51
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Tran GM, Ho-Le TP, Ha DT, Tran-Nguyen CH, Nguyen TSM, Pham TTN, Nguyen TA, Nguyen DA, Hoang HQ, Tran NV, Nguyen TV. Patterns of antimicrobial resistance in intensive care unit patients: a study in Vietnam. BMC Infect Dis 2017; 17:429. [PMID: 28619105 PMCID: PMC5472965 DOI: 10.1186/s12879-017-2529-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022] Open
Abstract
Background Antimicrobial resistance has emerged as a major concern in developing countries. The present study sought to define the pattern of antimicrobial resistance in ICU patients with ventilator-associated pneumonia. Methods Between November 2014 and September 2015, we enrolled 220 patients (average age ~ 71 yr) who were admitted to ICU in a major tertiary hospital in Ho Chi Minh City, Vietnam. Data concerning demographic characteristics and clinical history were collected from each patient. The Bauer–Kirby disk diffusion method was used to detect the antimicrobial susceptibility. Results Antimicrobial resistance was commonly found in ceftriaxone (88%), ceftazidime (80%), ciprofloxacin (77%), cefepime (75%), levofloxacin (72%). Overall, the rate of antimicrobial resistance to any drug was 93% (n = 153/164), with the majority (87%) being resistant to at least 2 drugs. The three commonly isolated microorganisms were Acinetobacter (n = 75), Klebsiella (n = 39), and Pseudomonas aeruginosa (n = 29). Acinetobacter baumannii were virtually resistant to ceftazidime, ceftriaxone, piperacilin, imipenem, meropenem, ertapenem, ciprofloxacin and levofloxacin. High rates (>70%) of ceftriaxone and ceftazidime-resistant Klebsiella were also observed. Conclusion These data indicated that critically ill patients on ventilator in Vietnam were at disturbingly high risk of antimicrobial resistance. The data also imply that these Acinetobacter, Klebsiella, and Pseudomonas aeruginosa and multidrug resistance pose serious therapeutic problems in ICU patients. A concerted and systematic effort is required to rapidly identify high risk patients and to reduce the burden of antimicrobial resistance in developing countries.
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Affiliation(s)
- Giang M Tran
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam.
| | - Thao P Ho-Le
- Centre for Health Technologies, University of Technology Sydney, Sydney, Australia
| | - Duc T Ha
- National Hospital of Can Tho, Can Tho City, Vietnam
| | - Chau H Tran-Nguyen
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Tuyet S M Nguyen
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Thao T N Pham
- University of Medical and Pharmacy, Ho Chi Minh City, Vietnam.,Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tuyet A Nguyen
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Dung A Nguyen
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Hoa Q Hoang
- ICU, Gia Dinh People's Hospital, 1 No Trang Long Street, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Ngoc V Tran
- University of Medical and Pharmacy, Ho Chi Minh City, Vietnam.,Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tuan V Nguyen
- Centre for Health Technologies, University of Technology Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wale, Sydney, Australia
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52
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Xie J, Peters BM, Li B, Li L, Yu G, Xu Z, Shirtliff ME. Clinical features and antimicrobial resistance profiles of important Enterobacteriaceae pathogens in Guangzhou representative of Southern China, 2001–2015. Microb Pathog 2017; 107:206-211. [DOI: 10.1016/j.micpath.2017.03.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 11/27/2022]
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53
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Yang X, Goswami S, Gorityala BK, Domalaon R, Lyu Y, Kumar A, Zhanel GG, Schweizer F. A Tobramycin Vector Enhances Synergy and Efficacy of Efflux Pump Inhibitors against Multidrug-Resistant Gram-Negative Bacteria. J Med Chem 2017; 60:3913-3932. [DOI: 10.1021/acs.jmedchem.7b00156] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Xuan Yang
- Department
of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Sudeep Goswami
- Department
of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | | | - Ronald Domalaon
- Department
of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Yinfeng Lyu
- Department
of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Institute
of Animal Nutrition, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Ayush Kumar
- Department
of Microbiology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department
of Medical Microbiology, University of Manitoba, Winnipeg, MB R3T 1R9, Canada
| | - George G. Zhanel
- Department
of Medical Microbiology, University of Manitoba, Winnipeg, MB R3T 1R9, Canada
| | - Frank Schweizer
- Department
of Chemistry, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department
of Medical Microbiology, University of Manitoba, Winnipeg, MB R3T 1R9, Canada
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54
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Lyu Y, Yang X, Goswami S, Gorityala BK, Idowu T, Domalaon R, Zhanel GG, Shan A, Schweizer F. Amphiphilic Tobramycin-Lysine Conjugates Sensitize Multidrug Resistant Gram-Negative Bacteria to Rifampicin and Minocycline. J Med Chem 2017; 60:3684-3702. [PMID: 28409644 DOI: 10.1021/acs.jmedchem.6b01742] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chromosomally encoded low membrane permeability and highly efficient efflux systems are major mechanisms by which Pseudomonas aeruginosa evades antibiotic actions. Our previous reports have shown that amphiphilic tobramycin-fluoroquinolone hybrids can enhance efficacy of fluoroquinolone antibiotics against multidrug-resistant (MDR) P. aeruginosa isolates. Herein, we report on a novel class of tobramycin-lysine conjugates containing an optimized amphiphilic tobramycin-C12 tether that sensitize Gram-negative bacteria to legacy antibiotics. Combination studies indicate the ability of these conjugates to synergize rifampicin and minocycline against MDR and extensively drug resistant (XDR) P. aeruginosa isolates and enhance efficacy of both antibiotics in the Galleria mellonella larvae in vivo infection model. Mode of action studies indicate that the amphiphilic tobramycin-lysine adjuvants enhance outer membrane cell penetration and affect the proton motive force, which energizes efflux pumps. Overall, this study provides a strategy for generating effective antibiotic adjuvants that overcome resistance of rifampicin and minocycline in MDR and XDR Gram-negative bacteria including P. aeruginosa.
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Affiliation(s)
- Yinfeng Lyu
- Institute of Animal Nutrition, Northeast Agricultural University , Harbin, Heilongjiang 150030, P.R. China.,Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada
| | - Xuan Yang
- Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada
| | - Sudeep Goswami
- Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada
| | | | - Temilolu Idowu
- Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada
| | - Ronald Domalaon
- Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, University of Manitoba , Winnipeg, MB R3T 1R9, Canada
| | - Anshan Shan
- Institute of Animal Nutrition, Northeast Agricultural University , Harbin, Heilongjiang 150030, P.R. China
| | - Frank Schweizer
- Department of Chemistry, University of Manitoba , Winnipeg, MB R3T 2N2, Canada.,Department of Medical Microbiology/Infectious Diseases, University of Manitoba , Winnipeg, MB R3T 1R9, Canada
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Comparison of 11 Phenotypic Assays for Accurate Detection of Carbapenemase-Producing Enterobacteriaceae. J Clin Microbiol 2017; 55:1046-1055. [PMID: 28077701 DOI: 10.1128/jcm.02338-16] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/07/2017] [Indexed: 12/25/2022] Open
Abstract
Early identification of carbapenemase-producing Enterobacteriaceae (CPE) is essential to prevent their dissemination within health care settings. Our objective was to evaluate the accuracy of 11 phenotypic assays for the detection of CPE. Two collections of carbapenem-resistant Enterobacteriaceae (CRE) isolates were evaluated, including 191 retrospective isolates (122 CP-CRE and 69 non-CP isolates) as well as 45 prospective clinical isolates (15 CP-CRE and 30 non-CP-CRE) obtained over a 3-month period. The sensitivity and specificity of each test was determined, with molecular genotype serving as the gold standard. Among the retrospective cohort, sensitivities ranged from 72% for the boronic acid synergy test for the detection of KPC producers to ≥98% for the modified Carba NP, the Rapidec Carba NP, the manual Blue Carba, and the modified carbapenem inactivation method for the detection of any CPE. Sensitivity differed among tests across enzyme classes. All assays had excellent specificity exceeding 95%, with the exception of the boronic acid synergy test (88%) and modified Hodge test (91%). Prospectively, 45 CRE isolates were encountered over a 3-month period, including 15 CPE (33%) and 30 non-CP-CRE (67%). Results from the prospective cohort were similar. However, a decrease in specificity was observed across most tests, likely due to restricted inclusion of non-CP-CRE to assess the specificity of the assays. Overall, accuracy of CPE detection varied across phenotypic tests. Local epidemiology of CP genotypes, turnaround time, and ease of incorporation into the laboratory workflow should be considered when selecting a phenotypic assay for clinical use.
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Pei G, Yin W, Zhang Y, Wang T, Mao Y, Sun Y. Efficacy and safety of biapenem in treatment of infectious disease: a meta-analysis of randomized controlled trials. J Chemother 2017; 28:28-36. [PMID: 25407221 DOI: 10.1179/1973947814y.0000000226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Biapenem is a parenteral carbapenem antibiotic that has powerful antibacterial activity. The aim of this study is to evaluate the efficacy and safety of biapenem for the treatment of infection diseases. METHODS We performed a meta-analysis of published randomized-controlled trials (RCTs) identified in Embase, PubMed, and Cochrane library that compared the efficacy and safety of biapenem with other antibiotic regimes for the treatment of patients with infections. RESULTS Eight RCTs were included in the meta-analysis, involving totally 1685 patients with lower respiratory tract infections (LRTIs), complicated urinary tract infections (cUTIs), and complicated intra-abdominal infections (cIAIs). There was no difference found between the patients with LRTIs, cUTIs, or cIAIs treated with biapenem and comparators, regarding treatment success and adverse events. CONCLUSION This meta-analysis provides evidence that biapenem can be used as effectively and safely as imipenem-cilstatin or meropenem, for the treatment of patients with LRTIs, cUTIs, and cIAIs. It may be a considerable option for the treatment of these infections.
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Affiliation(s)
- Guangsheng Pei
- a Department of Respiratory Medicine , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
| | - Weijiao Yin
- b Department of Oncology , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
| | - Yongmei Zhang
- a Department of Respiratory Medicine , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
| | - Tongsheng Wang
- a Department of Respiratory Medicine , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
| | - Yimin Mao
- a Department of Respiratory Medicine , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
| | - Yuxia Sun
- a Department of Respiratory Medicine , The First Affiliated Hospital of Henan University of Science and Technology , Luoyang , PR China
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57
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Salerno F, Borzio M, Pedicino C, Simonetti R, Rossini A, Boccia S, Cacciola I, Burroughs AK, Manini MA, La Mura V, Angeli P, Bernardi M, Dalla Gasperina D, Dionigi E, Dibenedetto C, Arghittu M. The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study. Liver Int 2017; 37:71-79. [PMID: 27364035 DOI: 10.1111/liv.13195] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/17/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation. RESULTS Three hundred and thirteen culture-positive infections (173 community acquired [CA] and 140 hospital acquired [HA]) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone-resistant Gram-negative isolates were 48%, 44% were extended-spectrum beta-lactamase producers and 9% carbapenem resistant. In 83/313 culture-positive infections (27%), multidrug-resistant agents (MDRA) were isolated. This prevalence did not differ between CA and HA infections. MDRA were identified in 17 of 37 patients on quinolone prophylaxis, and in 46 of 166 not on prophylaxis (45% vs 27%; P<.03). In 287 cases an empiric antibiotic therapy was undertaken, in 37 (12.9%) this therapy failed. The in-hospital mortality rate of this subset of patients was significantly higher compared to patients who received an effective broad(er)-spectrum therapy (P=.038). During a 3-month follow-up, 56/203 culture-positive patients (27.6%) died, 24/63 who have had MDRA-related infections (38%) and 32/140 who have had antibiotic-susceptible infections (22.8%) (P=.025). Multivariate analysis disclosed MDRA infection, age, hepatocellular carcinoma, bilirubin, international normalized ratio and the occurrence of portal hypertension-related complications independent predictors of death. CONCLUSIONS Infection by MDRA is frequent in patients with cirrhosis and the prognosis is severe, especially in patients unresponsive to empiric antibiotic therapy.
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Affiliation(s)
- Francesco Salerno
- Medicina Interna, IRCCS San Donato, Università degli studi di Milano, San Donato Milanese, Milano, Italy
| | - Mauro Borzio
- Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy
| | - Claudia Pedicino
- Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy
| | - Rosa Simonetti
- Unità di Medicina 2, Ospedali Riuniti, Villa Sofia Cervello, Palermo, Italy
| | - Angelo Rossini
- Unità di Epatologia, Dipartimento di Medicina, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - Sergio Boccia
- Unità di Gastroenterologia, Azienda Universitaria Ospedaliera di Ferrara, Ferrara, Italy
| | - Irene Cacciola
- Unità di Epatologia Clinica e Biomolecolare, Policlinico Universitario, Messina, Italy
| | | | - Matteo A Manini
- Gastroenterologia-1, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Vincenzo La Mura
- Medicina Interna, IRCCS San Donato, Università degli studi di Milano, San Donato Milanese, Milano, Italy
| | - Paolo Angeli
- Medicina Clinica e Sperimentale, Policlinico Universitario, Padova, Italy
| | - Mauro Bernardi
- Unità di Semeiotica Medica, Department of Clinical Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Dalla Gasperina
- Sezione di Malattie Infettive, Dipartimento di Medicina Clinica, Università dell'Insubria, Varese, Italy
| | - Elena Dionigi
- Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy
| | - Clara Dibenedetto
- Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy
| | - Milena Arghittu
- Unità di Gastroenterologia e Microbiologia, Ospedale Predabissi, Melegnano, Italy
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58
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[Risk factors for methicillin-resistant Staphylococcus aureus bacteremia: A multicenter matched case-control study]. BIOMEDICA 2016; 36:612-619. [PMID: 27992988 DOI: 10.7705/biomedica.v36i4.3193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/07/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus is a frequent pathogen at critical care services. Its presence leads to increased hospital stays and mortality risk in patients with bacteremia. However, the etiology of this resistance marker has not been fully studied. OBJECTIVE To identify risk factors associated with the emergence of methicillin-resistant S. aureus bacteremia in critically ill patients treated at intensive care units in Bogotá, Colombia. MATERIALS AND METHODS We conducted a retrospective paired case-control study, nested in a cohort of patients diagnosed with S. aureus bacteremia and treated at intensive care units between 2006 and 2008 in Bogotá. Cases were patients with positive blood culture to methicillin resistance, matched in a 1:1 ratio with methicillin-sensitive controls isolated from the same institution and hospitalization year. We used conditional logistic regression to analyze the risk factors associated with the presence of resistance, with emphasis on prior antibiotic therapy. RESULTS We included 372 patients with S. aureus bacteremia. Factors such as the use of pre-hospital devices: vascular (OR=1.986, 95% CI 1.038 to 3.801) and urinary (OR=2.559, 95% CI: 1.170 to 5.596), along with the number of previously used antibiotics, were associated with the emergence of resistance. The number of antibiotics used previously was determined to have a gradient effect, particularly carbapenems. CONCLUSIONS The rational use of antibiotics and surveillance of exposure to surgical procedures or use of invasive devices are interventions that could diminish the emergence of methicillin-resistant S. aureus bacteremia causes.
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59
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Lewis SJ, Chaijamorn W, Shaw AR, Mueller BA. In silico trials using Monte Carlo simulation to evaluate ciprofloxacin and levofloxacin dosing in critically ill patients receiving prolonged intermittent renal replacement therapy. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0055-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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60
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Hannaoui I, Barguigua A, Serray B, El Mdaghri N, Timinouni M, Ait Chaoui A, El Azhari M. Intestinal carriage of vancomycin-resistant enterococci in a community setting in Casablanca, Morocco. J Glob Antimicrob Resist 2016; 6:84-87. [DOI: 10.1016/j.jgar.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/15/2022] Open
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61
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Hamishehkar H, Shadmehr P, Mahmoodpoor A, Mashayekhi SO, Entezari-Maleki T. Antimicrobial susceptibility patterns among bacteria isolated from intensive care units of the largest teaching hospital at the northwest of Iran. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000300006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | - Taher Entezari-Maleki
- Tabriz University of Medical Sciences, Iran; Tabriz University of Medical Sciences, Iran
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62
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Singh N, Pattnaik D, Neogi DK, Jena J, Mallick B. Prevalence of ESBL in Escherichia coli Isolates Among ICU Patients in a Tertiary Care Hospital. J Clin Diagn Res 2016; 10:DC19-DC22. [PMID: 27790433 DOI: 10.7860/jcdr/2016/21260.8544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/27/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Resistance to common antibiotics is a matter of grave concern in treating infections in hospital settings especially in Intensive Care Units (ICUs). One of the most commonly used and effective group of antibiotics, cephalosporins, exhibit resistance due to production of Extended Spectrum Beta- Lactamases (ESBLs). The prevalence of ESBL producing Escherichia coli (E.coli) has increased throughout the world and is a major cause of treatment failure in ICUs. As per our knowledge studies were not available on the prevalence of ESBL producing E.coli in ICUs of this region. AIM To determine the prevalence of ESBLs among Escherichia coli isolates in ICUs of a tertiary care hospital. MATERIALS AND METHODS A cross sectional study was conducted over a period of 4 years (Sept 2011 to Sept 2015) in the Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar. Consecutive non-duplicate isolates of E.coli recovered from 6800 clinical samples of patients admitted to different Intensive Care Units (ICUs) were subjected to ESBL screening test and then to CLSI recommended Phenotypic Confirmatory Disc Diffusion Tests (PCDDT) for ESBL production determination. RESULTS Out of 6800 samples, 1038 were E.coli isolates and 452(44%) were resistant to third generation cephalosporins. ESBL producing Escherichia coli among them were 276 (61.1%). Paediatric ICU showed the highest prevalence of ESBL E.coli at 80.9%. The highest prevalence of ESBL E.coli was in urine samples (82.6%) followed by pus (9.8%). The most effective antibiotic for ESBL producers was imipenem (96.7% sensitive), followed by amikacin (88.4%) and piperacillin- tazobactum (87%). CONCLUSION This study has highlighted the high prevalence of ESBL producing E.coli in the ICUs of our hospital. An in depth analysis of their antibiogram will be helpful in formulating the antibiotic policy and prevent spread of ESBL strains. It is recommended that ESBL testing should be done routinely to curtail antibiotic resistance and to effectively implement infection control measures.
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Affiliation(s)
- Nipa Singh
- Assistant Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India
| | - Dipti Pattnaik
- Professor and HOD, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India
| | - Dhruba Kumar Neogi
- Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India
| | - Jagadananda Jena
- Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India
| | - Bandana Mallick
- Professor, Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS) , Bhubaneswar, Odisha, India
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63
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Montúfar Andrade FE, Madrid Muñoz CA, Villa Franco JP, Diaz Correa LM, Vélez Rivera JD, Vega Miranda J, Bedoya Londoño AM, Zuleta Tobón JJ, Montufar Pantoja MC. Bacteremia por Staphylococcus coagulasa negativo con concentración inhibitoria mínima para vancomicina ≥ 2. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Population Pharmacokinetics of Doripenem in Critically Ill Patients with Sepsis in a Malaysian Intensive Care Unit. Antimicrob Agents Chemother 2015; 60:206-14. [PMID: 26482304 DOI: 10.1128/aac.01543-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/13/2015] [Indexed: 01/28/2023] Open
Abstract
Doripenem has been recently introduced in Malaysia and is used for severe infections in the intensive care unit. However, limited data currently exist to guide optimal dosing in this scenario. We aimed to describe the population pharmacokinetics of doripenem in Malaysian critically ill patients with sepsis and use Monte Carlo dosing simulations to develop clinically relevant dosing guidelines for these patients. In this pharmacokinetic study, 12 critically ill adult patients with sepsis receiving 500 mg of doripenem every 8 h as a 1-hour infusion were enrolled. Serial blood samples were collected on 2 different days, and population pharmacokinetic analysis was performed using a nonlinear mixed-effects modeling approach. A two-compartment linear model with between-subject and between-occasion variability on clearance was adequate in describing the data. The typical volume of distribution and clearance of doripenem in this cohort were 0.47 liters/kg and 0.14 liters/kg/h, respectively. Doripenem clearance was significantly influenced by patients' creatinine clearance (CL(CR)), such that a 30-ml/min increase in the estimated CL(CR) would increase doripenem CL by 52%. Monte Carlo dosing simulations suggested that, for pathogens with a MIC of 8 mg/liter, a dose of 1,000 mg every 8 h as a 4-h infusion is optimal for patients with a CL(CR) of 30 to 100 ml/min, while a dose of 2,000 mg every 8 h as a 4-h infusion is best for patients manifesting a CL(CR) of >100 ml/min. Findings from this study suggest that, for doripenem usage in Malaysian critically ill patients, an alternative dosing approach may be meritorious, particularly when multidrug resistance pathogens are involved.
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65
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Peng Y, Shi J, Bu T, Li Y, Ye X, Chen X, Yao Z. Alarming and increasing prevalence of multidrug-resistant Pseudomonas aeruginosa among healthcare-associated infections in China: A meta-analysis of cross-sectional studies. J Glob Antimicrob Resist 2015; 3:155-160. [PMID: 27873704 DOI: 10.1016/j.jgar.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022] Open
Abstract
A number of studies have reported on the prevalence of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) among healthcare-associated infections (HAIs) in China; however, the exact rate of MDR-PA is unclear due to different definitions. Therefore, this meta-analysis was conducted to explore the prevalence of MDR-PA among HAIs in China based on an international recommended standard. Medline, Ovid, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang databases were systematically searched and papers published before February 2014 providing exact data on MDR-PA in the Chinese population were identified. Overall effects, subgroup analysis and sensitivity analysis were performed using Stata v.13.0 software. Twenty-six studies were finally included. The overall prevalence of MDR-PA was 29.0% (95% confidence interval 24.6-33.4%). The rate of MDR-PA increased over time (P<0.001). The prevalence of MDR-PA was higher among patients in intensive care units (ICUs) (41.4%) than among non-ICU patients (24.1%) (P<0.001). In conclusion, the present meta-analysis comprehensively evaluated the prevalence of MDR PA in China and the findings suggest that MDR-PA should receive more attention.
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Affiliation(s)
- Yang Peng
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China; Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jing Shi
- Department of Preventative Medicine, Hebei University of Traditional Medicine, Shijiazhuang, China
| | - Tao Bu
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China; Department of Prevention and Health Care, The First Teaching Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying Li
- Public Health Laboratory Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaohua Ye
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China; Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiaofeng Chen
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China; Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenjiang Yao
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China; Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, China.
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Solé M, Fàbrega A, Cobos-Trigueros N, Zamorano L, Ferrer-Navarro M, Ballesté-Delpierre C, Reustle A, Castro P, Nicolás JM, Oliver A, Martínez JA, Vila J. In vivo evolution of resistance of Pseudomonas aeruginosa strains isolated from patients admitted to an intensive care unit: mechanisms of resistance and antimicrobial exposure. J Antimicrob Chemother 2015; 70:3004-13. [PMID: 26260130 DOI: 10.1093/jac/dkv228] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/04/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The main objective of this study was to investigate the relationship among the in vivo acquisition of antimicrobial resistance in Pseudomonas aeruginosa clinical isolates, the underlying molecular mechanisms and previous exposure to antipseudomonal agents. METHODS PFGE was used to study the molecular relatedness of the strains. The MICs of ceftazidime, cefepime, piperacillin/tazobactam, imipenem, meropenem, ciprofloxacin and amikacin were determined. Outer membrane protein profiles were assessed to study OprD expression. RT-PCR was performed to analyse ampC, mexB, mexD, mexF and mexY expression. The presence of mutations was analysed through DNA sequencing. RESULTS We collected 17 clonally related paired isolates [including first positive samples (A) and those with MICs increased ≥4-fold (B)]. Most B isolates with increased MICs of imipenem, meropenem and ceftazidime became resistant to these drugs. The most prevalent resistance mechanisms detected were OprD loss (65%), mexB overexpression (53%), ampC derepression (29%), quinolone target gene mutations (24%) and increased mexY expression (24%). Five (29%) B isolates developed multidrug resistance. Meropenem was the most frequently (71%) received treatment, explaining the high prevalence of oprD mutations and likely mexB overexpression. Previous exposure to ceftazidime showed a higher impact on selection of increased MICs than previous exposure to piperacillin/tazobactam. CONCLUSIONS Stepwise acquisition of resistance has a critical impact on the resistance phenotypes of P. aeruginosa, leading to a complex scenario for finding effective antimicrobial regimens. In the clinical setting, meropenem seems to be the most frequent driver of multidrug resistance development, while piperacillin/tazobactam, in contrast to ceftazidime, seems to be the β-lactam least associated with the selection of resistance mechanisms.
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Affiliation(s)
- Mar Solé
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anna Fàbrega
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Laura Zamorano
- University Hospital Son Espases, Palma de Mallorca, Spain
| | - Mario Ferrer-Navarro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Ballesté-Delpierre
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anna Reustle
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Antonio Oliver
- University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Jordi Vila
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Radji M, Fauziah S, Aribinuko N. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia. Asian Pac J Trop Biomed 2015; 1:39-42. [PMID: 23569722 DOI: 10.1016/s2221-1691(11)60065-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 09/27/2010] [Accepted: 10/15/2010] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia. METHODS A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method. RESULTS Specimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively. CONCLUSIONS Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.
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Affiliation(s)
- Maksum Radji
- Laboratory of Microbiology and Biotechnology, Department of Pharmacy, Faculty of Mathematics and Science, University of Indonesia, Depok, 16424, Indonesia
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Lebeaux D, Leflon-Guibout V, Ghigo JM, Beloin C. In vitro activity of gentamicin, vancomycin or amikacin combined with EDTA or l-arginine as lock therapy against a wide spectrum of biofilm-forming clinical strains isolated from catheter-related infections. J Antimicrob Chemother 2015; 70:1704-12. [PMID: 25712314 DOI: 10.1093/jac/dkv044] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/03/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Treatment of catheter-related bloodstream infections (CRBSI) is hampered by the characteristic tolerance of bacterial biofilms towards antibiotics. Our objective was to study the effect of the combination of antibiotics and the alkaline amino acid l-arginine or the cation chelator EDTA on the bacterial killing of in vitro biofilms formed by an array of clinical strains responsible for CRBSI and representative of epidemiologically relevant bacterial species. METHODS Among 32 strains described in a previous clinical study, we focused on the most antibiotic-tolerant strains including CoNS (n = 4), Staphylococcus aureus (n = 4), Enterococcus faecalis (n = 2), Pseudomonas aeruginosa (n = 4) and Enterobacteriaceae (n = 4). We used an in vitro biofilm model (96-well plate assay) to study biofilm tolerance and tested various combinations of antibiotics and non-antibiotic adjuvants. Gentamicin, amikacin or vancomycin was combined with disodium EDTA or l-arginine for 24 h to reproduce the antibiotic lock therapy (ALT) approach. Killing of biofilm bacteria was measured by cfu quantification after a vigorous step of pipetting up and down in order to detach all biofilm bacteria from the surface of the wells. RESULTS Both of our adjuvant strategies significantly increased the effect of antibiotics against biofilms formed by Gram-positive and Gram-negative bacterial pathogens. The combination of gentamicin + EDTA was active against all tested strains apart from one P. aeruginosa. The combination of gentamicin + l-arginine was active against most of the tested strains with the notable exception of CoNS for which no potentiation was observed. We also demonstrated that amikacin + EDTA was active against Gram-negative bacteria and that vancomycin + EDTA was active against Gram-positive bacteria. CONCLUSIONS The addition of EDTA enhanced the activity of gentamicin, amikacin and vancomycin against biofilms formed by a wide spectrum of bacterial strains responsible for CRBSI.
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Affiliation(s)
- David Lebeaux
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, Université Paris Descartes, 149 Rue de Sèvres, 75743 Paris cedex 15, France
| | | | - Jean-Marc Ghigo
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France
| | - Christophe Beloin
- Institut Pasteur, Genetics of Biofilms Unit, Department of Microbiology, 28 rue du Dr Roux, 75724 Paris cedex 15, France
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Poole K. Stress responses as determinants of antimicrobial resistance in Pseudomonas aeruginosa: multidrug efflux and more. Can J Microbiol 2015; 60:783-91. [PMID: 25388098 DOI: 10.1139/cjm-2014-0666] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pseudomonas aeruginosa is a notoriously antimicrobial-resistant organism that is increasingly refractory to antimicrobial chemotherapy. While the usual array of acquired resistance mechanisms contribute to resistance development in this organism a multitude of endogenous genes also play a role. These include a variety of multidrug efflux loci that contribute to both intrinsic and acquired antimicrobial resistance. Despite their roles in resistance, however, it is clear that these efflux systems function in more than just antimicrobial efflux. Indeed, recent data indicate that they are recruited in response to environmental stress and, therefore, function as components of the organism's stress responses. In fact, a number of endogenous resistance-promoting genes are linked to environmental stress, functioning as part of known stress responses or recruited in response to a variety of environmental stress stimuli. Stress responses are, thus, important determinants of antimicrobial resistance in P. aeruginosa. As such, they represent possible therapeutic targets in countering antimicrobial resistance in this organism.
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Affiliation(s)
- Keith Poole
- Department of Biomedical and Molecular Sciences, Botterell Hall, Queen's University, Kingston, ON K7L 3N6, Canada
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Salem AH, Zhanel GG, Ibrahim SA, Noreddin AM. Monte Carlo simulation analysis of ceftobiprole, dalbavancin, daptomycin, tigecycline, linezolid and vancomycin pharmacodynamics against intensive care unit-isolated methicillin-resistant Staphylococcus aureus. Clin Exp Pharmacol Physiol 2015; 41:437-43. [PMID: 24341387 DOI: 10.1111/1440-1681.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 11/12/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to compare the potential of ceftobiprole, dalbavancin, daptomycin, tigecycline, linezolid and vancomycin to achieve their requisite pharmacokinetic/pharmacodynamic (PK/PD) targets against methicillin-resistant Staphylococcus aureus isolates collected from intensive care unit (ICU) settings. Monte Carlo simulations were carried out to simulate the PK/PD indices of the investigated antimicrobials. The probability of target attainment (PTA) was estimated at minimum inhibitory concentration values ranging from 0.03 to 32 μg/mL to define the PK/PD susceptibility breakpoints. The cumulative fraction of response (CFR) was computed using minimum inhibitory concentration data from the Canadian National Intensive Care Unit study. Analysis of the simulation results suggested the breakpoints of 4 μg/mL for ceftobiprole (500 mg/2 h t.i.d.), 0.25 μg/mL for dalbavancin (1000 mg), 0.12 μg/mL for daptomycin (4 mg/kg q.d. and 6 mg/kg q.d.) and tigecycline (50 mg b.i.d.), and 2 μg/mL for linezolid (600 mg b.i.d.) and vancomycin (1 g b.i.d. and 1.5 g b.i.d.). The estimated CFR were 100, 100, 70.6, 88.8, 96.5, 82.4, 89.4, and 98.3% for ceftobiprole, dalbavancin, daptomycin (4 mg/kg/day), daptomycin (6 mg/kg/day), linezolid, tigecycline, vancomycin (1 g b.i.d.) and vancomycin (1.5 g b.i.d.), respectively. In conclusion, ceftobiprole and dalbavancin have the highest probability of achieving their requisite PK/PD targets against methicillin-resistant Staphylococcus aureus isolated from ICU settings. The susceptibility predictions suggested a reduction of the vancomycin breakpoint to 1 μg/mL.
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Affiliation(s)
- Ahmed Hamed Salem
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Darveau M, Ducharme-Désilets C, Archambault P, Marcoux D. Translating Evidence Into Practice: The Importance of Continuing Local Bacterial Surveillance Even When National Data Are Available. Infect Control Hosp Epidemiol 2015; 30:1128-30. [DOI: 10.1086/606041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lau CHF, Krahn T, Gilmour C, Mullen E, Poole K. AmgRS-mediated envelope stress-inducible expression of the mexXY multidrug efflux operon of Pseudomonas aeruginosa. Microbiologyopen 2014; 4:121-35. [PMID: 25450797 PMCID: PMC4335980 DOI: 10.1002/mbo3.226] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 01/07/2023] Open
Abstract
AmgRS is an envelope stress-responsive two-component system and aminoglycoside resistance determinant in Pseudomonas aeruginosa that is proposed to protect cells from membrane damage caused by aminoglycoside-generated mistranslated polypeptides. Consistent with this, a ΔamgR strain showed increased aminoglycoside-promoted membrane damage, damage that was largely absent in AmgRS-activated amgS-mutant strains. Intriguingly, one such mutation, V121G, while providing for enhanced resistance to aminoglycosides, rendered P. aeruginosa susceptible to several ribosome-targeting nonaminoglycoside antimicrobials that are inducers and presumed substrates of the MexXY-OprM multidrug efflux system. Surprisingly, the amgSV 121G mutation increased mexXY expression threefold, suggesting that export of these nonaminoglycosides was compromised in the amgSV 121G mutant. Nonetheless, a link was established between AmgRS activation and mexXY expression and this was confirmed in studies showing that aminoglycoside-promoted mexXY expression is dependent on AmgRS. While nonaminoglycosides also induced mexXY expression, this was not AmgRS-dependent, consistent with these agents not generating mistranslated polypeptides and not activating AmgRS. The aminoglycoside inducibility of mexXY was abrogated in a mutant lacking the AmgRS target genes htpX and PA5528, encoding a presumed cytoplasmic membrane-associated protease and a membrane protein of unknown function, respectively. Thus, aminoglycoside induction of mexXY is a response to membrane damage and activation of the AmgRS two-component system.
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Affiliation(s)
- Calvin Ho-Fung Lau
- Department of Biomedical and Molecular Sciences, Botterell Hall, Queen's University, Kingston, Ontario, K7L 3N6, Canada.
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Peng Y, Bi J, Shi J, Li Y, Ye X, Chen X, Yao Z. Multidrug-resistant Pseudomonas aeruginosa infections pose growing threat to health care-associated infection control in the hospitals of Southern China: a case-control surveillance study. Am J Infect Control 2014; 42:1308-11. [PMID: 25444305 DOI: 10.1016/j.ajic.2014.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multidrug-resistant Pseudomonas aeruginosa (MDRPA) is one of the most common agents among health care-associated infections. There is a lack of data on the clinical features of MDRPA from Southern China. METHODS A case-control surveillance study of P aeruginosa was conducted based on surveillance from July 2008-December 2012, in 5 hospitals of Guangzhou, China. Data were analyzed by univariate analysis and multivariate logistic regression using Stata 13 (StataCorp, College Station, TX). RESULTS Of the 348 P aeruginosa strains, the prevalence of MDRPA was 54%, and it has increased over time. Isolates of P aeruginosa showed increased resistance to most antimicrobials during this time period. Independent risk factors were tracheal intubation insertion (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.16-4.23; P = .02) and use of carbapenem (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.75-6.47; P < .01). The distribution of MDRPA infections was uneven among the 5 hospitals (P = .01). Being infected with MDRPA strains resulted in longer duration of hospitalization (39 vs 24 days) and higher mortality (49% vs 20%). CONCLUSION The infections of MDRPA were severe issues. More stringent measures should be applied for those with independent predictors of MDRPA infections because they may induce adverse clinical outcomes.
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Talebi M, Jahangiri S, Eshraghi S, Pourshafie MR. Ribotyping, Antibiotic Resistance Pattern, and Virulence Factors of Vancomycin-Resistant Enterococcus faecium Isolates From UTIs. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hasanin A, Eladawy A, Mohamed H, Salah Y, Lotfy A, Mostafa H, Ghaith D, Mukhtar A. Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt. Pan Afr Med J 2014; 19:177. [PMID: 25815098 PMCID: PMC4366122 DOI: 10.11604/pamj.2014.19.177.4307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/09/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction The prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB. Methods A one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance. Results During one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection. Conclusion Extensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.
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Affiliation(s)
- Ahmed Hasanin
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Eladawy
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Mohamed
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmin Salah
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Lotfy
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan Mostafa
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ghaith
- Department of clinical pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mukhtar
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
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Jomha MY, Yusef H, Holail H. Antimicrobial and biocide resistance of bacteria in a Lebanese tertiary care hospital. J Glob Antimicrob Resist 2014; 2:299-305. [PMID: 27873691 DOI: 10.1016/j.jgar.2014.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 08/14/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022] Open
Abstract
The environment in a Lebanese tertiary-level care hospital was examined for bacterial contamination. In total, 8 open-air and 62 surface samples were taken and CFU were enumerated. Morphologically different isolates (n=104) were obtained and tested for resistance to a wide range of antibiotics by the Kirby-Bauer disc diffusion method. Minimum bactericidal concentrations of isolates to seven different biocides used within this facility were also determined using both qualitative and quantitative methods. Gram-positive bacteria (82.7% of isolates) were encountered more often than Gram-negative bacteria (17.3%), and the genus Staphylococcus was most prevalent among isolates (59.6% of the isolates). Gram-positive isolates showed the highest resistance to penicillin (60.6%), clindamycin (54.5%) and ceftazidime (39.4%); the lowest frequencies of resistance were seen with vancomycin (0% of isolates), nitrofurantoin (3.5%), tetracycline (12.1%) and ciprofloxacin (12.1%). The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase negative staphylococci among all environmental samples was 3.8% and 11.5% of isolates, respectively. All Gram-negative isolates were multidrug-resistant (MDR). With respect to biocides, the highest frequency of resistance was to quaternary ammonium compounds (QACs) (13.5% of isolates) and the lowest frequency of resistance was to QAC/biguanide complex (<1% of isolates) and Anios DVA (3.8%). MDR bacteria can pose a serious threat in the hospital environment, showing the need for prudent use of antibiotics and correct infection control procedures.
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Affiliation(s)
- Mariam Yousif Jomha
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon.
| | - Hoda Yusef
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon
| | - Hanafy Holail
- Department of Biological and Environmental Sciences, Faculty of Science, Beirut Arab University, Beirut, Lebanon
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Najar-Peerayeh S, Jazayeri Moghadas A, Behmanesh M. Antibiotic Susceptibility and mecA Frequency in Staphylococcus epidermidis, Isolated From Intensive Care Unit Patients. Jundishapur J Microbiol 2014; 7:e11188. [PMID: 25485050 PMCID: PMC4255212 DOI: 10.5812/jjm.11188] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/08/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022] Open
Abstract
Background: Coagulase-negative staphylococci (CoNS), especially Staphylococcus epidermidis, are considered as normal flora of human epithelia and also important opportunistic pathogens for nosocomial infections. S. epidermidis can also act as a reservoir for mecA, responsible for high-level resistance to methicillin and transferring it to S. aureus. Objectives: The aim of this study was to determine the prevalence of S. epidermidis as well as antibiotic susceptibility pattern and mecA prevalence in S. epidermidis isolated from intensive care unit (ICU) patients. Materials and Methods: A cross-sectional study was conducted from September 2010 to September 2011 and 184 coagulase-negative staphylococci were collected from different clinical samples in three hospitals. S. epidermidis was identified by conventional bacteriological tests. Antibiotic susceptibility testing was performed using disk diffusion method. Frequency of mecA was detected by specific PCR. Results: Frequency of S. epidermidis was 34.8%, the most susceptibility was seen to linezolid and vancomycin, and the least susceptibility was seen to tetracycline.Majority of the S. epidermidis isolates carried mecA (92.2%). The most common resistant pattern was trimethoprim-sulfamethoxazole, tetracycline, erythromycin, and methicillin resistance, found in 23.4% of the isolates, followed by resistance to methicillin as the second-most common resistant pattern, observed in 20.3% of the isolates. Conclusions: Frequency of S. epidermidis was significantly lower, compared to other studies. Presence rate of mecA and susceptibility to linezolid and vancomycin did not show significant differences with other investigations, while resistant to trimethoprim-sulfamethoxazole was significantly lower compared to other investigations, and resistance to tetracycline was significantly higher in comparison to other investigations. Presence of methicillin-resistant S. epidermidis in ICU patients, especially in individuals with compromised immune systems, may cause infection and would be more complicated in the case of antibiotic resistance.
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Affiliation(s)
- Shahin Najar-Peerayeh
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding author: Shahin Najar-Peerayeh, Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-2182883870, Fax: +98-2182884555, E-mail:
| | - Ali Jazayeri Moghadas
- Department of Microbiology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, IR Iran
| | - Mehrdad Behmanesh
- Department of Genetic, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, IR Iran
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Domalaon R, Yang X, O'Neil J, Zhanel GG, Mookherjee N, Schweizer F. Structure-activity relationships in ultrashort cationic lipopeptides: the effects of amino acid ring constraint on antibacterial activity. Amino Acids 2014; 46:2517-30. [PMID: 25069750 DOI: 10.1007/s00726-014-1806-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/04/2014] [Indexed: 01/08/2023]
Abstract
Taking a minimalistic approach in efforts to lower the cost for the development of new synthetic antimicrobial peptides, ultrashort cationic lipopeptides were designed to mimic the amphiphilic nature crucial for their activity but with only a very short peptide sequence ligated to a lipidic acid. Nine ultrashort cationic lipopeptides were prepared to study the effects of ring constraint in the amino acid side chain of the peptide component. USCL-PCat1, consisting of only four L-4R-aminoproline residues and acylated with palmitic acid at the N-terminus, was found to populate a polyproline II helical secondary conformation that is stable to different pHs and temperatures using circular dichroism. The synthesized lipopeptides were found to have a micellar structure in water using negative staining transmission electron microscopy. We found that constraining the side chain of the amino acid component is not beneficial to the antimicrobial activity. USCL-Dab1, USCL-Dab3 and USCL-K1 showed promising activity against a panel of laboratory reference and clinically isolated Gram-positive and Gram-negative bacterial strains, some of which are multidrug resistant. No appreciable cytotoxicity against human monocytic THP-1 cells was observed up to concentrations of 20-40 µM for all synthesized compounds. Moreover, all USCLs did not induce the production of either pro-inflammatory cytokines or chemokines up to 40 µM.
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Affiliation(s)
- Ronald Domalaon
- Department of Chemistry, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
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Yong D, Shin HB, Kim YK, Cho J, Lee WG, Ha GY, Choi TY, Jeong SH, Lee K, Chong Y. Increase in the Prevalence of Carbapenem-Resistant Acinetobacter Isolates and Ampicillin-Resistant Non-Typhoidal Salmonella Species in Korea: A KONSAR Study Conducted in 2011. Infect Chemother 2014; 46:84-93. [PMID: 25024870 PMCID: PMC4091365 DOI: 10.3947/ic.2014.46.2.84] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022] Open
Abstract
Background Antimicrobial surveillance is important for providing an up-to-date understanding of the epidemiology of antimicrobial resistance and for creating a forum for rational drug development. In this study, we analyzed antimicrobial test data generated in 2011 by hospitals and commercial laboratories participating in the Korean Nationwide Surveillance of Antimicrobial Resistance program (KONSAR). Materials and Methods Data on the results of susceptibility tests conducted in 32 hospitals and two commercial laboratories were analyzed. Data on isolates from patients admitted to an intensive care unit (ICU) and those admitted to other wards were compared. Intermediate susceptibility was not analyzed and duplicate isolates were excluded. Results Escherichia coli was the most prevalent organism identified in both the hospital and commercial laboratories. Among the hospital isolates, methicillin-resistant Staphylococcus aureus (MRSA), penicillin G-non-susceptible Streptococcus pneumoniae, and ampicillin-resistant Enterococcus faecium remained as prevalent as they were in 2009. The proportion of vancomycin-resistant E. faecium (VR-EFM) slightly decreased from 29% in 2009 to 23% in 2011. Resistance rates of Klebsiella pneumoniae to ceftazidime, cefoxitin, fluoroquinolone, and amikacin were 24%, 14%, 27%, and 8%, respectively. Resistance rates of Pseudomonas aeruginosa to fluoroquinolone, ceftazidime, imipenem, and amikacin were 33%, 20%, 22%, and 16%, respectively, whereas those of Acinetobacter spp. resistance were 71%, 66%, 64, and 51%, respectively. The prevalence of oxyimino-cephalosporin-resistant E. coli and K. pneumoniae, carbapenem-resistant Acinetobacter spp. and P. aeruginosa, MRSA, and VR-EFM among ICU isolates was higher than those among non-ICU isolates. Extended-spectrum β-lactamase-producing E. coli and K. pneumoniae, imipenem-resistant P. aeruginosa, and VR-EFM were more prevalent among isolates from commercial laboratories than those from hospitals. Resistance rates of K. pneumoniae to ceftazidime and amikacin decreased from 32% and 24% in 2005 to 24% and 8% in 2011, respectively. The resistance rate of P. aeruginosa to amikacin decreased from 22% in 2005 to 16% in 2011. The proportion of imipenem-resistant Acinetobacter spp. increased from 16% in 2005 to 64% in 2011. Conclusions The prevalence of MRSA, penicillin G-non-susceptible S. pneumoniae, and ampicillin-resistant E. faecium among clinical isolates tested in laboratories remained high. Multidrug resistance was more prevalent among isolates from ICUs. The prevalence of ceftazidime-resistant and amikacin-resistant K. pneumoniae and amikacin-resistant P. aeruginosa decreased after 2005, while the prevalence of imipenem-resistant Acinetobacter spp. increased.
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Affiliation(s)
- Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Bong Shin
- Department of Laboratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Jihyun Cho
- Department of Laboratory Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Wee Gyo Lee
- Department of Laboratory Medicine, Ajou University Hospital, Suwon, Korea
| | - Gyoung Yim Ha
- Department of Laboratory Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Tae Yeal Choi
- Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Yunsop Chong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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Randhawa V, Sarwar S, Walker S, Elligsen M, Palmay L, Daneman N. Weighted-incidence syndromic combination antibiograms to guide empiric treatment of critical care infections: a retrospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R112. [PMID: 24887215 PMCID: PMC4075242 DOI: 10.1186/cc13901] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/15/2014] [Indexed: 01/14/2023]
Abstract
Introduction Empiric antimicrobial selection for critical care infections must balance the need for timely adequate coverage with the resistance pressure exerted by broadspectrum agents. We estimated the potential of weighted incidence syndromic combination antibiograms (WISCAs) to improve time to adequate coverage for critical care infections. In contrast to traditional antibiograms, WISCAs display the likelihood of coverage for a specific infectious syndrome (rather than individual pathogens), and also take into account the potential for poly-microbial infections and the use of multi-drug regimens. Methods Cases of ventilator-associated pneumonia (VAP) and catheter-related bloodstream infection (CRBSI) were identified over three years using stringent surveillance criteria. Based on the susceptibility profile of the culprit pathogens, we calculated the WISCA percentages of infections that would have been adequately covered by common antimicrobial(s). We then computed the excess percentage coverage offered by WISCA regimens compared to the actual antimicrobials administered to patients by 12 h, 24 h, and 48 h from culture collection. Results Among 163 patients with critical care infection, standard practice only resulted in adequate coverage of 35% of patients by 12 h, 52% by 24 h, and 75% by 48 h. No WISCA mono-therapy regimen offered greater than 85% adequate overall coverage for VAP and CRBSI. A wide range of dual therapy regimens would have conferred greater than 90% adequate coverage, with excess coverage estimated to be as high as +56%, +42% and +18% at 12 h, 24 h and 48 h, respectively. We did not detect a decrease in mortality associated with early adequate treatment, and so could not estimate potential downstream benefits. Conclusions WISCA-derived empiric antimicrobial regimens can be calculated for patients with intensive care unit (ICU)-acquired infections, and have the potential to reduce time to adequate treatment. Prospective research must confirm whether implementation of WISCA prescribing aids facilitate timely adequate treatment and improved ICU outcomes.
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Book M, Lehmann LE, Zhang X, Stüber F. Monitoring infection: from blood culture to polymerase chain reaction (PCR). Best Pract Res Clin Anaesthesiol 2014; 27:279-88. [PMID: 24012238 DOI: 10.1016/j.bpa.2013.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/28/2013] [Indexed: 01/14/2023]
Abstract
In patients with sepsis, diagnosis of blood stream infection (BSI) is a key concern to the therapist. Direct verification of pathogens in the blood stream executed by blood cultures (BC) still is regarded as the gold standard up to date. The quickest possible initiation of an appropriate antimicrobial therapy is a cornerstone of an effective therapy. Moreover, in this view BC can also serve to identify antimicrobial agents to target the pathogen. However, when employing BC the time needed until microbiological results are available ranges from 24 up to 72 h. Moreover, infections caused by multiple pathogens often remain undetected and concurrent antibiotic therapy may lower the overall sensitivity. Alternative pathogen characterization can be performed by polymerase chain reaction (PCR) based amplification methods. Results using PCR can be obtained within 6-8 h. Therefore, the time delay until an appropriate therapy can be reduced enormously. Moreover, these methods have the potential to enhance the sensitivity in the diagnosis of blood stream infections. Therefore, PCR based methods might be a valuable adjunct to present procedures of diagnosing bacteraemia.
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Affiliation(s)
- Malte Book
- University Department of Anaesthesiology and Pain Medicine, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Pliakos I, Michalopoulos N, Papavramidis TS, Arampatzi S, Diza-Mataftsi E, Papavramidis S. The Effect of Vacuum-Assisted Closure in Bacterial Clearance of the Infected Abdomen. Surg Infect (Larchmt) 2014; 15:18-23. [DOI: 10.1089/sur.2012.156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ioannis Pliakos
- Third Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- Third Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Theodossis S. Papavramidis
- Third Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Stergiani Arampatzi
- Second Department of Microbiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Eudoxia Diza-Mataftsi
- Second Department of Microbiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Spiros Papavramidis
- Third Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Talebi M, Sadeghi J, Pourshafie MR. Molecular Characterization of Vancomycin-Resistant Enterococcus faecium Isolated from Intensive Care Units. Curr Microbiol 2014; 68:615-20. [DOI: 10.1007/s00284-013-0517-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/23/2013] [Indexed: 11/24/2022]
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Severe sepsis facilitates intestinal colonization by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and transfer of the SHV-18 resistance gene to Escherichia coli during antimicrobial treatment. Antimicrob Agents Chemother 2013; 58:1039-46. [PMID: 24277046 DOI: 10.1128/aac.01632-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Infections caused by multidrug-resistant pathogens are frequent and life threatening in critically ill patients. To investigate whether severe sepsis affects gut colonization by resistant pathogens and genetic exchange between opportunistic pathogens, we tested the intestinal-colonization ability of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain carrying the SHV-18 resistance gene and the transfer ability of the resistance gene to endogenous Escherichia coli under ceftriaxone treatment in rats with burn injury only or severe sepsis induced by burns plus endotoxin exposure. Without ceftriaxone treatment, the K. pneumoniae strain colonized the intestine in both septic and burned rats for a short time, with clearance occurring earlier in burn-only rats but never in sham burn rats. In both burned and septic rats, the colonization level of the challenge strain dropped at the beginning and then later increased during ceftriaxone treatment, after which it declined gradually. This pattern coincided with the change in resistance of K. pneumoniae to ceftriaxone during and after ceftriaxone treatment. Compared with burn-only injury, severe sepsis had a more significant effect on the change in antimicrobial resistance to ceftriaxone. Only in septic rats was the resistance gene successfully transferred from the challenge strain to endogenous E. coli during ceftriaxone treatment; the gene persisted for at least 4 weeks after ceftriaxone treatment. We concluded that severe sepsis can facilitate intestinal colonization by an exogenous resistant pathogen and the transfer of the resistance gene to a potential endogenous pathogen during antimicrobial treatment.
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Sharma SK, Hadda V, Mathur P, Gulati V, Sahney C. Profile of micro-organisms in intensive care unit of a level-1 trauma centre: A retrospective study. Indian J Crit Care Med 2013; 17:87-91. [PMID: 23983413 PMCID: PMC3752873 DOI: 10.4103/0972-5229.114827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Patients with trauma usually require highly specialized care in ICU and many times their recovery is complicated by infections. Aim of this study was to determine the profile of pathogens and their impact on outcome among these patients. Materials and Methods: The clinical records of 101 consecutive patients who were admitted for more than 48-hrs in ICU during Jun-Dec 2007 were analyzed. Results: Total of 953 samples from blood, urine, BAL or pus/collection were subjected to cultures. From 276 samples, 299 organisms were isolated. Among pathogens Candida Spp. [89 (29%)] were the most common, followed by Acinetobacter Spp. [69 (23%)], Pseudomonas Spp. [63 (21%)], Klebsiella Spp. [31 (10%)], coagulase negative Staphylococcus aureus [16 (5%)], E coli [12 (4%)], Enterobacter Spp. [7 (2%)], S aureus [6 (2%)], Enterococcus Spp. [5 (2%)], Citrobacter Spp. [2 (0.6%)], S maltophila [1 (0.3%)] and Providentia Spp. [1 (0.3%)]. For gram negative pathogens drug-resistance rates were as follows: Fluoroquinolones, 76%; 3rd generation cephalosporins, 74%; aminoglycosides, 66%; β-lactams/β-lactamase inhibitors combinations, 64%; and carbapenems, 50%. Among these 27% of pathogens were resistant to all 5 classes of drugs. 58% of Staphylococcus aureus were methicillin-resistant whereas 85% of coagulase negative Staphylococcus were methicillin resistant. The mortality was higher among patients in whom pathogens were isolated [Odd's Ratio (OR) 0.185; 95% confidence interval (CI) 0.049-0.640; P = 0.002]. Conclusions: Isolation of multi-drug resistant pathogens is common among trauma patients admitted in ICU and is associated with increased mortality and could impact on the consumption of hospital resources. The importance of high rate of fungal isolation needs to be studied among these patients.
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Affiliation(s)
- Shefali K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Goswami NN, Trivedi HR, Goswami APP, Patel TK, Tripathi CB. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India. J Pharmacol Pharmacother 2013; 2:158-64. [PMID: 21897707 PMCID: PMC3157123 DOI: 10.4103/0976-500x.83279] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85%) isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%), was the predominant organism. S. aureus was sensitive to rifampicin (89.58%), levofloxacin (60.42%), and vancomycin (54.17%). Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%), gatifloxacin (51.35%), and meropenem (51.35%). Escherichia coli was sensitive to levofloxacin (72.41%) and ciprofloxacin (62.07%). Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%), levofloxacin (63.16%), gatifloxacin (63.16%), and linezolid (56.52%). Proteus mirabilis was sensitive to ciprofloxacin (75%) and linezolid (62.50). Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14%) followed by levofloxacin (50%). Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.
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Orsi GB, Falcone M, Venditti M. Surveillance and management of multidrug-resistant microorganisms. Expert Rev Anti Infect Ther 2013; 9:653-79. [PMID: 21819331 DOI: 10.1586/eri.11.77] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Multidrug-resistant organisms are an established and growing worldwide public health problem and few therapeutic options remain available. The traditional antimicrobials (glycopeptides) for multidrug-resistant Gram-positive infections are declining in efficacy. New drugs that are presently available are linezolid, daptomicin and tigecycline, which have well-defined indications for severe infections, and talavancin, which is under Phase III trial for hospital-acquired pneumonia. Unfortunately the therapies available for multidrug-resistant Gram-negatives, including carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae, are limited to only colistin and tigecycline. Both of these drugs are still not registered for severe infections, such as hospital acquired pneumonia. Consequently, as confirmed by scientific evidence, a multidisciplinary approach is needed. Surveillance, infection control procedures, isolation and antimicrobial stewardship should be implemented to reduce multidrug-resistant organism diffusion.
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Affiliation(s)
- Giovanni Battista Orsi
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, P.le Aldo Moro 5, 00185 Roma, Italy
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Popović N, Stefanović-Budimkić M, Mitrović N, Urošević A, Milošević B, Pelemiš M, Jevtović D, Beslać-Bumbaširević L, Jovanović D. The Frequency of Poststroke Infections and Their Impact on Early Stroke Outcome. J Stroke Cerebrovasc Dis 2013; 22:424-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/22/2013] [Accepted: 03/01/2013] [Indexed: 11/26/2022] Open
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Adam HJ, Baxter MR, Davidson RJ, Rubinstein E, Fanella S, Karlowsky JA, Lagace-Wiens PRS, Hoban DJ, Zhanel GG, Zhanel GG, Hoban DJ, Adam HJ, Karlowsky JA, Baxter MR, Nichol KA, Lagace-Wiens PRS, Walkty A. Comparison of pathogens and their antimicrobial resistance patterns in paediatric, adult and elderly patients in Canadian hospitals. J Antimicrob Chemother 2013; 68 Suppl 1:i31-7. [DOI: 10.1093/jac/dkt024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhanel GG, Adam HJ, Baxter MR, Fuller J, Nichol KA, Denisuik AJ, Lagace-Wiens PRS, Walkty A, Karlowsky JA, Schweizer F, Hoban DJ, Zhanel GG, Hoban DJ, Adam HJ, Karlowsky JA, Baxter MR, Nichol KA, Lagace-Wiens PRS, Walkty A. Antimicrobial susceptibility of 22746 pathogens from Canadian hospitals: results of the CANWARD 2007-11 study. J Antimicrob Chemother 2013; 68 Suppl 1:i7-22. [DOI: 10.1093/jac/dkt022] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCracken M, Wong A, Mitchell R, Gravel D, Conly J, Embil J, Johnston L, Matlow A, Ormiston D, Simor AE, Smith S, Du T, Hizon R, Mulvey MR. Molecular epidemiology of vancomycin-resistant enterococcal bacteraemia: results from the Canadian Nosocomial Infection Surveillance Program, 1999-2009. J Antimicrob Chemother 2013; 68:1505-9. [DOI: 10.1093/jac/dkt054] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zelenitsky S, Rubinstein E, Ariano R, Iacovides H, Dodek P, Mirzanejad Y, Kumar A. Vancomycin pharmacodynamics and survival in patients with methicillin-resistant Staphylococcus aureus-associated septic shock. Int J Antimicrob Agents 2013; 41:255-60. [DOI: 10.1016/j.ijantimicag.2012.10.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/19/2012] [Indexed: 01/22/2023]
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Antimicrobial resistance surveillance systems: Are potential biases taken into account? CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013. [PMID: 23205029 DOI: 10.1155/2011/276017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The validity of surveillance systems has rarely been a topic of investigation. OBJECTIVE To assess potential biases that may influence the validity of contemporary antimicrobial-resistant (AMR) pathogen surveillance systems. METHODS In 2008, reports of laboratory-based AMR surveillance systems were identified by searching Medline. Surveillance systems were appraised for six different types of bias. Scores were assigned as '2' (good), '1' (fair) and '0' (poor) for each bias. RESULTS A total of 22 surveillance systems were included. All studies used appropriate denominator data and case definitions (score of 2). Most (n=18) studies adequately protected against case ascertainment bias (score = 2), with three studies and one study scoring 1 and 0, respectively. Only four studies were deemed to be free of significant sampling bias (score = 2), with 17 studies classified as fair, and one as poor. Eight studies had explicitly removed duplicates (score = 2). Seven studies removed duplicates, but lacked adequate definitions (score = 1). Seven studies did not report duplicate removal (score = 0). Eighteen of the studies were considered to have good laboratory methodology, three had some concerns (score = 1), and one was considered to be poor (score = 0). CONCLUSION Contemporary AMR surveillance systems commonly have methodological limitations with respect to sampling and multiple counting and, to a lesser degree, case ascertainment and laboratory practices. The potential for bias should be considered in the interpretation of surveillance data.
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Pharmacodynamic profiling of antimicrobials against Gram-negative respiratory isolates from Canadian hospitals. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013. [PMID: 23205024 DOI: 10.1155/2011/971701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND With diminishing antimicrobial potency, the choice of effective empirical therapy has become more challenging. Thus, the pharmacodynamic evaluation of potential therapies is essential to identify optimal agents, doses and administration strategies. METHODS Monte Carlo simulation was conducted for standard and/or prolonged infusion regimens of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, doripenem, ertapenem, meropenem and piperacillin/tazobactam. Minimum inhibitory concentrations were obtained for Escherichia coli (n=64 respiratory isolates), Enterobacter cloacae (n=53), Klebsiella pneumoniae (n=75) and Pseudomonas aeruginosa (n=273) throughout Canada. The cumulative fraction of response (CFR) was calculated using bactericidal targets for each regimen against each species. A CFR ≥90% was defined as optimal. RESULTS All cefepime, doripenem, ertapenem and meropenem regimens achieved optimal exposures against Enterobacteriaceae, whereas target attainment was organism and dose dependent for the other agents. Prolonged infusion doripenem and meropenem 1 g and 2 g every 8 h, along with standard infusion doripenem and meropenem 2 g every 8 h, were the only regimens to attain optimal exposures against P aeruginosa. Ciprofloxacin had the lowest CFR against P aeruginosa, followed by cefepime. Among the P aeruginosa isolates collected in the intensive care unit (ICU) compared with the wards, differences of 0.5% to 10% were noted in favour of non-ICU isolates for all agents; however, marked differences (10% to 15%) in CFR were observed for ciprofloxacin in favour of ICU isolates. CONCLUSION Standard dosing of cefepime, doripenem, ertapenem and meropenem has a high likelihood of obtaining optimal pharmacodynamic indexes against these Enterobacteriaceae. For P aeruginosa, aggressive treatment with high-dose and/or prolonged infusion regimens are likely required to address the elevated resistance rates of respiratory isolates from Canada.
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The use of intravenous colistin among children in the United States: results from a multicenter, case series. Pediatr Infect Dis J 2013; 32:17-22. [PMID: 22935871 PMCID: PMC4427054 DOI: 10.1097/inf.0b013e3182703790] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A rapid increase in multidrug-resistant Gram-negative infections has led to a reemergence of colistin use globally. Although it is well described among adults, colistin use and its associated toxicities in children are poorly understood. We report findings from the largest case series of pediatric colistin use to date. METHODS We queried pediatric infectious diseases specialists from the Emerging Infections Network to identify members who had prescribed intravenous colistin within the past 7 years. We collected relevant demographic and clinical data. Bivariate analyses and multivariable logistic regression were performed. RESULTS Two hundred twenty-nine pediatric infectious diseases specialists completed the survey (84% response); 22% had prescribed colistin to children. Among respondents, 92 cases of colistin use from 25 institutions were submitted. The most commonly targeted organisms were multidrug-resistant Pseudomonas (67.4%), multidrug-resistant Acinetobacter -baumanii (11.9%), carbapenemase-producing Enterobacteriaceae (13.0%) and extended-spectrum β-lactamase producing Enterobacteriaceae (5.4%). Development of resistance to colistin was observed in 20.5% of patients. Additional antimicrobial therapy was administered to 84% of patients, and 22% of children experienced nephrotoxicity (not associated with dosage or interval of colistin prescribed). Renal function returned to baseline in all patients. Children aged ≥13 years had approximately 7 times the odds of developing nephrotoxicity than younger children, even after controlling for receipt of additional nephrotoxic agents (odds ratio 7.16; 95% confidence interval: 1.51-14.06; P = 0.013). Four children exhibited reversible neurotoxicity. CONCLUSIONS Most pediatric infectious diseases specialists have no experience prescribing colistin. Colistin use in children has been associated primarily with nephrotoxicity and, to a lesser extent, neurotoxicity, both of which are reversible. Emergence of resistance to colistin is concerning.
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Orsini J, Mainardi C, Muzylo E, Karki N, Cohen N, Sakoulas G. Microbiological profile of organisms causing bloodstream infection in critically ill patients. J Clin Med Res 2012; 4:371-7. [PMID: 23226169 PMCID: PMC3513418 DOI: 10.4021/jocmr1099w] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2012] [Indexed: 01/08/2023] Open
Abstract
Background Bloodstream infection (BSI) is the most frequent infection in critically ill patients. As BSI’s among patients in intensive care units (ICU’s) are usually secondary to intravascular catheters, they can be caused by both Gram-positive and Gram-negative microorganisms as well as fungi. Infection with multidrug-resistant (MDR) organisms is becoming more common, making the choice of empirical antimicrobial therapy challenging. The objective of this study is to evaluate the spectrum of microorganisms causing BSI’s in a Medical-Surgical Intensive Care Unit (MSICU) and their antimicrobial resistance patterns. Methods A prospective observational study among all adult patients with clinical signs of sepsis was conducted in a MSICU of an inner-city hospital in New York City between May 1, 2010 and May 30, 2011. Results A total of 722 adult patients with clinical signs of systemic inflammatory response syndrome (SIRS) and/or sepsis were admitted to the MSICU between May 1, 2010 and May 30, 2011. From those patients, 91 (12.6%) had one or more positive blood culture. A 122 isolates were identified: 72 (59%) were Gram-positive bacteria, 38 (31.1%) were Gram-negative organisms, and 12 (9.8%) were fungi. Thirteen (34.2%) Gram-negative organisms and 14 (19.4%) Gram-positive bacteria were classified as MDR. Conclusions Antimicrobial resistance, particularly among Gram-negative organisms, continues to increase at a rapid rate, especially in the ICU’s. Coordinated infection control interventions and antimicrobial stewardship policies are warranted in order to slow the emergence of resistance.
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Affiliation(s)
- Jose Orsini
- Department of Medicine, New York University School of Medicine at Woodhull Medical and Mental Health Center, USA
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Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012; 2012:976273. [PMID: 23097666 PMCID: PMC3477668 DOI: 10.1155/2012/976273] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species except S. pneumoniae and H. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum β-lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance in Staphylococci. Neisseria gonorrhoeae acquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller's diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.
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Affiliation(s)
- Axel Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts Univerity of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, 24105 Kiel, Germany
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Synthesis and antibacterial activities of amphiphilic neomycin B-based bilipid conjugates and fluorinated neomycin B-based lipids. Molecules 2012; 17:9129-41. [PMID: 22858839 PMCID: PMC6268716 DOI: 10.3390/molecules17089129] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 12/15/2022] Open
Abstract
Investigating the effect of lipid hydrophobicity on the activity of amphiphilic neomycin B conjugates, six polycationic amphiphiles (PAs) were created. Four of the new compounds incorporated either palmitic or arachidic di-lipid lysine tails, while two had single fluorinated undecanoic acid tails. The basicity of half of the compounds was increased through the incorporation of six guanidine moieties, in order to assess the effect of base strength on antimicrobial activity. A panel of ten bacteria was used for the testing, with seven strains obtained from the American Type Culture Collection series and three clinical isolates from Canadian Intensive Care Units. When compared to previous results with hydrocarbon monolipids the PAs all compounds were found to have reduced activity, though the hemolytic activity of the compounds with fluorinated tails was sharply reduced, with only a moderate reduction in antimicrobial activity.
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100
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Guanidylation and tail effects in cationic antimicrobial lipopeptoids. PLoS One 2012; 7:e41141. [PMID: 22844435 PMCID: PMC3402541 DOI: 10.1371/journal.pone.0041141] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/18/2012] [Indexed: 11/24/2022] Open
Abstract
Background Cationic antimicrobial peptides (CAMPs) are attractive scaffolds for the next generation of antimicrobial compounds, due to their broad spectrum of activity against multi-drug resistant bacteria and the reduced fitness of CAMP-insensitive mutants. Unfortunately, they are limited by poor in vivo performance, including ready cleavage by endogenous serum proteases. Methodology/Principal Findings To explore the potential for peptoid residues to replace well studied CAMP scaffolds we have produced a series of antimicrobial lipopeptoids, with sequences similar to previously reported lipopeptides. The activity of the peptoids was assessed against a panel of clinically relevant and laboratory reference bacteria, and the potential for non-specific binding was determined through hemolytic testing and repeating the antimicrobial testing in the presence of added bovine serum albumin (BSA). The most active peptoids displayed good to moderate activity against most of the Gram positive strains tested and moderate to limited activity against the Gram negatives. Antimicrobial activity was positively correlated with toxicity towards eukaryotic cells, but was almost completely eliminated by adding BSA. Conclusion/Significance The lipopeptoids had similar activities to the previously reported lipopeptides, confirming their potential to act as replacement, proteolytically stable scaffolds for CAMPs.
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