-day courses of oral ciprofloxacin and azithromycin. RESULTS The isolate was highly resistant to ciprofloxacin, erythromycin, tetracycline, and fosfomycin. The patient failed to respond to intravenous ertapenem, 1.0g/day for two weeks, to which the pathogen was susceptible. He was finally cured with oral gentamicin, 80mg four times daily, and stool cultures remained negative during the seven-month follow-up. CONCLUSION Oral aminoglycoside might be the most appropriate choice for eradication of persistent Campylobacter in the intestinal tract for macrolide- and fluoroquinolone-resistant isolate in agammaglobulinemia patients with chronic diarrhea or relapsing systemic infections.
Collapse
Affiliation(s)
- M Dan
- Infectious Disease Clinic, Maccabi Health Services, Bat Yam, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - M Parizade
- Maccabi Health Services, Bacteriology Unit, National Laboratory, Rehovot, Israel
| |
Collapse
|
14
|
Wang C, Schaefer L, Bian F, Yu Z, Pflugfelder SC, Britton RA, de Paiva CS. Dysbiosis Modulates Ocular Surface Inflammatory Response to Liposaccharide. Invest Ophthalmol Vis Sci 2020; 60:4224-4233. [PMID: 31618426 PMCID: PMC6795342 DOI: 10.1167/iovs.19-27939] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The purpose of this study was to investigate the inflammatory response of cornea and conjunctiva to topically applied lipopolysaccharide (LPS) in mice with and without antibiotic (antibiotic cocktail, ABX) induced dysbiosis. Methods Dysbiosis was induced by oral antibiotics for 14 days in a group of conventional female C57BL/6J (B6) mice. 16S rRNA sequencing investigated microbiome composition. Intestinal microbiome differences were assessed using 16S rRNA sequencing of fecal pellet DNA. Blood was collected after euthanasia. CD86 expression in draining nodes was examined by flow cytometry. At day 15, a single dose of LPS or vehicle was topically applied to ABX and naïve mice. Corneal epithelium and conjunctiva were obtained after 4 hours and processed for gene expression analysis. A separate group of germ-free (GF) B6 mice was also topically challenged with LPS. Results Antibiotic treatment significantly decreased intestinal diversity and increased serum levels of LPS. This was accompanied by a significant increase in CD86+MHC II+CD11c+CD11b+ cells in draining nodes. Compared to vehicle, topically applied LPS increased IL-1β, TNF-α, and CXCL10 mRNA transcripts in cornea and IL-1β, TNF-α, and CXCL10 in the conjunctiva in conventional and antibiotic-treated groups. However, there was higher TNF-α, CXCL10, and IL-12 expression in the cornea of LPS-treated ABX mice compared to LPS-treated mice with intact microbiota. LPS stimulation on GF conjunctiva mirrored the results in ABX mice, although greater IL-12 and IFN-γ expression was observed in GF conjunctiva compared to conventional LPS-treated mice. Conclusions Acute depletion of commensals through antibiotics or germ-free environment worsens the inflammatory response to LPS.
Collapse
Affiliation(s)
- Changjun Wang
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China.,Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
| | - Laura Schaefer
- Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States
| | - Fang Bian
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
| | - Zhiyuan Yu
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
| | - Stephen C Pflugfelder
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
| | - Robert A Britton
- Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, United States
| | - Cintia S de Paiva
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
| |
Collapse
|
15
|
Ljungquist O, Kampmann C, Resman F, Riesbeck K, Tham J. Probiotics for intestinal decolonization of ESBL-producing Enterobacteriaceae: a randomized, placebo-controlled clinical trial. Clin Microbiol Infect 2019; 26:456-462. [PMID: 31494254 DOI: 10.1016/j.cmi.2019.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Infections with extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE) are a major healthcare concern. Our goal was to investigate whether a probiotic mixture could be used for eradication therapy in patients with prolonged intestinal EPE carriage. METHODS We performed a randomized, placebo-controlled, single-blinded clinical superiority trial in the south of Sweden between February 2017 and April 2019. Probiotic Vivomixx®, a mixture of 8 different living bacterial strains or placebo was given to adult outpatients intestinally colonized for at least 3 months with EPE. Patients with suspected active infections at the time of evaluation were excluded, and also those with immunosuppression, severe psychiatric disorder, drug abuse or dementia. Each patient in the probiotic arm was administered 2 sachets (9.0 × 1011 live bacteria) twice daily for 2 months. The primary outcome was intestinal EPE eradication at the end of the 1-year follow-up, as shown by 3 consecutive negative EPE rectal swabs during the follow-up year. The per protocol follow-up for all patients was 1, 3, 6 and 12 months after the initiation of the intervention. ClinicalTrials.gov Identifier: NCT03860415. RESULTS In total, the target size of 80 patients were included. The median age was 68 years in both groups. The number of females in the probiotics group was 23 (58%) and in the placebo group 28 (70%). At the end of the trial, 12.5% (5 out of 40) of the patients in the probiotic group had achieved successful eradication of EPE, as defined by the primary outcome, in the intention to treat analysis. In the placebo group, 5% (2 out of 40) of the patients had achieved successful eradication of EPE (odds ratio 2.71; 95% confidence interval (CI), 0.49-14.9; p 0.24). CONCLUSIONS Successful EPE eradication was observed in very few individuals. This trial did not support Vivomixx® as being superior to placebo for intestinal decolonization in adult patients with chronic colonization of EPE, but was limited in power.
Collapse
Affiliation(s)
- O Ljungquist
- Clinical Microbiology and Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Infectious Disease, Helsingborg's Hospital, Helsingborg, Region Skåne, Sweden.
| | - C Kampmann
- Department of Medical Sciences, Clinical Microbiology, Uppsala University, Sweden; Department of Infectious Disease, SUS Lund, Region Skåne, Sweden
| | - F Resman
- Clinical Microbiology and Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - K Riesbeck
- Clinical Microbiology and Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - J Tham
- Clinical Microbiology and Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
16
|
Battipaglia G, Malard F, Rubio MT, Ruggeri A, Mamez AC, Brissot E, Giannotti F, Dulery R, Joly AC, Baylatry MT, Kossmann MJ, Tankovic J, Beaugerie L, Sokol H, Mohty M. Fecal microbiota transplantation before or after allogeneic hematopoietic transplantation in patients with hematologic malignancies carrying multidrug-resistance bacteria. Haematologica 2019; 104:1682-1688. [PMID: 30733264 PMCID: PMC6669143 DOI: 10.3324/haematol.2018.198549] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/31/2019] [Indexed: 01/03/2023] Open
Abstract
Fecal microbiota transplantation is an effective treatment in recurrent Clostridium difficile infection. Promising results to eradicate multidrug-resistant bacteria have also been reported with this procedure, but there are safety concerns in immunocompromised patients. We report results in ten adult patients colonized with multidrug-resistant bacteria, undergoing fecal microbiota transplantation before (n=4) or after (n=6) allogeneic hematopoietic stem cell transplantation for hematologic malignancies. were obtained from healthy related or unrelated donors. Fecal material was delivered either by enema or via nasogastric tube. Patients were colonized or had infections from either carbapenemase-producing bacteria (n=8) or vancomycin-resistant enterococci (n=2). Median age at fecal microbiota transplantation was 48 (range, 16-64) years. Three patients needed a second transplant from the same donor due to initial failure of the procedure. With a median follow up of 13 (range, 4-40) months, decolonization was achieved in seven of ten patients. In all patients, fecal micro-biota transplantation was safe: one patient presented with constipation during the first five days after FMT and two patients had grade I diarrhea. One case of gut grade III acute graft-versus-host disease occurred after fecal microbiota transplantation. In patients carrying or infected by multidrug-resistant bacteria, fecal microbiota transplantation is an effective and safe decolonization strategy, even in those with hematologic malignancies undergoing hematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Giorgia Battipaglia
- Department of Hematology, Saint Antoine Hospital, Paris, France
- Federico II University, Hematology Department, Naples, Italy
| | - Florent Malard
- Department of Hematology, Saint Antoine Hospital, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Marie Therèse Rubio
- Department of Hematology, Saint Antoine Hospital, Paris, France
- Service d'Hématologie, Hôpital Brabois, CHRU Nancy, France
- CMRS UMR 7563, IMoPa, Biopole de l'Université de Lorraine, France
| | | | | | - Eolia Brissot
- Department of Hematology, Saint Antoine Hospital, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | | | - Remy Dulery
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | - Anne Christine Joly
- Microbiote Transplant Préparations Unit, Pharmacy Department, Saint Antoine Hospital, Paris, France
| | - Minh Tam Baylatry
- Microbiote Transplant Préparations Unit, Pharmacy Department, Saint Antoine Hospital, Paris, France
| | - Marie Jeanne Kossmann
- Unité d'Hygiène et de Lutte Contre les Infections Nosocomiales, Saint Antoine Hospital, Paris, France
| | - Jacques Tankovic
- Department of Bacteriology, Saint Antoine Hospital, Paris, France
| | - Laurent Beaugerie
- Microbiote Transplant Préparations Unit, Pharmacy Department, Saint Antoine Hospital, Paris, France
- Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France
| | - Harry Sokol
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
- Department of Gastroenterology, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, École Normale Supérieure, PSL Research University, CNRS, INSERM, AP-HP, Hôpital Saint-Antoine, Laboratoire de Biomolécules, LBM, F-75005 Paris, France
- INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France
| | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| |
Collapse
|
17
|
Pouch SM, Patel G. Multidrug-resistant Gram-negative bacterial infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13594. [PMID: 31102483 DOI: 10.1111/ctr.13594] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 12/11/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period. MDR Gram-negative bacilli, including carbapenem-resistant Enterobacteriaceae, MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii, remain a threat to successful organ transplantation. Clinicians now have access to at least five novel agents with activity against some of these organisms, with others in the advanced stages of clinical development. No agent, however, provides universal and predictable activity against any of these pathogens, and very little is available to treat infections with MDR nonfermenting Gram-negative bacilli including A baumannii. Despite advances, empiric antibiotics should be tailored to local microbiology and targeted regimens should be tailored to susceptibilities. Source control remains an important part of the therapeutic armamentarium. Morbidity and mortality associated with infections due to MDR Gram-negative organisms remain unacceptably high. Heightened infection control and antimicrobial stewardship initiatives are needed to prevent these infections, curtail their transmission, and limit the evolution of MDR Gram-negative pathogens, especially in the setting of organ transplantation.
Collapse
Affiliation(s)
| | - Gopi Patel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
18
|
Giacobbe DR, Corcione S, Salsano A, Del Puente F, Mornese Pinna S, De Rosa FG, Mikulska M, Santini F, Viscoli C. Current and emerging pharmacotherapy for the treatment of infections following open-heart surgery. Expert Opin Pharmacother 2019; 20:751-772. [PMID: 30785333 DOI: 10.1080/14656566.2019.1574753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Patients undergoing open-heart surgery may suffer from postoperative complications, including severe infections. Antimicrobials to treat infectious complications in this population should be selected thoughtfully, taking into account three different and fundamental issues: (i) the site of infection; (ii) the suspected or proven causative agent and its susceptibility pattern; and (iii) the risk of suboptimal pharmacokinetic characteristics and potential toxicity of the chosen drug/s. AREAS COVERED The present narrative review summarizes the current and future antimicrobial options for the treatment of infections developing after open-heart surgery. EXPERT OPINION The pharmacological treatment of infections developing in cardiac surgery patients poses peculiar challenges, including the need for an active empirical therapy for severe events such as bloodstream infections, deep sternal wound infections, or early-onset postoperative prosthetic endocarditis. In addition, the risk for multidrug-resistant pathogens should also be taken into account in endemic areas. A multidisciplinary evaluation on a patient-by-patient basis, deeply involving infectious diseases specialists and cardiothoracic surgeons, remains essential for appropriately balancing both short-term and long-term risks and benefits of any possible surgical reintervention in combination with adequate pharmacotherapy.
Collapse
Affiliation(s)
| | - Silvia Corcione
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | - Antonio Salsano
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Filippo Del Puente
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy
| | - Simone Mornese Pinna
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | | | - Malgorzata Mikulska
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Francesco Santini
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Claudio Viscoli
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| |
Collapse
|
19
|
Tacconelli E, Mazzaferri F, de Smet AM, Bragantini D, Eggimann P, Huttner BD, Kuijper EJ, Lucet JC, Mutters NT, Sanguinetti M, Schwaber MJ, Souli M, Torre-Cisneros J, Price JR, Rodríguez-Baño J. ESCMID-EUCIC clinical guidelines on decolonization of multidrug-resistant Gram-negative bacteria carriers. Clin Microbiol Infect 2019; 25:807-817. [PMID: 30708122 DOI: 10.1016/j.cmi.2019.01.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/08/2019] [Accepted: 01/12/2019] [Indexed: 12/16/2022]
Abstract
SCOPE The aim of these guidelines is to provide recommendations for decolonizing regimens targeting multidrug-resistant Gram-negative bacteria (MDR-GNB) carriers in all settings. METHODS These evidence-based guidelines were produced after a systematic review of published studies on decolonization interventions targeting the following MDR-GNB: third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE), carbapenem-resistant Enterobacteriaceae (CRE), aminoglycoside-resistant Enterobacteriaceae (AGRE), fluoroquinolone-resistant Enterobacteriaceae (FQRE), extremely drug-resistant Pseudomonas aeruginosa (XDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), cotrimoxazole-resistant Stenotrophomonas maltophilia (CRSM), colistin-resistant Gram-negative organisms (CoRGNB), and pan-drug-resistant Gram-negative organisms (PDRGNB). The recommendations are grouped by MDR-GNB species. Faecal microbiota transplantation has been discussed separately. Four types of outcomes were evaluated for each target MDR-GNB:(a) microbiological outcomes (carriage and eradication rates) at treatment end and at specific post-treatment time-points; (b) clinical outcomes (attributable and all-cause mortality and infection incidence) at the same time-points and length of hospital stay; (c) epidemiological outcomes (acquisition incidence, transmission and outbreaks); and (d) adverse events of decolonization (including resistance development). The level of evidence for and strength of each recommendation were defined according to the GRADE approach. Consensus of a multidisciplinary expert panel was reached through a nominal-group technique for the final list of recommendations. RECOMMENDATIONS The panel does not recommend routine decolonization of 3GCephRE and CRE carriers. Evidence is currently insufficient to provide recommendations for or against any intervention in patients colonized with AGRE, CoRGNB, CRAB, CRSM, FQRE, PDRGNB and XDRPA. On the basis of the limited evidence of increased risk of CRE infections in immunocompromised carriers, the panel suggests designing high-quality prospective clinical studies to assess the risk of CRE infections in immunocompromised patients. These trials should include monitoring of development of resistance to decolonizing agents during treatment using stool cultures and antimicrobial susceptibility results according to the EUCAST clinical breakpoints.
Collapse
Affiliation(s)
- E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Germany; Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
| | - F Mazzaferri
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - A M de Smet
- University of Groningen, University Medical Centre Groningen, Department of Critical Care, Groningen, the Netherlands
| | - D Bragantini
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - P Eggimann
- Adult Critical Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B D Huttner
- Division of Infectious Diseases and Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - E J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J-C Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France; IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - N T Mutters
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Institute for Infection Prevention and Hospital Epidemiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Microbiologia, Rome, Italy
| | - M J Schwaber
- National Centre for Infection Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - M Souli
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Torre-Cisneros
- Infectious Diseases Service, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), Department of Medicine, University of Córdoba, Córdoba, Spain
| | - J R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - J Rodríguez-Baño
- Division of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena / Department of Medicine, University of Seville / Biomedicine Institute of Seville (IBiS), Seville, Spain
| |
Collapse
|
20
|
Bassetti M, Carannante N, Pallotto C, Righi E, Di Caprio G, Bernardo M, Sodano G, Mallardo E, Francisci D, Sartor A, Graziano E, Tascini C. KPC-producing Klebsiella pneumoniae gut decolonisation following ceftazidime/avibactam-based combination therapy: A retrospective observational study. J Glob Antimicrob Resist 2018; 17:109-111. [PMID: 30468915 DOI: 10.1016/j.jgar.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES KPC-producing Klebsiella pneumoniae (KPC-Kp) gut colonisation is a major risk factor for developing systemic infection. Ceftazidime/avibactam (CAZ/AVI) may have a role as decolonisation therapy in special situations. METHODS This was a retrospective, observational, multicentre study. The KPC-Kp gut decolonisation rate of CAZ/AVI-based therapy (Group A) was compared with other antimicrobial regimens (Group B) in patients with KPC-Kp infection. RESULTS Among 12 patients in Group A, 11 (91.7%) achieved gut decolonisation. None of the 24 patients of Group B were decolonised. CONCLUSION CAZ/AVI-based therapy could be useful in KPC-Kp gut decolonisation in high-risk patients.
Collapse
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy
| | - Carlo Pallotto
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy; Infectious Diseases Section, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy.
| | - Elda Righi
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Giovanni Di Caprio
- Infectious Diseases Section, Department of Mental Health and Public Medicine, University of Campania 'Luigi Vanvitelli', largo Madonna delle Grazie, Naples, Italy
| | - Mariano Bernardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Giuseppe Sodano
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Enza Mallardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Daniela Francisci
- Infectious Diseases Section, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy
| | - Assunta Sartor
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy
| |
Collapse
|
21
|
Bassetti M, Righi E, Carnelutti A, Graziano E, Russo A. Multidrug-resistantKlebsiella pneumoniae: challenges for treatment, prevention and infection control. Expert Rev Anti Infect Ther 2018; 16:749-761. [DOI: 10.1080/14787210.2018.1522249] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elda Righi
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessia Carnelutti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elena Graziano
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Russo
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| |
Collapse
|
22
|
Davido B, Moussiegt A, Dinh A, Bouchand F, Matt M, Senard O, Deconinck L, Espinasse F, Lawrence C, Fortineau N, Saleh-Mghir A, Caballero S, Escaut L, Salomon J. Germs of thrones - spontaneous decolonization of Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) in Western Europe: is this myth or reality? Antimicrob Resist Infect Control 2018; 7:100. [PMID: 30123500 PMCID: PMC6090624 DOI: 10.1186/s13756-018-0390-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
Background In France, Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) are considered as Extensively Drug-Resistant (XDR) bacteria. Their management requires reinforcement of hospital’s hygiene policies, and currently there is few consistent data concerning the spontaneous decolonization in XDR colonized patients. Our aim is to study the natural history of decolonization of XDR carriers over time in a hospital setting in a low prevalence country. Material and methods Retrospective multicenter study over 2 years (2015–2016) in 2 different tertiary care hospital sites and units having an agreement for permanent cohorting of such XDR carriers. We gathered the type of microorganisms, risk factors for colonization and rectal swabs from patient’s follow-up. We also evaluated patient care considering isolation precautions. Results We included 125 patients, aged 63+/−19y, including 72.8% of CRE (n = 91), 24.8% of VRE (n = 31) and 2.4% (n = 3) co-colonized with CRE and VRE. CRE were mainly E. coli (n = 54), K. pneumoniae (n = 51) and E. cloacae (n = 6). Mechanisms of resistance were mainly OXA-48 (n = 69), NDM-1 (n = 11), OXA-232 (n = 8) and KPC (n = 3). Prior antibiotic therapy was reported in 38.4% (n = 48) of cases. Conversely, 17.6% (n = 22) received antibiotics during follow-up. Spontaneous decolonization occurred within the first 30 days in 16.4% (n = 19/116) of cases and up to 48.2% after day-90 with a median follow-up of 96 days (0–974). We estimated that XDR carriage was associated with a larger care burden in 13.6% (n = 17) of cases, especially due to a prolongation of hospitalization of 32.5 days (15–300). Conclusions Our study shows that spontaneous decolonization is increasing over time (up to 48.2%). We can regret that only few patients underwent screening after 1 year, emphasizing the need for more monitoring and prospective studies.
Collapse
Affiliation(s)
- Benjamin Davido
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Aurore Moussiegt
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Aurélien Dinh
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Frédérique Bouchand
- 2Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Morgan Matt
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Olivia Senard
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Laurene Deconinck
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Florence Espinasse
- 3Hygiène Hospitalière, Hôpital Universitaire Ambroise-Paré, AP-HP, 92210 Boulogne-Billancourt, France
| | - Christine Lawrence
- 4Hygiène Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - Nicolas Fortineau
- 5Laboratoire de Microbiologie, Hôpital Universitaire Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Azzam Saleh-Mghir
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| | | | - Lelia Escaut
- 7Maladies Infectieuses, Hôpital Universitaire Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Jérome Salomon
- 1Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380 Garches, France
| |
Collapse
|
23
|
Timsit JF, Bassetti M. Antipathy against SDD is justified: Yes. Intensive Care Med 2018; 44:1165-1168. [PMID: 29881989 DOI: 10.1007/s00134-018-5183-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jean-François Timsit
- UMR 1137, IAME Team 5, DeSCID: Decision Sciences in Infectious Diseases, Control and Care INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,APHP Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, Paris, France.
| | - Matteo Bassetti
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericorida, Udine, Italy.,University of Udine School of Medicine, Udine, Italy
| |
Collapse
|
24
|
Sánchez-Ramírez C, Hípola-Escalada S, Cabrera-Santana M, Hernández-Viera MA, Caipe-Balcázar L, Saavedra P, Artiles-Campelo F, Sangil-Monroy N, Lübbe-Vázquez CF, Ruiz-Santana S. Long-term use of selective digestive decontamination in an ICU highly endemic for bacterial resistance. Crit Care 2018; 22:141. [PMID: 29843808 PMCID: PMC5975678 DOI: 10.1186/s13054-018-2057-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We examined whether long-term use of selective digestive tract decontamination (SDD) was effective in reducing intensive care unit (ICU)-acquired infection and antibiotic consumption while decreasing colistin-, tobramycin-, and most of the antibiotic-resistant colonization rates in a mixed ICU with a high endemic level of multidrug-resistant bacteria (MDRB). METHODS In this cohort study, which was conducted in a 30-bed medical-surgical ICU, clinical outcomes before (1 year, non-SDD group) and after (4 years) implementation of SDD were compared. ICU patients who were expected to require tracheal intubation for > 48 hours were given a standard prophylactic SDD regimen. Oropharyngeal and rectal swabs were obtained on admission and once weekly thereafter. RESULTS ICU-acquired infections occurred in 110 patients in the non-SDD group and in 258 in the SDD group. A significant (P < 0.001) reduction of infections caused by MDRB (risk ratio [RR], 0.31; 95% CI, 0.23-0.41) was found after SDD and was associated with low rates of colistin- and tobramycin-resistant colonization. Colistin- and tobramycin-acquired increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at admission, was nonsignificant (0.82; 95% CI, 0.56 to 1.95; 1.13; 95% CI, 0.75 to 1.70, respectively). SDD was also a protective factor for ICU-acquired infections caused by MDR gram-negative pathogens and Acinetobacter baumannii in the multivariate analysis. In addition, a significant (P < 0.001) reduction of ventilator-associated pneumonia (VAP) (RR, 0.43; 95% CI, 0.32-0.59) and secondary bloodstream infection (BSI) (RR, 0.35; 95% CI, 0.24-0.52) was found. A decrease in antibiotic consumption was also observed. CONCLUSIONS Treatment with SDD during 4 years was effective in an ICU setting with a high level of resistance, with clinically relevant reductions of infections caused by MDRB, and with low rates of colistin- and tobramycin-resistant colonization with nonsignificant increasing rate of ICU colonization resistance by 1000 days, adjusted by the rate of resistances at ICU admission. In addition, VAP and secondary BSI rates were significantly lower after SDD. Notably, a decrease in antimicrobial consumption was also observed.
Collapse
Affiliation(s)
- Catalina Sánchez-Ramírez
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - Silvia Hípola-Escalada
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - Miriam Cabrera-Santana
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - María Adela Hernández-Viera
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - Liliana Caipe-Balcázar
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - Pedro Saavedra
- Mathematics Department, Universidad de las Palmas de Gran Canaria, Las Palmas, Spain
| | - Fernando Artiles-Campelo
- Microbiology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Nayra Sangil-Monroy
- Pharmacy Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Carlos Federico Lübbe-Vázquez
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| | - Sergio Ruiz-Santana
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, La Ballena s/n, E-35010 Las Palmas, Spain
| |
Collapse
|
25
|
Carannante N, Pallotto C, Bernardo M, Di Caprio G, Tascini C. Treatment of a Klebsiella pneumoniae KPC cellulitis and gut decolonization with ceftazidime/avibactam in a migrant from Libya. J Chemother 2018; 30:183-184. [DOI: 10.1080/1120009x.2018.1424504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Novella Carannante
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Carlo Pallotto
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
- Infectious Diseases Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Mariano Bernardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Giovanni Di Caprio
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Carlo Tascini
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| |
Collapse
|
26
|
Bassetti M, Giacobbe DR, Giamarellou H, Viscoli C, Daikos GL, Dimopoulos G, De Rosa FG, Giamarellos-Bourboulis EJ, Rossolini GM, Righi E, Karaiskos I, Tumbarello M, Nicolau DP, Viale PL, Poulakou G. Management of KPC-producing Klebsiella pneumoniae infections. Clin Microbiol Infect 2017; 24:133-144. [PMID: 28893689 DOI: 10.1016/j.cmi.2017.08.030] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas. AIMS To provide practical suggestion for physicians dealing with the management of KPC-KP infections in critically ill patients, based on expert opinions. SOURCES PubMed search for relevant publications related to the management of KPC-KP infections. CONTENTS A panel of experts developed a list of 12 questions to be addressed. In view of the current lack of high-level evidence, they were asked to provide answers on the bases of their knowledge and experience in the field. The panel identified several key aspects to be addressed when dealing with KPC-KP in critically ill patients (preventing colonization in the patient, preventing infection in the colonized patient and colonization of his or her contacts, reducing mortality in the infected patient by rapidly diagnosing the causative agent and promptly adopting the best therapeutic strategy) and provided related suggestions that were based on the available observational literature and the experience of panel members. IMPLICATIONS Diagnostic technologies could speed up the diagnosis of KPC-KP infections. Combination treatment should be preferred to monotherapy in cases of severe infections. For non-critically ill patients without severe infections, results from randomized clinical trials are needed for ultimately weighing benefits and costs of using combinations rather than monotherapy. Multifaceted infection control interventions are needed to decrease the rates of colonization and cross-transmission of KPC-KP.
Collapse
Affiliation(s)
- M Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
| | - D R Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - H Giamarellou
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - C Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - G L Daikos
- 1st Department of Propaedeutic Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - F G De Rosa
- Department of Medical Science, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Turin, Italy
| | - E J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - I Karaiskos
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - M Tumbarello
- Institute of Infectious Diseases Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D P Nicolau
- Center for Anti-infective Research and Development, Hartford, CT, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - P L Viale
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Poulakou
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | | | | |
Collapse
|
27
|
Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2017; 32:36-57. [PMID: 28811074 DOI: 10.1016/j.trre.2017.07.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/17/2022]
Abstract
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.
Collapse
|
28
|
Pouch SM, Satlin MJ. Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies. Virulence 2017; 8:391-402. [PMID: 27470662 PMCID: PMC5477691 DOI: 10.1080/21505594.2016.1213472] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 07/09/2016] [Indexed: 01/28/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.
Collapse
Affiliation(s)
- Stephanie M. Pouch
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | |
Collapse
|
29
|
Micozzi A, Gentile G, Minotti C, Cartoni C, Capria S, Ballarò D, Santilli S, Pacetti E, Grammatico S, Bucaneve G, Foà R. Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias. BMC Infect Dis 2017; 17:203. [PMID: 28283020 PMCID: PMC5345173 DOI: 10.1186/s12879-017-2297-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CRKP) spread and infections in patients with haematological malignancies are a serious concern especially in endemic areas. Treatment failures and delay in appropriate therapy for CRKP infections are frequent and the mortality rate associated with CRKP bacteremia in neutropenic haematological patients is reported about 60%. METHODS Haematological patients harboring CRKP hospitalized between February 2012 and May 2013 in an Italian Teaching hospital were examined. Conditions favouring CRKP spread in a haematological unit, risk factors for bacteremia in CRKP-carriers and for CRKP bacteremia-related death were evaluated in this observational retrospective study. RESULTS CRKP was isolated in 22 patients, 14 (64%) had bacteremia. Control measures implementation, particularly the weekly rectal screening for CRKP performed in all hospitalized patients and contact precautions for CRKP-carriers and newly admitted patients until proved CRKP-negative, reduced significantly the CRKP spread (14 new carriers identified of 131 screened patients vs 5 of 242 after the intervention, p = 0.001). Fifty-eight percent of carriers developed CRKP bacteremia, and acute myeloid leukemia (AML) resulted independently associated with the bacteremia occurrence (p = 0.02). CRKP bacteremias developed mainly during neutropenia (86%) and in CRKP-carriers (79%). CRKP bacteremias were breakthrough in 10 cases (71%). Ten of 14 patient with CRKP bacteremias died (71%) and all had AML. The 70% of fatal bacteremias occurred in patients not yet recognized as CRKP-carriers and 80% were breakthrough. Initial adequate antibiotic therapy resulted the only independent factor able to protect against death (p = 0.02). CONCLUSIONS The identification of CRKP-carriers is confirmed critical to prevent CRKP spread. AML patients colonized by CRKP resulted at high risk of CRKP-bacteremia and poor outcome and the adequacy of the initial antibiotic therapy may be effective to improve survival. To limit the increase of resistance, the extensive use of antibiotics active against CRKP should be avoided, but in the setting of high CRKP pressure and high-risk CRKP-colonized haematological patients, timely empiric antibiotic combinations active against CRKP could be suggested as treatment of febrile neutropenia.
Collapse
Affiliation(s)
- Alessandra Micozzi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| | - Giuseppe Gentile
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| | | | | | | | - Daniele Ballarò
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| | | | - Emanuele Pacetti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| | - Sara Grammatico
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| | | | - Robin Foà
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161 Rome, Italy
| |
Collapse
|
30
|
Alp S, Akova M. Antibacterial Resistance in Patients with Hematopoietic Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2017; 9:e2017002. [PMID: 28101308 PMCID: PMC5224809 DOI: 10.4084/mjhid.2017.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Recipients of hematopoietic stem cell transplantation (HSCT) are at substantial risk of bacterial, fungal, viral, and parasitic infections depending on the time elapsed since transplantation, presence of graft-versus-host disease (GVHD), and the degree of immunosuppression. Infectious complications in HSCT recipients are associated with high morbidity and mortality. Bacterial infections constitute the major cause of infectious complications, especially in the early post-transplant period. The emergence of antibacterial resistance complicates the management of bacterial infections in this patient group. Multidrug-resistant bacterial infections in this group of patients have attracted considerable interest and may lead to significant morbidity and mortality. Empirical antibacterial therapy in patients with HSCT and febrile neutropenia has a critical role for survival and should be based on local epidemiology. This review attempts to provide an overview of risk factors and epidemiology of emerging resistant bacterial infections and their management in HSCT recipients.
Collapse
Affiliation(s)
- Sehnaz Alp
- Associate Professor, Hacettepe University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Murat Akova
- Professor, Hacettepe University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| |
Collapse
|
31
|
Salomão MCC, Heluany-Filho MA, Menegueti MG, Kraker MEAD, Martinez R, Bellissimo-Rodrigues F. A randomized clinical trial on the effectiveness of a symbiotic product to decolonize patients harboring multidrug-resistant Gram-negative bacilli. Rev Soc Bras Med Trop 2016; 49:559-566. [PMID: 27812649 DOI: 10.1590/0037-8682-0233-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/09/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION: We aimed to evaluate the effectiveness of a symbiotic product to decolonize the intestinal tract of patients harboring multidrug-resistant (MDR) Gram-negative bacilli and to prevent nosocomial infections. METHODS: This was a randomized, double blind, placebo-controlled clinical trial, conducted in a tertiary-care university hospital. All adult hospitalized patients with a positive clinical culture and a positive rectal swab for any MDR Gram-negative bacilli were potentially eligible. Exclusion criteria were pregnancy, immunosuppression, and bowel obstruction/perforation. The intervention consisted of administering a symbiotic product (Lactobacillus bulgaricus, Lactobacillus rhamnosus, and fructo-oligosaccharides) twice a day for seven days via the oral/enteral route. RESULTS: Between August 1, 2012 and December 22, 2013, 116 of 275 eligible patients were allocated to treatment (n=57) and placebo (n=59). Overall, 101 patients received at least four doses of the study products and were included in the modified intention-to-treat analysis. The primary study outcome, a negative rectal swab for MDR Gram-negative bacilli after treatment, was identified in 16.7% (8/48) and 20.7% (11/53) of patients in the experimental and placebo group, respectively (p=0.60). The secondary outcome, the combined incidence of nosocomial respiratory and urinary tract infections, was 37.5% (18/48) in the experimental group versus 22.6% (12/53) in the control group (adjusted odds ratio: 1.95, 95% confidence interval: 0.69-5.50, p=0.21). Length of stay after the beginning of the intervention, incidence of adverse events, and in-hospital mortality rates were similar in both study groups. CONCLUSIONS: Under the present study conditions, symbiotic administration was not effective for decolonizing hospitalized patients harboring MDR Gram-negative bacilli.
Collapse
Affiliation(s)
- Mariana Correa Coelho Salomão
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Disciplina de Moléstias Infecciosas e Parasitárias, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mário Augusto Heluany-Filho
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mayra Gonçalves Menegueti
- Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Roberto Martinez
- Disciplina de Moléstias Infecciosas e Parasitárias, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Bellissimo-Rodrigues
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.,Disciplina de Moléstias Infecciosas e Parasitárias, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
32
|
Oral decontamination with aminoglycosides is associated with lower risk of mortality and infections in high-risk patients colonized with colistin-resistant, KPC-producing
Klebsiella pneumoniae. J Antimicrob Chemother 2016; 71:3242-3249. [DOI: 10.1093/jac/dkw272] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/17/2016] [Accepted: 06/02/2016] [Indexed: 12/31/2022] Open
|
33
|
Bar-Yoseph H, Hussein K, Braun E, Paul M. Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother 2016; 71:2729-39. [PMID: 27317444 DOI: 10.1093/jac/dkw221] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ESBL-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae (CRE) are rapidly spreading worldwide. Their natural reservoir is intestinal. METHODS We carried out a systematic review and meta-analysis to estimate CRE and ESBL carriage duration and to evaluate the effect of decolonization therapy. We included cohort and comparative studies examining the natural history of CRE/ESBL colonization, examining rates of carriage following decolonization or comparing decolonization and no decolonization conducted in the healthcare setting or in the community. A comprehensive search was conducted until November 2015. We compiled carriage rates at 1, 3, 6 and 12 months with and without decolonization therapy and assessed the effect of decolonization. RESULTS Thirty-seven studies fulfilled inclusion criteria. In healthcare settings, pooled ESBL/CRE colonization rates decreased without intervention from 76.7% (95% CI = 69.3%-82.8%) at 1 month to 35.2% (95% CI = 28.2%-42.9%) at 12 months of follow-up. Following decolonization, the rate was 37.1% (95% CI = 27.5%-47.7%) at end of therapy and 57.9% (95% CI = 43.1%-71.4%) at 1 month. In two randomized trials, carriage was significantly reduced at end of therapy (risk ratio = 0.42, 95% CI = 0.25-0.65), but the effect was not significant after 1 month (risk ratio = 0.72, 95% CI = 0.48-1.05), with no longer follow-up. Heterogeneity was explained by surveillance methodology, with no differences observed between ESBLs and CREs. Among community dwellers, ESBL colonization decreased from 52.3% (95% CI = 29.5%-74.2%) at 1 month to 19.2% (95% CI = 9.7%-34.4%) at 6 months. CONCLUSIONS A significant proportion of ESBL and CRE carriers remain colonized up to 1 year in the healthcare setting. While short-term decolonization therapy reduces carriage during therapy, its longer-term effects are unclear.
Collapse
Affiliation(s)
- Haggai Bar-Yoseph
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khetam Hussein
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Braun
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
34
|
Tatarelli P, Mikulska M. Multidrug-resistant bacteria in hematology patients: emerging threats. Future Microbiol 2016; 11:767-80. [PMID: 27196948 DOI: 10.2217/fmb-2015-0014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Multidrug-resistant (MDR) bacteria, particularly Gram negatives, such as Enterobacteriaceae resistant to third-generation cephalosporins or carbapenems and MDR Pseudomonas aeruginosa, are increasingly frequent in hematology patients. The prevalence of different resistant species varies significantly between centers. Thus, the knowledge of local epidemiology is mandatory for deciding the most appr-opriate management protocols. In the era of increasing antibiotic resistance, empirical therapy of febrile neutropenia should be individualized. A de-escalation approach is recommended in case of severe clinical presentation in patients who are at high risk for infection with a resistant strain. Targeted therapy of an MDR Gram negative usually calls for a combination treatment, although no large randomized trials exist in this setting. Infection control measures are the cornerstone of limiting the spread of MDR pathogens in hematology units.
Collapse
Affiliation(s)
- Paola Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy
| |
Collapse
|
35
|
Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 2016; 7:280-97. [PMID: 27002635 PMCID: PMC4871679 DOI: 10.1080/21505594.2016.1156821] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel de-escalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.
Collapse
Affiliation(s)
- Giulia Gustinetti
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
| |
Collapse
|
36
|
Bassetti M, Pecori D, Sibani M, Corcione S, De Rosa FG. Epidemiology and Treatment of MDR Enterobacteriaceae. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0065-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
37
|
Oral administration of gentamicin for prophylaxis of KPC-producing Klebsiella pneumoniae gut colonization in patients treated with a novel parenchymal-sparing liver surgery: the GEN Gut study. Intensive Care Med 2015; 42:124-5. [DOI: 10.1007/s00134-015-4049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
|
38
|
Considerations About Antimicrobial Stewardship in Settings with Epidemic Extended-Spectrum β-Lactamase-Producing or Carbapenem-Resistant Enterobacteriaceae. Infect Dis Ther 2015; 4:65-83. [PMID: 26362292 PMCID: PMC4569644 DOI: 10.1007/s40121-015-0081-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Indexed: 10/26/2022] Open
Abstract
Infections caused by gram-negative bacteria (GNB) resistant to multiple classes of antibiotics are increasing in many hospitals. Extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae in particular are now endemic in many parts of the world and represent a serious public health threat. In this era, antimicrobial stewardship programs are essential as targeted and responsible use of antibiotics improves patient outcomes and hopefully limits the selective pressure that drives the further emergence of resistance. However, some stewardship strategies aimed at promoting carbapenem-sparing regimens remain controversial and are difficult to implement when resistance rates to non-carbapenem antibiotics are increasing. Coordinated efforts between stewardship programs and infection control are essential for reversing conditions that favor the emergence and dissemination of multidrug-resistant GNB within the hospital and identifying extra-institutional "feeder reservoirs" of resistant strains such as long-term care facilities, where colonization is common despite limited numbers of serious infections. In settings where ESBL resistance is endemic, the cost-effectiveness of expanded infection control efforts and antimicrobial stewardship is still unknown. Once a patient has been colonized, selective oral or digestive decontamination may be considered, but evidence supporting its effectiveness is limited in patients who are already colonized or in centers with high rates of resistance. Moreover, temporary success at decolonization may be associated with a higher risk of relapse with strains that are resistant to the decolonizing antibiotics.
Collapse
|
39
|
Bacterial infections in hematopoietic stem cell transplantation recipients. Curr Opin Hematol 2015; 21:451-8. [PMID: 25295742 DOI: 10.1097/moh.0000000000000088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Bacterial infections are among the most frequent complications of hematopoietic stem cell transplant (HSCT). This review describes current epidemiology and management of bacterial infections. RECENT FINDINGS Multidrug resistant (MDR) bacteria are increasingly frequent in HSCT recipients, but significant differences in etiology of bacterial infections and prevalence of resistant strains exist between different transplant centers. Methicillin-resistant coagulase-negative staphylococci, extended-spectrum beta-lactamase-producing Enterobacteriaceae, vancomycin-resistant enterococci and MDR Pseudomonas aeruginosa are the most relevant examples. Infection control measures are mandatory to limit the spread of resistant strains. Selective digestive decontamination is controversial and potentially associated with inducing resistance to antibiotics that might be the last treatment option, such as colistin or aminoglycosides. Empirical therapy should be individualized, and an escalation or de-escalation approach should be chosen depending on local epidemiology, colonization and clinical presentation. Antimicrobial stewardship, with the aim of improving management of bacterial infections, should be put in place in transplant units. SUMMARY Bacterial infections in the transplant population warrant currently particular attention to limit the negative impact of infections caused by resistant strains.
Collapse
|
40
|
Rossolini GM. Extensively drug-resistant carbapenemase-producing Enterobacteriaceae: an emerging challenge for clinicians and healthcare systems. J Intern Med 2015; 277:528-31. [PMID: 25627464 DOI: 10.1111/joim.12350] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G M Rossolini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Experimental and Clinical Medicine, University of Florence and Clinical Microbiology Unit, Florence Careggi University Hospital, Florence, Italy
| |
Collapse
|
41
|
Girmenia C, Viscoli C, Piciocchi A, Cudillo L, Botti S, Errico A, Sarmati L, Ciceri F, Locatelli F, Giannella M, Bassetti M, Tascini C, Lombardini L, Majolino I, Farina C, Luzzaro F, Rossolini GM, Rambaldi A. Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: an Italian multidisciplinary consensus statement. Haematologica 2015; 100:e373-6. [PMID: 25862702 DOI: 10.3324/haematol.2015.125484] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, Sapienza University of Rome
| | - Claudio Viscoli
- Clinica Malattie Infettive, University of Genoa (DISSAL), AOU IRCCS San Martino-IST, Genoa
| | - Alfonso Piciocchi
- Fondazione GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto), Rome
| | - Laura Cudillo
- Fondazione Policlinico Tor Vergata, Unità di Trapianto University Tor Vergata, Rome
| | - Stefano Botti
- Unità di Ematologia, IRCCS-Azienda Arcispedale S. Maria Nuova, Reggio Emilia
| | - Antonio Errico
- Dipartimento di Ematologia, Azienda Ospedaliera di Careggi, University of Florence
| | - Loredana Sarmati
- Fondazione Policlinico Tor Vergata, Unità di Malattie Infettive, University Tor Vergata, Rome
| | - Fabio Ciceri
- Unità Operative di Ematologia e Trapianto Midollo Osseo, IRCCS Ospedale San Raffaele, Milan
| | - Franco Locatelli
- Dipartimento di Oncoematologia, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Università di Pavia
| | - Maddalena Giannella
- Clinica di Malattie Infettive, University of Bologna, S. Orsola-Malpighi Hospital
| | - Matteo Bassetti
- Divisione di Malattie Infettive, Santa Maria Misericordia University Hospital, Udine
| | - Carlo Tascini
- Unità di Malattie Infettive, Cisanello Hospital, Pisa
| | - Letizia Lombardini
- Dipartimento di Ematologia, Azienda Ospedaliera di Careggi, University of Florence Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome
| | - Ignazio Majolino
- UOC di Ematologia e Trapianti di Cellule Staminali, Azienda Ospedaliera S. Camillo-Forlanini, Rome
| | - Claudio Farina
- USC Microbiologia e Virologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - Francesco Luzzaro
- USC Microbiologia e Virologia, Azienda Ospedaliera della Provincia di Lecco, Lecco
| | - Gian Maria Rossolini
- Dipartimento di Biotecnologie Mediche, University of Siena Dipartimento di Medicina Sperimentale e Clinica, University of Florence SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi, Florence
| | - Alessandro Rambaldi
- Divisione di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
42
|
De Rosa FG, Corcione S, Cavallo R, Di Perri G, Bassetti M. Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K. pneumoniae infections: a critical agenda. Future Microbiol 2015; 10:283-94. [DOI: 10.2217/fmb.14.121] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The wide dissemination of carbapenemase producing K. pneumoniae (KPC-Kp) has caused a public health crisis of global dimensions, due to the serious infections in hospitalized patients associated with high mortality. In 2014, we aim to review clinical data on KPC-Kp at a time when a pro-active strategy (combating the problem before it is established) is no longer useful, focusing on epidemiology, patient risk profile, infection control, digestive tract colonization and treatment issues such as the role of carbapenems or carbapenem sparing strategies, colistin and resistance, dual carbapenem administration and the role of tigecycline. All these issues are illustrated prospectively to provide a forum for a Consensus strategy when not only intensive care units but also medical and surgical wards are affected by the epidemics.
Collapse
Affiliation(s)
- Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149 Torino, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149 Torino, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatric Sciences, Microbiology & Virology, University of Turin, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, Infectious Diseases, University of Turin, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149 Torino, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
| |
Collapse
|
43
|
Arena F, Giani T, Vaggelli G, Terenzi G, Pecile P, Rossolini GM. Accuracy of different methods for susceptibility testing of gentamicin with KPC carbapenemase-producing Klebsiella pneumoniae. Diagn Microbiol Infect Dis 2015; 81:132-4. [DOI: 10.1016/j.diagmicrobio.2014.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/06/2014] [Accepted: 10/28/2014] [Indexed: 12/24/2022]
|
44
|
Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: a nationwide retrospective survey from Italy. Bone Marrow Transplant 2014; 50:282-8. [PMID: 25310302 DOI: 10.1038/bmt.2014.231] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 11/09/2022]
Abstract
Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) represent a challenging problem after SCT. A retrospective survey (January 2010 to July 2013) involving 52 Italian centers was performed to assess the epidemiology and the prognostic factors of CRKp infections in auto- and allo-SCT. Cases of CRKp infection were reported in 53.4% of centers. CRKp infections were documented in 25 auto-SCTs and 87 allo-SCTs, with an incidence of 0.4% (from 0.1% in 2010 to 0.7% in 2013) and 2% (from 0.4% in 2010 to 2.9% in 2013), respectively. A CRKp colonization documented before or after transplant was followed by an infection in 25.8% of auto-SCT and 39.2% of allo-SCT patients. The infection-related mortality rates were 16% and 64.4%, respectively. A pre-transplant CRKp infection (hazard ratio (HR) 0.33, 95% confidence intervals (CIs) 0.15-0.74; P=0.007) and a not CRKp-targeted first-line treatment (HR 2.67, 95% CI 1.43-4.99; P=0.002) were independent factors associated with an increased mortality in allo-SCT patients who developed a CRKp infection. Our study shows challenging findings of CRKp infections in SCT patients in Italy particularly after allo-SCT. The detection of carriers and the definition of early therapeutic strategies represent critical aspects of the management of CRKp infections after SCT.
Collapse
|
45
|
Management of Intra-abdominal Infections due to Carbapenemase-Producing Organisms. Curr Infect Dis Rep 2014; 16:428. [DOI: 10.1007/s11908-014-0428-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|