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Ruiz-Ramos J, Monje-López ÁE, Medina-Catalan D, Herrera-Mateo S, Hernández-Ontiveros H, Rivera-Martínez MA, Pereira-Batista CS, Puig-Campmany M. PREDICTION OF MULTIDRUG-RESISTANT BACTERIA IN URINARY TRACT INFECTIONS IN THE EMERGENCY DEPARTMENT. J Emerg Med 2023:S0736-4679(23)00231-7. [PMID: 37385920 DOI: 10.1016/j.jemermed.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Urinary tract infections (UTI) due to multidrug-resistant bacteria are a frequent reason for visiting the emergency department (ED). OBJECTIVES The aim of this study was to evaluate the applicability of a predictive model of infection by multidrug-resistant microorganisms in UTIs treated in an ED. METHODS This is a retrospective observational study. Adult patients admitted to an ED with a diagnosis of UTI and positive urine culture were included. The main objective was to evaluate the area under the curve of the receiver operating characteristic (AUC-ROC), the scale proposed by González-del-Castillo, considering infection by a resistant pathogen as the dependent variable and the scale score of the predictive model used as the independent variable. RESULTS The study included 414 patients with UTIs, 125 (30.2%) of which were caused by multidrug-resistant microorganisms. A total of 38.4% of patients were treated with antibiotics during the previous 3 months and a multidrug-resistant pathogen was isolated from 10.4% of the total during the previous 6 months. The AUC-ROC of the scale for predicting UTIs due to multidrug-resistant microorganisms was 0.79 (95% confidence interval 0.76-0.83), the optimal cut-off point being 9 points, with a sensitivity of 76.8% and a specificity of 71.6%. CONCLUSIONS The use of the predictive model evaluated is a useful tool in real clinical practice to improve the success of empirical treatment of patients presenting to the ED with a diagnosis of UTI and positive urine culture pending identification.
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Affiliation(s)
- Jesus Ruiz-Ramos
- Pharmacy Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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In Vitro Activity of Robenidine Analogues NCL259 and NCL265 against Gram-Negative Pathogens. Antibiotics (Basel) 2022; 11:antibiotics11101301. [PMID: 36289959 PMCID: PMC9598656 DOI: 10.3390/antibiotics11101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Multidrug-resistant (MDR) Gram-negative pathogens, especially Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Enterobacter spp., are recognized by the World Health Organization as the most critical priority pathogens in urgent need of drug development. In this study, the in vitro antimicrobial activity of robenidine analogues NCL259 and NCL265 was tested against key human and animal Gram-negative clinical isolates and reference strains. NCL259 and NCL265 demonstrated moderate antimicrobial activity against these Gram-negative priority pathogens with NCL265 consistently more active, achieving lower minimum inhibitory concentrations (MICs) in the range of 2−16 µg/mL. When used in combination with sub-inhibitory concentrations of polymyxin B to permeabilize the outer membrane, NCL259 and NCL265 elicited a synergistic or additive activity against the reference strains tested, reducing the MIC of NCL259 by 8- to 256- fold and the MIC of NCL265 by 4- to 256- fold. A small minority of Klebsiella spp. isolates (three) were resistant to both NCL259 and NCL265 with MICs > 256 µg/mL. This resistance was completely reversed in the presence of the efflux pump inhibitor phenylalanine-arginine-beta-naphthylamide (PAβN) to yield MIC values of 8−16 µg/mL and 2−4 µg/mL for NCL259 and NCL256, respectively. When NCL259 and NCL265 were tested against wild-type E. coli isolate BW 25113 and its isogenic multidrug efflux pump subunit AcrB deletion mutant (∆AcrB), the MIC of both compounds against the mutant ∆AcrB isolate was reduced 16-fold compared to the wild-type parent, indicating a significant role for the AcrAB-TolC efflux pump from Enterobacterales in imparting resistance to these robenidine analogues. In vitro cytotoxicity testing revealed that NCL259 and NCL265 had much higher levels of toxicity to a range of human cell lines compared to the parent robenidine, thus precluding their further development as novel antibiotics against Gram-negative pathogens.
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Madhobi KF, Kalyanaraman A, Anderson DJ, Dodds Ashley E, Moehring RW, Lofgren ET. Use of Contact Networks to Estimate Potential Pathogen Risk Exposure in Hospitals. JAMA Netw Open 2022; 5:e2225508. [PMID: 35930285 PMCID: PMC9356318 DOI: 10.1001/jamanetworkopen.2022.25508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Person-to-person contact is important for the transmission of health care-associated pathogens. Quantifying these contact patterns is crucial for modeling disease transmission and understanding routes of potential transmission. OBJECTIVE To generate and analyze the mixing matrices of hospital patients based on their contacts within hospital units. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study, mixing matrices were created using a weighted contact network of connected hospital patients, in which contact was defined as occupying the same hospital unit for 1 day. Participants included hospitalized patients at 299 hospital units in 24 hospitals in the Southeastern United States that were part of the Duke Antimicrobial Stewardship Outreach Network between January 2015 and December 2017. Analysis was conducted between October 2021 and February 2022. MAIN OUTCOMES AND MEASURES The mixing matrices of patients for each hospital unit were assessed using age, Elixhauser Score, and a measure of antibiotic exposure. RESULTS Among 1 549 413 hospitalized patients (median [IQR] age, 44 [26-63] years; 883 580 [56.3%] women) in 299 hospital units, some units had highly similar patterns across multiple hospitals, although the number of patients varied to a great extent. For most of the adult inpatient units, frequent mixing was observed for older adult groups, while outpatient units (eg, emergency departments and behavioral health units) showed mixing between different age groups. Most units mixing patterns followed the marginal distribution of age; however, patients aged 90 years or older with longer lengths of stay created a secondary peak in some medical wards. From the mixing matrices by Elixhauser Score, mixing between patients with relatively higher comorbidity index was observed in intensive care units. Mixing matrices by antibiotic spectrum, a 4-point scale based on priority for antibiotic stewardship programs, resulted in 6 major distinct patterns owing to the variation of the type of antibiotics used in different units, namely those dominated by a single antibiotic spectrum (narrow, broad, or extended), 1 pattern spanning all antibiotic spectrum types and 2 forms of narrow- and extended-spectrum dominant exposure patterns (an emergency room where patients were exposed to one type of antibiotic or the other and a pediatric ward where patients were exposed to both types). CONCLUSIONS AND RELEVANCE This quality improvement study found that the mixing patterns of patients both within and between hospitals followed broadly expected patterns, although with a considerable amount of heterogeneity. These patterns could be used to inform mathematical models of health care-associated infections, assess the appropriateness of both models and policies for smaller community hospitals, and provide baseline information for the design of interventions that rely on altering patient contact patterns, such as practices for transferring patients within hospitals.
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Affiliation(s)
- Kaniz Fatema Madhobi
- School of Electrical Engineering and Computer Science, Washington State University, Pullman
| | - Ananth Kalyanaraman
- School of Electrical Engineering and Computer Science, Washington State University, Pullman
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth Dodds Ashley
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Rebekah W. Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Eric T. Lofgren
- Paul G. Allen School for Global Health, Washington State University, Pullman
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Alkhzem AH, Woodman TJ, Blagbrough IS. Design and synthesis of hybrid compounds as novel drugs and medicines. RSC Adv 2022; 12:19470-19484. [PMID: 35865575 PMCID: PMC9257310 DOI: 10.1039/d2ra03281c] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 12/13/2022] Open
Abstract
The development of highly effective conjugate chemistry approaches is a way to improve the quality of drugs and of medicines. The aim of this paper is to highlight and review such hybrid compounds and the strategies underpinning their design. A variety of unique hybrid compounds provide an excellent toolkit for novel biological activity, e.g. anticancer and non-viral gene therapy (NVGT), and as templates for killing bacteria and preventing antibiotic drug resistance. First we discuss the anticancer potential of hybrid compounds, containing daunorubicin, benzyl- or tetrahydroisoquinoline-coumarin, and cytotoxic NSAID-pyrrolizidine/indolizine hybrids, then NVGT cationic lipid-based delivery agents, where steroids or long chain fatty acids as the lipid moiety are bound to polyamines as the cationic moiety. These polyamines can be linear as in spermidine or spermine, or on a polycyclic sugar template, aminoglycosides kanamycin and neomycin B, the latter substituted with six amino groups. They are highly efficient for the delivery of both fluorescent DNA and siRNA. Molecular precedents can be found for the design of hybrid compounds in the natural world, e.g., squalamine, the first representative of a previously unknown class of natural antibiotics of animal origin. These polyamine-bile acid (e.g. cholic acid type) conjugates display many exciting biological activities with the bile acids acting as a lipidic region and spermidine as the polycationic region. Analogues of squalamine can act as vectors in NVGT. Their natural role is as antibiotics. Novel antibacterial materials are urgently needed as recalcitrant bacterial infection is a worldwide problem for human health. Ribosome inhibitors founded upon dimers of tobramycin or neomycin, bound as ethers by a 1,6-hexyl linker or a more complex diether-disulfide linker, improved upon the antibiotic activity of aminoglycoside monomers by 20- to 1200-fold. Other hybrids, linked by click chemistry, conjugated ciprofloxacin to neomycin, trimethoprim, or tedizolid, which is now in clinical trials.
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Affiliation(s)
| | - Timothy J Woodman
- Department of Pharmacy and Pharmacology, University of Bath Bath BA2 7AY UK
| | - Ian S Blagbrough
- Department of Pharmacy and Pharmacology, University of Bath Bath BA2 7AY UK
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Sah AK, Feglo PK. Plasmid-mediated quinolone resistance determinants in clinical bacterial pathogens isolated from the Western Region of Ghana: a cross-sectional study. Pan Afr Med J 2022; 43:207. [PMID: 36942137 PMCID: PMC10024564 DOI: 10.11604/pamj.2022.43.207.33734] [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: 03/02/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction quinolones are critically important antibiotics that are reserved for treating very severe infections caused by multidrug-resistant bacterial pathogens. However, their indiscriminate uses have resulted in an increased number of resistant strains in many parts of the world including Ghana. We determined the quinolone resistance profile of Gram-negative bacterial pathogens and characterized the underlying molecular determinants of resistance. Methods Gram-negative pathogens obtained from clinical specimens at three hospital laboratories were tested for resistance to quinolones and other commonly used antibiotics. ESBL production among the Enterobacterial isolates was confirmed using the combined disc diffusion method. We then used PCR to determine seven types of plasmid-mediated quinolone resistance genes present in the isolates resistant to nalidixic acid and ciprofloxacin. Results in this study, 29.5% of the isolates were resistant to ciprofloxacin, with the highest of 50% among E. coli resistance to the other quinolones was levofloxacin (24.4%), norfloxacin (24.9%), and nalidixic acid (38.9%). Significant proportions of the quinolone-resistant isolates were ESBL producers (P-values < 0.001). The aac(6´)-Ib-cr, qnrS, oqxA, and qepA genes were present in 43 (89.6%), 27 (56.3%), 23 (47.9%), and one (2.1%) of the isolates, respectively. None of the isolates tested positive to qnrA, qnrB, and oqxB genes. The presence of the aac(6´)-Ib-cr gene positively correlated with resistance to ceftriaxone, cefotaxime, and gentamicin (P-values < 0.05). Conclusion high proportions of Gram-negative bacterial isolates were resistant to quinolones and most of these isolates possessed multiple PMQR genes. There is a need to implement measures to limit the spread of these organisms.
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Affiliation(s)
- Andrews Kwabena Sah
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Laboratory Unit, Prestea Government Hospital, Prestea, Ghana
| | - Patrick Kwame Feglo
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Corresponding author: Patrick Kwame Feglo, Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Pérez-Lazo G, Abarca-Salazar S, Lovón R, Rojas R, Ballena-López J, Morales-Moreno A, Flores-Paredes W, Arenas-Ramírez B, Illescas LR. Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital. Antibiotics (Basel) 2021; 10:antibiotics10101221. [PMID: 34680802 PMCID: PMC8532675 DOI: 10.3390/antibiotics10101221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
A descriptive design was carried out studying the correlation between antimicrobial consumption and resistance profiles of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) in a Peruvian hospital, including the surgical, clinical areas and the intensive care unit (ICU) during the time period between 2015 and 2018. There was a significant correlation between using ceftazidime and the increase of carbapenem-resistant Pseudomonas aeruginosa isolations (R = 0.97; p < 0.05) and the resistance to piperacillin/tazobactam in Enterobacter spp. and ciprofloxacin usage (R = 0.97; p < 0.05) in the medical wards. The Pseudomonas aeruginosa resistance to piperacillin/tazobactam and amikacin in the intensive care unit (ICU) had a significant reduction from 2015 to 2018 (67% vs. 28.6%, 65% vs. 34.9%, p < 0.001). These findings give valuable information about the rates and dynamics in the relationship between antibiotic usage and antimicrobial resistance patterns in a Peruvian hospital and reinforce the need for continuous support and assessment of antimicrobial stewardship strategies, including microbiological indicators and antimicrobial consumption patterns.
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Affiliation(s)
- Giancarlo Pérez-Lazo
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (J.B.-L.); (A.M.-M.)
- Correspondence: (G.P.-L.); (L.R.I.)
| | - Susan Abarca-Salazar
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Renata Lovón
- Hospital Pharmacy Unit, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (R.L.); (R.R.)
| | - Rocío Rojas
- Hospital Pharmacy Unit, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (R.L.); (R.R.)
| | - José Ballena-López
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (J.B.-L.); (A.M.-M.)
| | - Adriana Morales-Moreno
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (J.B.-L.); (A.M.-M.)
| | - Wilfredo Flores-Paredes
- Clinical Pathology Department, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru;
| | - Berenice Arenas-Ramírez
- Infection Prevention and Control Unit, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru;
| | - Luis Ricardo Illescas
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (J.B.-L.); (A.M.-M.)
- Correspondence: (G.P.-L.); (L.R.I.)
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Muvunyi V, Mpirimbanyi C, Katabogama JB, Cyuzuzo T, Nkubana T, Mugema JB, Musoni E, Urimubabo C, Rickard J. Community- and Hospital-Acquired Infections in Surgical patients at a Tertiary Referral Hospital in Rwanda. World J Surg 2021; 44:3290-3298. [PMID: 32535645 DOI: 10.1007/s00268-020-05634-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasing in globally. The aim of this study was to compare community-acquired infections (CAIs) and hospital-acquired infections (HAIs) and determine the rate of third-generation cephalosporin resistance and ESBL-PE at a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of Rwandan acute care surgery patients with infection. Samples were processed for culture and susceptibility patterns using Kirby-Bauer disk diffusion method. Third-generation cephalosporin resistance and ESBL-PE were compared in patients with CAI versus HAI. RESULTS Over 14 months, 220 samples were collected from 191 patients: 116 (62%) patients had CAI, 59 (32%) had HAI, and 12 (6%) had both CAI and HAI. Most (n = 178, 94%) patients were started on antibiotics with third-generation cephalosporins (ceftriaxone n = 109, 57%; cefotaxime n = 52, 27%) and metronidazole (n = 155, 81%) commonly given. Commonly isolated organisms included Escherichia coli (n = 62, 42%), Staphylococcus aureus (n = 27, 18%), and Klebsiella spp. (n = 22, 15%). Overall, 67 of 113 isolates tested had resistance to third-generation cephalosporins, with higher resistance seen in HAI compared with CAI (74% vs 46%, p value = 0.002). Overall, 47 of 89 (53%) isolates were ESBL-PE with higher rates in HAI compared with CAI (73% vs 38%, p value = 0.001). CONCLUSIONS There is broad and prolonged use of third-generation cephalosporins despite high resistance rates. ESBL-PE are high in Rwandan surgical patients with higher rates in HAI compared with CAIs. Infection prevention practices and antibiotic stewardship are critical to reduce infection rates with resistant organisms in a low-resource setting.
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Affiliation(s)
- Vital Muvunyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda
| | - Christophe Mpirimbanyi
- Department of Surgery, University of Rwanda, Kigali, Rwanda.,Department of Surgery, Kibungo Referral Hospital, Kibungo, Rwanda
| | | | | | - Theoneste Nkubana
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Emile Musoni
- Clinical Laboratory, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Christian Urimubabo
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University of Rwanda, Kigali, Rwanda. .,Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda. .,Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, USA.
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Robinson ED, Volles DF, Kramme K, Mathers AJ, Sawyer RG. Collaborative Antimicrobial Stewardship for Surgeons. Infect Dis Clin North Am 2020; 34:97-108. [PMID: 32008698 DOI: 10.1016/j.idc.2019.11.002] [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] [Indexed: 01/22/2023]
Abstract
Antimicrobial stewardship efforts that include surgeons rely on healthy and open communications between surgeons, infectious diseases specialists, and pharmacists. These efforts most frequently are related to surgical prophylaxis, the management of surgical infections, and surgical critical care. Policy should be based on best evidence and timely interactions to develop consensus on how to develop appropriate guidelines and protocols. Flexibility on all sides leads to increasingly strong relationships over time.
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Affiliation(s)
- Evan D Robinson
- Department of Medicine, Division of Infectious Diseases, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA
| | - David F Volles
- Department of Pharmacy, University of Virginia, PO Box 800674, Charlottesville, VA 22908, USA
| | - Katherine Kramme
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Amy J Mathers
- Department of Medicine, Division of Infectious Diseases, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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Gentili A, Di Pumpo M, La Milia DI, Vallone D, Vangi G, Corbo MI, Berloco F, Cambieri A, Damiani G, Ricciardi W, Laurenti P. A Six-Year Point Prevalence Survey of Healthcare-Associated Infections in an Italian Teaching Acute Care Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7724. [PMID: 33105772 PMCID: PMC7660067 DOI: 10.3390/ijerph17217724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
Healthcare-associated infections (HAI) represent one of the most common cause of infection and an important burden of disease. The aim of this study was to analyze the results of a six-year HAI point prevalence survey carried out yearly in a teaching acute care hospital from 2013 to 2018, following the European Center for Disease Prevention and Control (ECDC) guidelines. Surgical site infections, urinary tract infections, bloodstream infections, pneumonia, meningitis, and Clostridium difficile infections were considered as risk factors. A total of 328 patients with HAI were detected during the 6-year survey, with an average point prevalence of 5.24% (95% CI: 4.70-5.83%). Respiratory tract infections were the most common, followed by surgical site infections, urinary tract infections, primary bloodstream infections, Clostridium difficile infections, and central nervous system infections. A regression model showed length of stay at the moment of HAI detection, urinary catheter, central venous catheter, and antibiotic therapy to be the most important predictors of HAI prevalence, yielding a significant adjusted coefficient of determination (adjusted R2) of 0.2780. This will provide future infection control programs with specific HAI to focus on in order to introduce a proper prophylaxis and to limit exposure whenever possible.
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Affiliation(s)
- Andrea Gentili
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
| | - Marcello Di Pumpo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
| | - Daniele Ignazio La Milia
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Doriana Vallone
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
| | - Gino Vangi
- Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.I.C.); (F.B.); (A.C.)
| | - Maria Incoronata Corbo
- Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.I.C.); (F.B.); (A.C.)
| | - Filippo Berloco
- Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.I.C.); (F.B.); (A.C.)
| | - Andrea Cambieri
- Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (G.V.); (M.I.C.); (F.B.); (A.C.)
| | - Gianfranco Damiani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Patrizia Laurenti
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.); (D.V.); (G.D.); (W.R.); (P.L.)
- Department of Woman and Child Health and Public Health-Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
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Bio fabrication of silver nanoparticles with antibacterial and cytotoxic abilities using lichens. Sci Rep 2020; 10:16781. [PMID: 33033304 PMCID: PMC7544908 DOI: 10.1038/s41598-020-73683-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023] Open
Abstract
Recently, increase bacterial resistance to antimicrobial compounds issue constitutes a real threat to human health. One of the useful materials for bacterial control is Silver nanoparticles (AgNPs). Researchers tend to use biogenic agents to synthesize stable and safe AgNPs. The principal aim of this study was to investigate the ability of lichen in AgNPs formation and to find out their suppression ability to MDR bacteria as well as their cytotoxic activity. In the current study, lichens (Xanthoria parietina, Flavopunctelia flaventior) were collected from the south of the Kingdom of Saudi Arabia. Lichens methanolic extracts were used for conversion of Ag ions to AgNPs. Prepared biogenic AgNPs were characterized by Ultraviolet–Visible (UV–Vis) Spectroscopy, Transmission electron microscopy (TEM), Dynamic Light Scattering (DLS) and Zeta potential and Energy-Dispersive X-ray Spectroscopy (EDS). Lichens Secondary metabolites were determined by Fourier-Transform Infrared Spectroscopy (FTIR) and Gas Chromatography–Mass Spectrometry (GC–MS). The antibacterial activity and synergistic effect of AgNPs were evaluated against pathogenic bacteria, including gram-positive; Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), and gram-negative; (Pseudomonas aeruginosa, Escherichia coli) as well as the reference strains (ATCC) using the agar disk diffusion method. Cytotoxic effect of biogenic AgNPs was tested against HCT 116 (Human Colorectal Cancer cell), MDA-MB-231 (Breast cancer cell), and FaDu (Pharynx cancer cell) by MTT test. TEM imaging showed well-dispersed spherical particles of 1–40 nm size as well as zeta size showed 69–145 nm. Furthermore, FTIR and GC–MS identified various lichen chemical molecules. On the other hand, the highest antibacterial activity of AgNPs was noticed against P. aeruginosa, followed by MRSA, VRE, and E. coli. AgNPs influence on gram-negative bacteria was greater than that on gram-positive bacteria and their synergistic effect with some antibiotics was noted against examined microbes. Moreover, higher cytotoxicity for biogenic AgNPs against FaDu and HCT 116 cell line in relation to MDA-MB-231 was noted. Given the current findings, the biogenic AgNPs mediated by lichens had positive antibacterial, synergistic and cytotoxic powers. Therefore, they might be considered as a promising candidate to combat the multi-drug resistance organisms and some cancer cells.
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Pi H, Nguyen HT, Venter H, Boileau AR, Woolford L, Garg S, Page SW, Russell CC, Baker JR, McCluskey A, O'Donovan LA, Trott DJ, Ogunniyi AD. In vitro Activity of Robenidine Analog NCL195 in Combination With Outer Membrane Permeabilizers Against Gram-Negative Bacterial Pathogens and Impact on Systemic Gram-Positive Bacterial Infection in Mice. Front Microbiol 2020; 11:1556. [PMID: 32849325 PMCID: PMC7417630 DOI: 10.3389/fmicb.2020.01556] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Abstract
Multidrug-resistant (MDR) pathogens, particularly the ESKAPE group (Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Enterobacter spp.), have become a public health threat worldwide. Development of new antimicrobial classes and the use of drugs in combination are potential strategies to treat MDR ESKAPE pathogen infections and promote optimal antimicrobial stewardship. Here, the in vitro antimicrobial activity of robenidine analog NCL195 alone or in combination with different concentrations of three outer membrane permeabilizers [ethylenediaminetetraacetic acid (EDTA), polymyxin B nonapeptide (PMBN), and polymyxin B (PMB)] was further evaluated against clinical isolates and reference strains of key Gram-negative bacteria. NCL195 alone was bactericidal against Neisseria meningitidis and Neisseria gonorrhoeae (MIC/MBC = 32 μg/mL) and demonstrated synergistic activity against P. aeruginosa, E. coli, K. pneumoniae, and Enterobacter spp. strains in the presence of subinhibitory concentrations of EDTA, PMBN, or PMB. The additive and/or synergistic effects of NCL195 in combination with EDTA, PMBN, or PMB are promising developments for a new chemical class scaffold to treat Gram-negative infections. Tokuyasu cryo ultramicrotomy was used to visualize the effect of NCL195 on bioluminescent S. aureus membrane morphology. Additionally, NCL195’s favorable pharmacokinetic and pharmacodynamic profile was further explored in in vivo safety studies in mice and preliminary efficacy studies against Gram-positive bacteria. Mice administered two doses of NCL195 (50 mg/kg) by the intraperitoneal (IP) route 4 h apart showed no adverse clinical effects and no observable histological effects in major organs. In bioluminescent Streptococcus pneumoniae and S. aureus murine sepsis challenge models, mice that received two 50 mg/kg doses of NCL195 4 or 6 h apart exhibited significantly reduced bacterial loads and longer survival times than untreated mice. However, further medicinal chemistry and pharmaceutical development to improve potency, solubility, and selectivity is required before efficacy testing in Gram-negative infection models.
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Affiliation(s)
- Hongfei Pi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Hang Thi Nguyen
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia.,Department of Pharmacology, Toxicology, Internal Medicine and Diagnostics, Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi, Vietnam
| | - Henrietta Venter
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Alexandra R Boileau
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Lucy Woolford
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Sanjay Garg
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Cecilia C Russell
- Chemistry, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Jennifer R Baker
- Chemistry, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Adam McCluskey
- Chemistry, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Lisa A O'Donovan
- ARC Centre of Excellence in Plant Energy Biology, School of Agriculture, Food & Wine, The University of Adelaide, Urrbrae, SA, Australia
| | - Darren J Trott
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - Abiodun D Ogunniyi
- Australian Centre for Antimicrobial Resistance Ecology, School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
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12
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Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:7268519. [PMID: 32670442 PMCID: PMC7345606 DOI: 10.1155/2020/7268519] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
Background Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.
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13
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Mikomangwa WP, Bwire GM, Kilonzi M, Mlyuka H, Mutagonda RF, Kibanga W, Marealle AI, Minzi O, Mwambete KD. The Existence of High Bacterial Resistance to Some Reserved Antibiotics in Tertiary Hospitals in Tanzania: A Call to Revisit Their Use. Infect Drug Resist 2020; 13:1831-1838. [PMID: 32606832 PMCID: PMC7306467 DOI: 10.2147/idr.s250158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Antibiotic resistance poses burden to the community and health-care services. Efforts are being made at local, national and global level to combat the rise of antibiotic resistance including antibiotic stewardship. Surveillance to antibiotic resistance is of importance to aid in planning and implementing infection prevention and control measures. The study was conducted to assess the resistance pattern to cefepime, clindamycin and meropenem, which are reserved antibiotics for use at tertiary hospitals in Tanzania. Methods A hospital-based antibiotic resistance surveillance was conducted between July and November 2019 at Muhimbili National Hospital and Bugando Medical Center, Tanzania. All organisms isolated were identified based on colony morphology, Gram staining and relevant biochemical tests. Antibiotic susceptibility testing was performed on Muller-Hinton agar using Kirby-Bauer disc diffusion method. Antibiotic susceptibility was performed according to the protocol by National Committee for Clinical Laboratory Standards. Results A total of 201 clinical samples were tested in this study. Urine (39.8%, n=80) and blood (35.3%, n=71) accounted for most of the collected samples followed by pus (16.9%, n=34). The bacterial resistance to clindamycin, cefepime and meropenem was 68.9%, 73.2% and 8.5%, respectively. About 68.4% Staphylococcus aureus isolates were resistant to clindamycin whereby 56.3%, 75.6%, 93.8% and 100% of the tested Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa and Enterobacter cloacae, respectively, were cefepime resistant. About 8.5% of isolated Klebsiella spp were resistant and 6.4% had intermediate susceptibility to meropenem. Also, Pseudomonas aeruginosa was resistant by 31.2% and 25% had intermediate susceptibility to meropenem. Conclusion The bacterial resistance to clindamycin and cefepime is high and low in meropenem. Henceforth, culture and susceptibility results should be used to guide the use of these antibiotics. Antibiotics with low resistance rate should be introduced to the reserve category and continuous antibiotic surveillance is warranted.
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Affiliation(s)
- Wigilya P Mikomangwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Hamu Mlyuka
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Wema Kibanga
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Kennedy D Mwambete
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Coiffard B, Prud'Homme E, Hraiech S, Cassir N, Le Pavec J, Kessler R, Meloni F, Leone M, Thomas PA, Reynaud-Gaubert M, Papazian L. Worldwide clinical practices in perioperative antibiotic therapy for lung transplantation. BMC Pulm Med 2020; 20:109. [PMID: 32349719 PMCID: PMC7191774 DOI: 10.1186/s12890-020-1151-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices. Methods We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period. Results We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%). Conclusion Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.
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Affiliation(s)
- Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Hôpital Nord, 13015, Marseille, France. .,Aix Marseille University, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France. .,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.
| | - Eloi Prud'Homme
- Aix Marseille University, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Sami Hraiech
- Aix Marseille University, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
| | - Nadim Cassir
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Jérôme Le Pavec
- Department of Cardio-Thoracic Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Romain Kessler
- Department of Respiratory Medicine and Lung Transplantation, Federation of Translational Medicine of Strasbourg (FMTS), Nouvel Hôpital Civil, Strasbourg, France
| | - Federica Meloni
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marc Leone
- Aix Marseille University, APHM, Hôpital Nord, Department of Thoracic Surgery, Marseille, France
| | - Pascal Alexandre Thomas
- Aix Marseille University, APHM, Hôpital Nord, Department of Anesthesiology, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille University, APHM, Hôpital Nord, 13015, Marseille, France
| | - Laurent Papazian
- Aix Marseille University, APHM, Hôpital Nord, Intensive Care Unit, Marseille, France
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15
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Hofmann F, Heudorf U, Steul K, Wichelhaus TA, Besier S, Hogardt M, Hack D, Steinmann E, Kempf VAJ, Reinheimer C. Anamnestic risk factor evaluation of patients carrying carbapenem-resistant Enterobacterales and/or Acinetobacter baumannii - impact on infection control management at a German University Hospital. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc05. [PMID: 32547905 PMCID: PMC7273331 DOI: 10.3205/dgkh000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Carbapenem-resistant Enterobacterales and Acinetobacterbaumannii are of major concern in terms of infection prevention and control. This study evaluated factors that may increase the frequency of Enterobacterales and A. baumannii with carbapenem resistance (CR) in patients admitted to a German University Hospital for implementation of optimized infection control management. Methods: A five-year-retrospective epidemiological cohort analysis was conducted on anamnestic risk factors for carrying Enterobacterales and/or A. baumannii with CR in patients who were first tested positive for these species at University Hospital Frankfurt (UHF) between January 2013 and June 2018. Results: 364 patients were tested positive for Enterobacterales and/or A. baumannii with CR, resulting in n=400 bacterial isolates in total, with Klebsiella pneumoniae being the most frequently detected species (n=146/400; 36.5%; 95% confidence interval: 31.8–41.4). In patients who were tested positive for Enterobacterales and/or A. baumannii with CR, any hospital stay within the previous 12 months was the most frequently reported common factor (n=275/364; 75.5%; 70.8–79.9). Conclusion: A hospital stay within the previous 12 months, including hospitals in Germany and abroad, is a frequent characteristic of patients who tested positive for Enterobacterales and/or A. baumannii with CR. Upon admission, any previous hospital stay of the given patient within the previous 12 months should be determined. Infection control strategies such as screening measures need to be adapted to these patient groups in hospital settings. In order to reflect the varying determinants in “nosocomial” cases in greater detail, the existing criteria used to characterize “nosocomial detection” of gram-negative bacteria with CR should be reviewed.
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Affiliation(s)
- Franziska Hofmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Katrin Steul
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Silke Besier
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Daniel Hack
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Elvira Steinmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
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16
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Jacob I, Rangappa P, Thimmegowda LC, Rao K. A Study of Multidrug-Resistant, Colistin-Only-Sensitive Infections in Intubated and Mechanically Ventilated Patients Over 2 Years. J Glob Infect Dis 2020; 12:5-10. [PMID: 32165795 PMCID: PMC7045758 DOI: 10.4103/jgid.jgid_179_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/09/2019] [Accepted: 01/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Multidrug-resistant, Gram-negative infections are increasingly common in the intensive care unit (ICU). This study compares the occurrence and outcome of colistin-only-sensitive (COS) infections among mechanically ventilated patients at a tertiary hospital ICU. Methods The study included adult patients admitted over a period of 2 years, who were intubated and mechanically ventilated for more than 48 h. They were divided into two groups, those with COS infections and those without, and their GCS and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, ICU length of stay, leukocyte count, and mortality were compared. COS patients were divided into neurosurgery, neurology, respiratory, and sepsis with bacteremia groups. The COS organisms in each group, their sources, ICU length of stay, ventilator-free days, and mortality were analyzed. Results Three hundred and one patients were selected, of whom 41 (13.6%) had COS infections. COS patients had a longer ICU length of stay than non-COS patients (P = 0.001) but comparable APACHE II and GCS scores, leukocyte count, and mortality. The sepsis group accounted for 8 out of 15 (53%) deaths among COS patients (P = 0.03). Acinetobacter baumannii accounted for 61% of the COS infections, Klebsiella pneumonia: 24.4%, Pseudomonas aeruginosa: 12.2%, and Escherichia coli: 2.4%. Endotracheal secretion cultures accounted for 65.8% of COS isolates, urine cultures 17%, pus cultures 7.3%, and blood cultures 4.9%. ICU length of stay, ventilator-free days, and mortality were similar between each COS organism. Conclusion Intubated patients with multidrug-resistant, COS infections have a longer stay in ICU than non-COS patients. COS infections associated with bacteremia have high mortality.
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Affiliation(s)
- Ipe Jacob
- Department of Critical Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Pradeep Rangappa
- Department of Critical Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Lakshman C Thimmegowda
- Department of Critical Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
| | - Karthik Rao
- Department of Critical Care, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India
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17
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Wang CH, Yu CM, Hsu ST, Wu RX. Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients. J Hosp Infect 2019; 104:46-52. [PMID: 31505224 DOI: 10.1016/j.jhin.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. However, levofloxacin-resistant S. maltophilia (LRSM) are emerging worldwide. AIM To investigate LRSM risk factors in hospitalized patients and to determine antibiotic susceptibility patterns of LRSM isolates. METHODS In a retrospective matched case-control-control study, LRSM patients (the case group) were compared with two control groups: levofloxacin-susceptible S. maltophilia (LSSM) patients (control group A) and non-S. maltophilia-infected patients (control group B). Conditional logistic regression was used to analyse risk factors for LRSM occurrence. Tigecycline, ceftazidime, colistin, and trimethoprim/sulfamethoxazole (TMP/SMX) susceptibilities in collected LRSM clinical isolates were determined. FINDINGS A total of 105 LRSM, 105 LSSM, and 105 non-S. maltophilia-infected patients were analysed. The first multivariate analysis (cases vs group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariate analysis (cases vs group B) revealed that previous fluoroquinolone use, previous intensive care unit stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic susceptibility, ceftazidime, TMP/SMX, tigecycline, and colistin resistance rates were 42.0, 99.0, 78.0, and 40.0%, respectively. CONCLUSION LRSM antibiotic susceptibility patterns revealed multiple-drug resistance, which further limits treatment options for clinicians. To reduce LRSM occurrence, proper use of antibiotics, especially fluoroquinolones, is mandatory.
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Affiliation(s)
- C H Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - C-M Yu
- Department of Clinical Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - S-T Hsu
- Infection Control Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - R-X Wu
- Division of Infectious Diseases, Tri-Service General Hospital Penghu Branch, Penghu, Taiwan.
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18
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Leal HF, Azevedo J, Silva GEO, Amorim AML, de Roma LRC, Arraes ACP, Gouveia EL, Reis MG, Mendes AV, de Oliveira Silva M, Barberino MG, Martins IS, Reis JN. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC Infect Dis 2019; 19:609. [PMID: 31296179 PMCID: PMC6624930 DOI: 10.1186/s12879-019-4265-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). Methods We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. Results Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. Conclusions Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance. Electronic supplementary material The online version of this article (10.1186/s12879-019-4265-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Ferreira Leal
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Jailton Azevedo
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Giulyana Evelyn Oliveira Silva
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Angelica Maria Lima Amorim
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Larissa Rangel Cabral de Roma
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | | | | | - Mitermayer Galvão Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Ana Verena Mendes
- São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.,Bahiana School of Medicine and Public Health of the Bahia Foundation for the Development of Sciences, Salvador, Bahia, Brazil
| | | | | | - Ianick Souto Martins
- Faculty of Medicine, Fluminense Federal University Downtown, 24033-900, Niterói, Rio de Janeiro, Brazil
| | - Joice Neves Reis
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
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19
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Song JU, Kim YH, Lee MY, Lee J. The association of prior hospitalization with clinical outcomes among patients admitted with pneumonia: a propensity score matching study. BMC Infect Dis 2019; 19:349. [PMID: 31029091 PMCID: PMC6486997 DOI: 10.1186/s12879-019-3961-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 04/08/2019] [Indexed: 12/05/2022] Open
Abstract
Background Although prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited. We aimed to elucidate the clinical impact of PH on these patients. Methods PH was defined as hospitalization for two or more days in the preceding 90 days. Patients with PH-associated pneumonia (PHAP) or community-acquired pneumonia (CAP) were matched using the propensity score matching method, and the clinical outcomes were compared. We also conducted subgroup analyses based on intravenous antibiotic use during PH, duration of PH, and time to re-admission. Results A total of 704 patients were identified; the PHAP group included 97 patients (13.7%). After matching according to propensity scores, the baseline characteristics of the PHAP group were similar to those of the CAP group. The isolation rate of PDR pathogens as well as the 30-day and total in-hospital mortality did not differ between propensity score-matched PHAP and CAP patients (13.6% vs. 10.2%, P = 0.485; 10.2% vs. 14.8%, P = 0.362; and 13.6% vs. 15.9%, P = 0.671, respectively). In subgroup analyses, only intravenous antibiotic use during PH was associated with the isolation rate of PDR pathogens (adjusted OR: 5.066; 95% CI: 1.231–20.845). Conclusions PH itself might not be related with higher isolation rates of PDR pathogens or mortality in patients admitted with pneumonia. Therefore, it seems reasonable that broad spectrum antibiotic therapy for PDR pathogens should be selectively applied to PHAP patients with intravenous antibiotic use during PH.
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Affiliation(s)
- Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13 gil 15, Jeju-si, Jeju, Special Self-Governing Province, 690-767, South Korea.
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Prout AJ, Talisa VB, Carcillo JA, Angus DC, Chang CCH, Yende S. Epidemiology of Readmissions After Sepsis Hospitalization in Children. Hosp Pediatr 2019; 9:249-255. [PMID: 30824488 PMCID: PMC6434975 DOI: 10.1542/hpeds.2018-0175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The decline in hospital mortality in children hospitalized with sepsis has increased the number of survivors. These survivors are at risk for adverse long-term outcomes, including readmission and recurrent or unresolved infections. We described the epidemiology of 90-day readmissions after sepsis hospitalization in children. We tested the hypothesis that a sepsis hospitalization increases odds of 90-day readmissions. METHODS Retrospective cohort analysis of the Nationwide Readmissions Database. We included index unplanned admissions of non-neonatal pediatric patients and described the proportion of readmissions, including those involving infection or sepsis. We performed multivariable analysis to determine the odds of readmission after a sepsis and nonsepsis admission and compared costs of readmission after sepsis and nonsepsis admissions. RESULTS Of 562 817 pediatric admissions, 7634 (1.4%) and 555 183 (98.6%) were discharged alive after admissions with and without sepsis. The rate of 90-day readmission after sepsis was 21.4%: 7.2% and 25.5% in previously healthy and chronically ill patients. The adjusted mean cost during readmission was $7385. Half of readmissions (52.9%) involved recurrent infection or sepsis. Sepsis admissions were associated with higher odds of readmission at 90 days compared with nonsepsis admissions (adjusted odds ratio 1.15, 95% confidence interval 1.08-1.23). The results remained unchanged for 30-day and 6-month readmissions. CONCLUSIONS Readmissions occur after 1 in 5 pediatric sepsis hospitalizations and increase health care costs. Sepsis hospitalization increased odds of readmission and commonly involved recurrent infection or sepsis. Clinicians caring for these patients should consider surveillance for recurrent or unresolved infection, and researchers should explore underlying mechanisms and potential interventions to reduce readmissions.
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Affiliation(s)
- Andrew J Prout
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
- Division of Pediatrics
| | - Victor B Talisa
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
- Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
| | - Chung-Chou H Chang
- Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
- Department of Biostatistics, Graduate School of Public Health
| | - Sachin Yende
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center,
- Departments of Critical Care Medicine and
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Candel FJ, Mensa J, Pasquau J, González del Castillo J. La crisis de los antibióticos: de la prescripción empírica a la dirigida. Enferm Infecc Microbiol Clin 2019; 37:214-215. [DOI: 10.1016/j.eimc.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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Mithawala P, McGee EA. Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center. JOURNAL OF CONTEMPORARY PHARMACY PRACTICE 2019. [DOI: 10.37901/jcphp17-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective
The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups.
Methods
It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results.
Results
A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure.
Conclusion
Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.
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Il’in MV, Sysoeva AA, Bolotin DS, Novikov AS, Suslonov VV, Rogacheva EV, Kraeva LA, Kukushkin VY. Aminonitrones as highly reactive bifunctional synthons. An expedient one-pot route to 5-amino-1,2,4-triazoles and 5-amino-1,2,4-oxadiazoles – potential antimicrobials targeting multi-drug resistant bacteria. NEW J CHEM 2019. [DOI: 10.1039/c9nj04529e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A four-component one-pot reaction proceeds very rapidly under mild conditions and gives the heterocyclic systems in good yields.
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Affiliation(s)
- Mikhail V. Il’in
- Institute of Chemistry
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
| | - Alexandra A. Sysoeva
- Institute of Chemistry
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
| | - Dmitrii S. Bolotin
- Institute of Chemistry
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
| | - Alexander S. Novikov
- Institute of Chemistry
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
| | - Vitalii V. Suslonov
- Center for X-ray Diffraction Studies
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
| | | | - Liudmila A. Kraeva
- Saint Petersburg Pasteur Institute
- Saint Petersburg
- Russian Federation
- S. M. Kirov Military Medical Academy
- Saint Petersburg
| | - Vadim Yu. Kukushkin
- Institute of Chemistry
- Saint Petersburg State University
- Saint Petersburg
- Russian Federation
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Flores-Mireles A, Hreha TN, Hunstad DA. Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil 2019; 25:228-240. [PMID: 31548790 PMCID: PMC6743745 DOI: 10.1310/sci2503-228] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.
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Affiliation(s)
| | - Teri N. Hreha
- Washington University School of Medicine, Saint Louis, Missouri
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Coppéré Z, Voiriot G, Blayau C, Gibelin A, Labbe V, Fulgencio JP, Fartoukh M, Djibré M. Disparity of the "screen-and-isolate" policy for multidrug-resistant organisms: A national survey in French adult ICUs. Am J Infect Control 2018; 46:1322-1328. [PMID: 29980315 DOI: 10.1016/j.ajic.2018.05.025] [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: 03/16/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The prevalence of multidrug-resistant organisms (MDROs) has dramatically increased. The aim of this survey was to describe and analyze the different screening and isolation policies regarding MDROs in French adult intensive care units (ICUs). MATERIALS AND METHODS A multicenter online survey was performed among French ICUs, including 63 questions distributed into 4 parts: characteristics of the unit, MDRO screening policy, policy regarding contact precautions, and ecology of the unit. RESULTS From April 2015 to June 2016, 73 of 301 ICUs (24%) participated in the survey. MDRO screening was performed on admission in 96% of ICUs, for at least 1 MDRO (78%). MDRO screening was performed weekly during ICU stay in 83% of ICUs. Preemptive isolation was initiated on admission in 82% of ICUs, mostly in a targeted way (71%). Imported and acquired MDRO rates >10% were reported in 44% and 27% of ICUs, respectively. An MDRO outbreak had occurred within the past 3 years in 48% of cases. CONCLUSION French ICUs have variable screening and isolation approaches for MDROs, as up to 10 combinations were met. Discrepancies with the 2009 national guidelines were observed. Very few ICUs practice without some form of screening and isolation of patients upon admission.
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Antibiotic Hybrids: the Next Generation of Agents and Adjuvants against Gram-Negative Pathogens? Clin Microbiol Rev 2018. [PMID: 29540434 DOI: 10.1128/cmr.00077-17] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The global incidence of drug-resistant Gram-negative bacillary infections has been increasing, and there is a dire need to develop novel strategies to overcome this problem. Intrinsic resistance in Gram-negative bacteria, such as their protective outer membrane and constitutively overexpressed efflux pumps, is a major survival weapon that renders them refractory to current antibiotics. Several potential avenues to overcome this problem have been at the heart of antibiotic drug discovery in the past few decades. We review some of these strategies, with emphasis on antibiotic hybrids either as stand-alone antibacterial agents or as adjuvants that potentiate a primary antibiotic in Gram-negative bacteria. Antibiotic hybrid is defined in this review as a synthetic construct of two or more pharmacophores belonging to an established agent known to elicit a desired antimicrobial effect. The concepts, advances, and challenges of antibiotic hybrids are elaborated in this article. Moreover, we discuss several antibiotic hybrids that were or are in clinical evaluation. Mechanistic insights into how tobramycin-based antibiotic hybrids are able to potentiate legacy antibiotics in multidrug-resistant Gram-negative bacilli are also highlighted. Antibiotic hybrids indeed have a promising future as a therapeutic strategy to overcome drug resistance in Gram-negative pathogens and/or expand the usefulness of our current antibiotic arsenal.
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Kim ES, Park KU, Lee SH, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee CT, Lee JH. Comparison of viral infection in healthcare-associated pneumonia (HCAP) and community-acquired pneumonia (CAP). PLoS One 2018; 13:e0192893. [PMID: 29447204 PMCID: PMC5813982 DOI: 10.1371/journal.pone.0192893] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 01/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background Although viruses are known to be the second most common etiological factor in community-acquired pneumonia (CAP), the respiratory viral profile of the patients with healthcare-associated pneumonia (HCAP) has not yet been elucidated. We investigated the prevalence and the clinical impact of respiratory virus infection in adult patients with HCAP. Methods Patients admitted with HCAP or CAP, between January and December 2016, to a tertiary referral hospital in Korea, were prospectively enrolled, and virus identification was performed using reverse-transcription polymerase chain reaction (RT-PCR). Results Among 452 enrolled patients (224 with HCAP, 228 with CAP), samples for respiratory viruses were collected from sputum or endotracheal aspirate in 430 (95.1%) patients and from nasopharyngeal specimens in 22 (4.9%) patients. Eighty-seven (19.2%) patients had a viral infection, and the proportion of those with viral infection was significantly lower in the HCAP than in the CAP group (13.8% vs 24.6%, p = 0.004). In both the HCAP and CAP groups, influenza A was the most common respiratory virus, followed by entero-rhinovirus. The seasonal distributions of respiratory viruses were also similar in both groups. In the HCAP group, the viral infection resulted in a similar length of hospital stay and in-hospital mortality as viral–bacterial coinfection and bacterial infection, and the CAP group showed similar results. Conclusions The prevalence of viral infection in patients with HCAP was lower than that in patients with CAP, and resulted in a similar prognosis as viral–bacterial coinfection or bacterial infection.
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Affiliation(s)
- Eun Sun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Hoon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yeon Joo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young-Jae Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
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Labricciosa FM, Sartelli M, Abbo LM, Barbadoro P, Ansaloni L, Coccolini F, Catena F. Epidemiology and Risk Factors for Isolation of Multi-Drug-Resistant Organisms in Patients with Complicated Intra-Abdominal Infections. Surg Infect (Larchmt) 2018; 19:264-272. [PMID: 29298133 DOI: 10.1089/sur.2017.217] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with complicated intra-abdominal infections (cIAIs) caused by multi-drug-resistant organisms (MDROs) have been identified as being at increased risk for adverse outcomes. Prompt identification and stratification of these patients is essential in the clinical management, allowing the physician timely optimization of empiric antimicrobial therapy while awaiting results of intra-operative cultures to streamline antibiotic treatment. METHODS The study is a secondary analysis from two prospective multi-center color surveillance studies. It included all consecutively hospitalized adult patients undergoing surgical procedures, interventional drainage, or conservative treatment with cIAIs, with positive cultures performer on intra-operative samples of peritoneal fluid or purulent exudate/discrete abscesses. Patients with pancreatitis and primary peritonitis were excluded. A case-control approach has been used to evaluate the factors associated with the isolation of a MDRO in enrolled patients. RESULTS Among 1986 patients included in the study, a total of 3534 micro-organisms were isolated from intra-peritoneal fluid samples; in 46.5% of cultures, two or more pathogens were identified. The MDROs represented 9.8% of the total of isolated micro-organisms. The overall incidence rate of MDROs was 13.9%. The MDROs were more frequently isolated in patients with health-care-associated cIAIs (25.4%). Multi-nomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of MDROs were previous antimicrobial therapy administered within seven days before operation, presence of severe cardiovascular disease, white blood cell count <4000/mL or >12,000/mL, cIAI acquired in a healthcare setting, and inadequate source control. CONCLUSIONS The study showed that knowledge of five easily recognizable variables-assessable on hospital admission or as soon as the surgical intervention is concluded-might guide the surgeon to identify patients with cIAIs caused by MDROs, and therefore to choose the most adequate empiric antimicrobial therapy for them.
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Affiliation(s)
- Francesco M Labricciosa
- 1 Department of Biomedical Science and Public Health, School of Hygiene and Preventive Medicine , Faculty of Medicine and Surgery, Università Politecnica delle Marche, Ancona, Italy
| | | | - Lilian M Abbo
- 3 Infection Prevention & Antimicrobial Stewardship Jackson Health System, University of Miami Miller School of Medicine , Miami, Florida
| | - Pamela Barbadoro
- 1 Department of Biomedical Science and Public Health, School of Hygiene and Preventive Medicine , Faculty of Medicine and Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Ansaloni
- 4 General Surgery Department, Papa Giovanni XXIII Hospital , Bergamo, Italy
| | - Federico Coccolini
- 4 General Surgery Department, Papa Giovanni XXIII Hospital , Bergamo, Italy
| | - Fausto Catena
- 5 Department of Emergency Surgery, Maggiore Hospital , Parma, Italy
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Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Serrano-Urrea R, Fernández-de-Las-Peñas C, Carrasco-Garrido P. Time trends in antibiotic consumption in the elderly: Ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003-2014). PLoS One 2017; 12:e0185869. [PMID: 29186144 PMCID: PMC5706724 DOI: 10.1371/journal.pone.0185869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background The purposes of this study were: firstly, to estimate time trends in the prevalence of prescription antibiotic consumption between 2003 and 2014; secondly, to identify the factors associated with the probability of consuming antibiotics during this period in elderly persons in Spain. Methods We analyzed data collected from the Spanish National Health Survey in 2003 (n = 21,650), 2006 (n = 29,478), and 2012 (n = 20,007) and from the European Health Interview Survey for Spain in 2009 (n = 22,188) and 2014 (n = 22,842). Antibiotic consumption was the dependent variable. We also analyzed sociodemographic features, self-perceived health status, lifestyle habits, comorbid diseases, and disabilities using logistic regression models. Results The prevalence of antibiotic consumption increased from 2003 to 2014 in both sexes. The variables that predicted antibiotic consumption (men; women) were secondary education (OR 1.38; OR 1.31), visits to a general practitioner (OR 2.05; OR 2.15), hospitalization (OR 1.91; OR 1.83), therapy with > 4 non-antibiotic drugs (OR 3.36; OR 5.84), instrumental activities of daily living (OR 1.50; OR 1.24), and activities of daily living (OR 1.39; OR 1.35). In contrast, age > 85 years was associated with low antibiotic consumption in both men (OR 0.81) and women (OR 0.88). Conclusions The prevalence of antibiotic prescription has increased in Spain in the last decade. Our study identified several factors that appear to affect antibiotic consumption in elderly persons, with potential implications for healthcare providers.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Isabel Jiménez-Trujillo
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. Universidad Rey Juan Carlos. Alcorcón, Madrid
| | - Ramón Serrano-Urrea
- Department of Mathematics. Faculty of Computer Science Engineering. University of Castilla-La Mancha. Albacete, Castilla la Mancha. Spain
| | - César Fernández-de-Las-Peñas
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
| | - Pilar Carrasco-Garrido
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department. ITPSE Research Group. Universidad Rey Juan Carlos. Alcorcón, Madrid. Spain
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Arnold KE, Williams NJ, Bennett M. 'Disperse abroad in the land': the role of wildlife in the dissemination of antimicrobial resistance. Biol Lett 2017; 12:rsbl.2016.0137. [PMID: 27531155 DOI: 10.1098/rsbl.2016.0137] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/21/2016] [Indexed: 12/25/2022] Open
Abstract
Antimicrobial resistance (AMR) has been detected in the microbiota of many wildlife species, including long-distance migrants. Inadequately treated wastes from humans and livestock dosed with antimicrobial drugs are often assumed to be the main sources of AMR to wildlife. While wildlife populations closely associated with human populations are more likely to harbour clinically important AMR related to that found in local humans and livestock, AMR is still common in remote wildlife populations with little direct human influence. Most reports of AMR in wildlife are survey based and/or small scale, so researchers can only speculate on possible sources and sinks of AMR or the impact of wildlife AMR on clinical resistance. This lack of quantitative data on the flow of AMR genes and AMR bacteria across the natural environment could reflect the numerous AMR sources and amplifiers in the populated world. Ecosystems with relatively simple and well-characterized potential inputs of AMR can provide tractable, but realistic, systems for studying AMR in the natural environment. New tools, such as animal tracking technologies and high-throughput sequencing of resistance genes and mobilomes, should be integrated with existing methodologies to understand how wildlife maintains and disperses AMR.
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Affiliation(s)
- Kathryn E Arnold
- Environment Department, Faculty of Sciences, University of York, Heslington, York YO10 5NG, UK
| | - Nicola J Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston CH64 7TE, UK
| | - Malcolm Bennett
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire LE12 5RD, UK
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Implementation of daily chlorhexidine bathing to reduce colonization by multidrug-resistant organisms in a critical care unit. Am J Infect Control 2017; 45:1014-1017. [PMID: 28431846 DOI: 10.1016/j.ajic.2017.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU). METHODS From May 2010-January 2011, we screened patients admitted to a 24-bed ICU for and methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant gram-negative bacilli (FQRGNB). We calculated and plotted monthly incidence and prevalence of colonization of these MDROs. RESULTS Prevalence decreased in the immediate aftermath of daily CHG bathing implementation and generally remained at that level throughout the observation period. We observed low rates of incidence of MDRO colonization with VRE>FQRGNB>MRSA. Monthly prevalence of colonization and incidence for the composite of MRSA, VRE, and/or FQRGNB was 1.9%-27.9% and 0-1.1/100 patient-days, respectively. CONCLUSIONS Following the implementation of daily CHG bathing, the incidence of MDROs remained low and constant over time, whereas the prevalence decreased immediately after the implementation.
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Sonti R, Conroy ME, Welt EM, Hu Y, Luta G, Jamieson DB. Modeling risk for developing drug resistant bacterial infections in an MDR-naive critically ill population. Ther Adv Infect Dis 2017; 4:95-103. [PMID: 28748088 DOI: 10.1177/2049936117715403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To create a model predictive of an individual's risk of developing a de novo multidrug-resistant (MDR) infection while in the intensive care unit (ICU). METHODS This is a case-control study in which 189 ICU patients diagnosed with their first infection with an MDR organism were compared on the basis of demographic, past medical and clinical variables to randomly selected ICU patients without such an infection, era-matched in a 2:1 ratio. A prediction tool was derived using multivariate logistic regression. RESULTS Five features remained predictive of developing an infection with a drug-resistant pathogen: hospitalization within a year [adjusted odds ratio (OR) 2.14], chronic hemodialysis (3.86), underlying oxygen-dependent pulmonary disease (1.86), endotracheal intubation within 24 h (2.46) and reason for ICU admission (respiratory failure 2.89, non-respiratory failure, non-shock presentation 1.85). Using a scoring system (0-7 points) based on the adjusted OR, risk categories were derived (low: 0-2 points, intermediate: 3-4 points and high risk: 5-7 points). The negative predictive value at a score cutoff of 2 is excellent (88.9%). CONCLUSIONS A clinical prediction rule comprised of five easily measured ICU variables reasonably discriminates between patients who will develop their first MDR infection versus those who will not.
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Affiliation(s)
- Rajiv Sonti
- Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Megan E Conroy
- Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Elena M Welt
- Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Yi Hu
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, USA
| | - Daniel B Jamieson
- Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
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Djibré M, Fedun S, Le Guen P, Vimont S, Hafiani M, Fulgencio JP, Parrot A, Denis M, Fartoukh M. Universal versus targeted additional contact precautions for multidrug-resistant organism carriage for patients admitted to an intensive care unit. Am J Infect Control 2017; 45:728-734. [PMID: 28285725 DOI: 10.1016/j.ajic.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs. MATERIALS AND METHODS This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU. During the first 6-month period, screening for MDRO carriage and ACPs were performed in all patients. During the second 6-month period, screening was maintained, but ACP use was guided by the presence of at least 1 defined risk factor for MDRO. RESULTS During both periods, 33 (10%) and 30 (10%) among 327 and 297 admissions were, respectively, associated with a positive admission MDRO carriage. During both periods, a second screening was performed in 147 (45%) and 127 (43%) patients. Altogether, the rate of acquired MDRO (positive screening or clinical specimen) was similar during both periods (10% [n = 15] and 11.8% [n = 15], respectively; P = .66). CONCLUSIONS The results of our study contribute to support the safety of an isolation-targeted screening policy on ICU admission compared with universal screening and isolation regarding the rate of ICU-acquired MDRO colonization or infection.
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Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Larson E, Merkens W, Mielke M, Oltmanns P, Ross B, Rotter M, Schmithausen RM, Sonntag HG, Trautmann M. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc05. [PMID: 28451516 PMCID: PMC5388835 DOI: 10.3205/dgkh000290] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This consensus paper is based on presentations, subsequent discussions and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epidemiology and the inherent properties of Gram-negative bacteria, elucidating the patterns of the spread of antibiotic resistance, highlighting reservoirs as well as transmission pathways and risk factors for infection, mortality, treatment and prevention options as well as the consequences of their prevalence in livestock. Following a global, One Health approach and based on the evaluation of the existing knowledge about these pathogens, this paper gives recommendations for prevention and infection control measures as well as proposals for various target groups to tackle the threats posed by Gram-negative bacteria and prevent the spread and emergence of new antibiotic resistances.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Bärbel Christiansen
- Department of Internal Hygiene, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Elaine Larson
- School of Nursing, Columbia University, New York, USA.,Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Birgit Ross
- Hospital Hygiene, Essen University Hospital, Essen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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Abstract
Prescribing antibiotics is an essential component of initial therapy in sepsis. Early antibiotics are an important component of therapy, but speed of administration should not overshadow the patient-specific characteristics that determine the optimal breadth of antimicrobial therapy. Cultures should be drawn before antibiotic therapy if it does not significantly delay administration. Combination antibiotic therapy against gram-negative infections is not routinely required, and combination therapy involving vancomycin and piperacillin/tazobactam is associated with an increase in acute kidney injury. Emergency practitioners should be aware of special considerations in the administration and dosing of antibiotics in order to deliver optimal care to septic patients.
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Affiliation(s)
- Michael G Allison
- Critical Care Medicine, St. Agnes Hospital, 900 South Caton Avenue, Baltimore, MD 21229, USA
| | - Emily L Heil
- Department of Pharmacy, University of Maryland Medical Center, 29 South Greene Street, Room 400, Baltimore, MD 21201, USA
| | - Bryan D Hayes
- Department of Emergency Medicine, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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Akgul F, Bozkurt I, Sunbul M, Esen S, Leblebicioglu H. Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study. Pathog Glob Health 2016; 110:321-325. [PMID: 27903130 DOI: 10.1080/20477724.2016.1254976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted.
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Affiliation(s)
- Fethiye Akgul
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Ilkay Bozkurt
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Mustafa Sunbul
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Saban Esen
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Hakan Leblebicioglu
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
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Abstract
Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI), a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD), the Ebp pilus's adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE), revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI. IMPORTANCE Urinary catheterization is a routine medical procedure, and it has been estimated that 30 million Foley catheters are used annually in the United States. Importantly, placement of a urinary catheter renders the patient susceptible to developing a catheter-associated urinary tract infection, accounting for 1 million cases per year. Additionally, these infections can lead to serious complications, including bloodstream infection and death. Enterococcus strains are a common cause of these infections, and management of enterococcal infections has been more difficult in recent years due to the development of antibiotic resistance and the ability of strains to disseminate, resulting in a major threat in hospital settings. In this study, we developed an antibiotic-sparing treatment that is effective against diverse enterococcal isolates, including vancomycin-resistant enterococci, during catheter-associated urinary tract infections.
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Xayarath B, Freitag NE. When being alone is enough: noncanonical functions of canonical bacterial quorum-sensing systems. Future Microbiol 2016; 11:1447-1459. [PMID: 27750441 DOI: 10.2217/fmb-2016-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A number of bacterial pathogens are capable of detecting the presence of other bacteria located within their surrounding niche through a process of bacterial signaling and cell-to-cell communication commonly referred to as quorum sensing (QS). QS systems are commonly now described in the context of collective behaviors exhibited by groups of bacteria coordinating diverse arrays of physiological functions to enhance survival of the community. However, QS systems have also been implicated in a variety of processes distinct from the measure of bacterial cell density. This review will highlight noncanonical adaptations of canonical QS systems that have evolved to enable bacteria to detect nonself individuals within a population or to detect occupation of confined spaces.
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Affiliation(s)
- Bobbi Xayarath
- Department of Microbiology & Immunology, University of Illinois at Chicago, Chicago, IL 60612-7344, USA
| | - Nancy E Freitag
- Department of Microbiology & Immunology, University of Illinois at Chicago, Chicago, IL 60612-7344, USA
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Fan Y, Wang X, Li L, Yao Z, Chen S, Ye X. Potential Relationship between Phenotypic and Molecular Characteristics in Revealing Livestock-Associated Staphylococcus aureus in Chinese Humans without Occupational Livestock Contact. Front Microbiol 2016; 7:1517. [PMID: 27729903 PMCID: PMC5037164 DOI: 10.3389/fmicb.2016.01517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 01/20/2023] Open
Abstract
While some studies have defined Staphylococcus aureus based on its clonal complex and resistance pattern, few have explored the relations between the genetic lineages and antibiotic resistance patterns and immune evasion cluster (IEC) genes. Our aim was to investigate the potential relationship between phenotypic and molecular characteristics so as to reveal livestock-associated S. aureus in humans. The study participants were interviewed, and they provided two nasal swabs for S. aureus analysis. All S. aureus and methicillin-resistant S. aureus (MRSA) were tested for antibiotic susceptibility, multilocus sequence type and IEC genes. Of the 1162 participants, 9.3% carried S. aureus, including MRSA (1.4%) and multidrug-resistant S. aureus (MDRSA, 2.8%). The predominant multidrug-resistant pattern among MDRSA isolates was non-susceptibility to erythromycin, clindamycin and tetracycline. The most common S. aureus genotypes were ST7, ST6, ST188, and ST59, and the predominant MRSA genotype was ST7. Notably, the livestock-associated S. aureus isolates (IEC-negative CC9, IEC-negative tetracycline-resistant CC398, and IEC-negative tetracycline-resistant CC5) were found in people with no occupational livestock contact. These findings reveal a potential relationship between S. aureus CCs and IEC genes and antibiotic resistance patterns in defining livestock-associated S. aureus in humans and support growing concern about the potential livestock-to-human transmission of livestock-associated S. aureus by non-occupational livestock contact.
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Affiliation(s)
- Yanping Fan
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
| | - Xiaolin Wang
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
| | - Ling Li
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
| | - Sidong Chen
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University Guangzhou, China
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Bacteremia due to ESKAPE pathogens: An emerging problem in cancer patients. J Egypt Natl Canc Inst 2016; 28:157-62. [DOI: 10.1016/j.jnci.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/08/2016] [Accepted: 05/13/2016] [Indexed: 11/22/2022] Open
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Whiddon AR, Dawson KL, Fuentes A, Perez KK, Peterson LE, Kaleekal T. Postoperative antimicrobials after lung transplantation and the development of multidrug-resistant bacterial andClostridium difficileinfections: an analysis of 500 non-cystic fibrosis lung transplant patients. Clin Transplant 2016; 30:767-73. [DOI: 10.1111/ctr.12746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Amaris Fuentes
- CHI St. Luke's Health - Baylor St. Luke's Medical Center; Houston TX USA
| | - Katherine K. Perez
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
| | - Leif E. Peterson
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
| | - Thomas Kaleekal
- Houston Methodist Hospital; Houston TX USA
- Houston Methodist Research Institute; Houston TX USA
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Factores de riesgo asociados a infecciones por bacterias multirresistentes derivadas de la atención en salud en una institución hospitalaria de la ciudad de Medellín 2011-2014. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Toubiana J, Timsit S, Ferroni A, Grasseau M, Nassif X, Lortholary O, Zahar JR, Chalumeau M. Community-Onset Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France. Medicine (Baltimore) 2016; 95:e3163. [PMID: 27015202 PMCID: PMC4998397 DOI: 10.1097/md.0000000000003163] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.
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Affiliation(s)
- Julie Toubiana
- From the Department of General Pediatrics and Pediatric Infectious Disease (JT, MG, MC); Department of Pediatric Emergency (ST); Department of Microbiology (AF, XN, J-RZ); Department of Infectious Diseases and Tropical Medicine (OL), Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université Paris Descartes, IHU Imagine, Paris; and Unité de Prévention et de Lutte contre les Infections Nosocomiales (J-RZ), CHU d'Angers, Université d'Angers, Angers, France
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Cerceo E, Deitelzweig SB, Sherman BM, Amin AN. Multidrug-Resistant Gram-Negative Bacterial Infections in the Hospital Setting: Overview, Implications for Clinical Practice, and Emerging Treatment Options. Microb Drug Resist 2016; 22:412-31. [PMID: 26866778 DOI: 10.1089/mdr.2015.0220] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The increasing prevalence of infections due to multidrug-resistant (MDR) gram-negative bacteria constitutes a serious threat to global public health due to the limited treatment options available and the historically slow pace of development of new antimicrobial agents. Infections due to MDR strains are associated with increased morbidity and mortality and prolonged hospitalization, which translates to a significant burden on healthcare systems. In particular, MDR strains of Enterobacteriaceae (especially Klebsiella pneumoniae and Escherichia coli), Pseudomonas aeruginosa, and Acinetobacter baumannii have emerged as particularly serious concerns. In the United States, MDR strains of these organisms have been reported from hospitals throughout the country and are not limited to a small subset of hospitals. Factors that have contributed to the persistence and spread of MDR gram-negative bacteria include the following: overuse of existing antimicrobial agents, which has led to the development of adaptive resistance mechanisms by bacteria; a lack of good antimicrobial stewardship such that use of multiple broad-spectrum agents has helped perpetuate the cycle of increasing resistance; and a lack of good infection control practices. The rising prevalence of infections due to MDR gram-negative bacteria presents a significant dilemma in selecting empiric antimicrobial therapy in seriously ill hospitalized patients. A prudent initial strategy is to initiate treatment with a broad-spectrum regimen pending the availability of microbiological results allowing for targeted or narrowing of therapy. Empiric therapy with newer agents that exhibit good activity against MDR gram-negative bacterial strains such as tigecycline, ceftolozane-tazobactam, ceftazidime-avibactam, and others in the development pipeline offer promising alternatives to existing agents.
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Affiliation(s)
- Elizabeth Cerceo
- 1 Division of Hospital Medicine, Cooper Medical School of Rowan University , Camden, New Jersey
| | - Steven B Deitelzweig
- 2 Department of Hospital Medicine, Ochsner Clinical School, Ochsner Health Center , New Orleans, Louisiana
| | | | - Alpesh N Amin
- 4 Department of Medicine, University of California , Irvine, California
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Dong ZM, Chidi AP, Goswami J, Han K, Simmons RL, Rosengart MR, Tsung A. Prior inpatient admission increases the risk of post-operative infection in hepatobiliary and pancreatic surgery. HPB (Oxford) 2015; 17:1105-12. [PMID: 26333471 PMCID: PMC4644362 DOI: 10.1111/hpb.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatobiliary and pancreatic (HPB) operations have a high incidence of post-operative nosocomial infections. The aim of the present study was to determine whether hospitalization up to 1 year before HPB surgery is associated with an increased risk of post-operative infection, surgical-site infection (SSI) and infection resistant to surgical chemoprophylaxis. METHODS A retrospective cohort study of patients undergoing HPB surgeries between January 2008 and June 2013 was conducted. A multivariable logistic regression model was used for controlling for potential confounders to determine the association between pre-operative admission and post-operative infection. RESULTS Of the 1384 patients who met eligibility criteria, 127 (9.18%) experienced a post-operative infection. Pre-operative hospitalization was independently associated with an increased risk of a post-operative infection [adjusted odds ratio (aOR): 1.61, 95% confidence interval [CI]: 1.06-2.46] and SSI (aOR: 1.79, 95% CI: 1.07-2.97). Pre-operative hospitalization was also associated with an increased risk of post-operative infections resistant to standard pre-operative antibiotics (OR: 2.64, 95% CI: 1.06-6.59) and an increased risk of resistant SSIs (OR: 3.99, 95% CI: 1.25-12.73). DISCUSSION Pre-operative hospitalization is associated with an increased incidence of post-operative infections, often with organisms that are resistant to surgical chemoprophylaxis. Patients hospitalized up to 1 year before HPB surgery may benefit from extended spectrum chemoprophylaxis.
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Affiliation(s)
- Zachary M Dong
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Alexis P Chidi
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Julie Goswami
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Katrina Han
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Richard L Simmons
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of MedicinePittsburgh, PA, USA
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Tabatabaei SM, Behmanesh Pour F, Osmani S. Epidemiology of Hospital-Acquired Infections and Related Anti-Microbial Resistance Patterns in a Tertiary-Care Teaching Hospital in Zahedan, Southeast Iran. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/iji-29079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ceruso M, Carta F, Osman SM, Alothman Z, Monti SM, Supuran CT. Inhibition studies of bacterial, fungal and protozoan β-class carbonic anhydrases with Schiff bases incorporating sulfonamide moieties. Bioorg Med Chem 2015; 23:4181-4187. [DOI: 10.1016/j.bmc.2015.06.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
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Capasso C, Supuran CT. Bacterial, fungal and protozoan carbonic anhydrases as drug targets. Expert Opin Ther Targets 2015; 19:1689-704. [PMID: 26235676 DOI: 10.1517/14728222.2015.1067685] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The carbonic anhydrases (CAs, EC 4.2.1.1), a group of ubiquitously expressed metalloenzymes, are involved in numerous physiological and pathological processes, as well as in the growth and virulence of pathogens belonging to bacteria, fungi and protozoa. AREAS COVERED CAs belonging to at least four genetic families, the α-, β-, γ- and η-CAs, were discovered and characterized in many pathogens: i) Bacteria encode enzymes from one or more such families, which were investigated as potential drug targets. Inhibition of bacterial CAs by sulfonamides/phenol derivatives lead to inhibition of growth of the pathogen for Helicobacter pylori, Mycobacterium tuberculosis, Brucella suis; ii) Fungi encode for α- and β-CAs, and inhibitors of the sulfonamide, thiol or dithiocarbamate type inhibited the growth of some of them (Malassezia globosa, Candida albicans, Crytpococcus neoformans, etc) in vivo; and iii) Protozoa encode α-, β- or η-CAs. Sulfonamide, thiols and hydroxamates effectively killed such parasites (Trypanosoma cruzi, Leishmania donovani chagasi, Plasmodium falciparum) in vivo. EXPERT OPINION None of the microorganism CAs is validated as drug targets as yet, but the inhibitors designed against many such enzymes showed interesting in vitro/in vivo results. By interfering with the activity of CAs from microorganisms, both pH homeostasis as well as crucial biosynthetic reactions are impaired, which lead to significant antiinfective effects, not yet exploited for obtaining pharmacological agents. As resistance to the clinically used antiinfectives is a serious healthcare problem worldwide, inhibition of parasite CAs may constitute an alternative approach for obtaining such agents with novel mechanisms of action.
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Affiliation(s)
- Clemente Capasso
- a 1 CNR, Institute of Biosciences and Bioresorces (IBBR) , via P. Castellino, 111, 80131, Napoli, Italy
| | - Claudiu T Supuran
- b 2 University of Florence, Neurofarba Department, Section of Pharmaceutical Chemistry , Via U. Schiff 6, 5019 Sesto Fiorentino, Firenze, Italy
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Bailey KL, Kalil AC. Ventilator-Associated Pneumonia (VAP) with Multidrug-Resistant (MDR) Pathogens: Optimal Treatment? Curr Infect Dis Rep 2015; 17:494. [PMID: 26092246 DOI: 10.1007/s11908-015-0494-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ventilator-associated pneumonia (VAP) due to multidrug-resistant bacteria (MDR) is an emerging problem worldwide. Both gram-negative and gram-positive microorganisms are associated with VAP. We first describe the magnitude of the problem of MDR VAP followed by its clinical impact on survival outcomes, with the primary aim to review the optimal antibiotic choices to treat patients with MDR VAP. We discuss the challenges of intravenous and inhaled antibiotic treatments, as well as of monotherapy and combination antimicrobial therapies.
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Affiliation(s)
- Kristina L Bailey
- Pulmonary, Critical Care Allergy and Sleep Medicine Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Anvarinejad M, Japoni A, Davarpanah MA, Mahmudi H, Mammina C, Vazin A. Phenotypic and Molecular Epidemiology of Acinetobacter calcoaceticus baumannii Complex Strains Spread at Nemazee Hospital of Shiraz, Iran. Jundishapur J Microbiol 2015; 8:e19180. [PMID: 26322204 PMCID: PMC4548468 DOI: 10.5812/jjm.8(5)2015.19180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 11/09/2014] [Accepted: 11/24/2014] [Indexed: 01/25/2023] Open
Abstract
Background Acinetobacter calcoaceticus baumannii (ACB) complex are Gram-negative opportunistic bacteria with low virulence properties. Their resistance to antibiotics has become a matter of concern in hospital infections. Objectives The present study aimed to determine the prevalence and antimicrobial susceptibility of ACB isolates collected from the Nemazee hospital of Shiraz. In addition, Pulsed Field Gel Electrophoresis (PFGE) was used to determine the genetic patterns of these strains. Patients and Methods In this cross-sectional study, 93 strains of ACB complex were isolated from patients of Nemazee hospital, Shiraz, Iran. The antibiotic susceptibility patterns of the isolates to the following 15 antibiotics were determined: gentamicin, ticarcillin, ceftazidime, co-trimoxazole, imipenem, piperacillin tazobactam, amikacin, aztreonam, sulbactam, meropenem, tobramycin, cefotaxime, ceftriaxone, colistin, polymyxin B. Pulsed Field Gel Electrophoresis was used to determine the clonal relationship of these strains. Results Most of the isolates were found to be resistant to cefotaxime, co-trimoxazole, ceftriaxone, aztreonam, ceftazidime and ticarcillin (90%), and the least resistance was observed to colistin and polymyxin B. Among the 93 tested samples, 35 antimicrobial susceptibility patterns and 47 PFGE patterns were obtained. Conclusions High resistance to antibiotics was observed among the strains of ACB complex and the least resistance was towards colistin and polymyxin B, indicating that these antibiotics could be effective for treatment, in case there is no other choice. Using PFGE, the similarity between some strains of Acinetobacter was determined, which indicated epidemics in different parts of the hospital; such epidemics can in turn lead to increased incidence of Acinetobacter infections.
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Affiliation(s)
- Mojtaba Anvarinejad
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Aziz Japoni
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Ali Davarpanah
- Gastroenterohepatology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hossein Mahmudi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Caterina Mammina
- Department of Sciences for Health Promotion “G. D’Alessandro”, Palermo, Italy
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Afsaneh Vazin, Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7112424128, Fax: +98-7112424126, E-mail:
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