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Multidrug-Resistant Acinetobacter baumannii. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31828bbb1a] [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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52
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Bogan C, Marchaim D. The role of antimicrobial stewardship in curbing carbapenem resistance. Future Microbiol 2013; 8:979-91. [DOI: 10.2217/fmb.13.73] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Antimicrobial resistance is a continuing, growing, worldwide iatrogenic complication of modern medical care. Carbapenem resistance among certain pathogens poses a significant challenge. In order to reduce the spread of these nearly untreatable pathogens, preventative efforts should be directed at reducing patient-to-patient transmission and preventing the emergence of resistance among susceptible strains. One theoretical intervention to reduce the emergence of resistance is establishing and strictly adhering to an antimicrobial stewardship program. However, data pertaining to the direct effect of stewardship in curtailing carbapenem resistance among epidemiologically significant organisms are scarce. In this report, we review the potential biases associated with data interpretation in this research field, and we review the data pertaining to the impact of stewardship in curbing carbapenem resistance in three significant groups of pathogens: Pseudomonas aeruginosa, Enterobacteriaceae and Acinetobacter baumannii.
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Affiliation(s)
| | - Dror Marchaim
- Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, 70300, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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53
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Marchaim D, Katz DE, Munoz-Price LS. Emergence and Control of Antibiotic-resistant Gram-negative Bacilli in Older Adults. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13670-013-0051-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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54
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Azithromycin attenuates lung inflammation in a mouse model of ventilator-associated pneumonia by multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2013; 57:3883-8. [PMID: 23733468 DOI: 10.1128/aac.00457-13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acinetobacter baumannii is one of the main pathogens that cause ventilator-associated pneumonia (VAP) and is associated with a high rate of mortality. Little is known about the efficacy of macrolides against A. baumannii. In order to confirm the efficacy of azithromycin (AZM) against VAP caused by multidrug-resistant A. baumannii (MDRAB), we used a mouse model that mimics VAP by placement of a plastic tube in the bronchus. AZM (10 and 100 mg/kg of body weight) was administered subcutaneously every 24 h beginning at 3 h after inoculation. Phosphate-buffered saline was administered as the control. Survival was evaluated over 7 days. At 48 h postinfection, mice were sacrificed and the numbers of viable bacteria in lungs and bronchoalveolar lavage fluid were compared. Histopathological analysis of lung specimens was also performed. The treatment groups displayed significantly longer survival than the control group (P < 0.05). AZM did not have an antimicrobial effect. Histopathological examination of lung specimens indicated that the progression of lung inflammation was prevented in the AZM-treated groups. Furthermore, total cell and neutrophil counts, as well as cytokine levels, in bronchoalveolar lavage fluid were significantly decreased (P < 0.05) in the AZM-treated groups. AZM may have a role for the treatment of VAP with MDRAB because of its anti-inflammatory effects.
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55
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van Duin D, van Delden C. Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:31-41. [PMID: 23464996 DOI: 10.1111/ajt.12096] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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56
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Ku K, Pogue JM, Moshos J, Bheemreddy S, Wang Y, Bhargava A, Campbell M, Khandker N, Lephart PR, Chopra T, Hayakawa K, Martin ET, Abreu-Lanfranco O, Dhar S, Kaye KS, Marchaim D. Retrospective evaluation of colistin versus tigecycline for the treatment of Acinetobacter baumannii and/or carbapenem-resistant Enterobacteriaceae infections. Am J Infect Control 2012; 40:983-7. [PMID: 22440526 DOI: 10.1016/j.ajic.2011.12.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Therapeutic options are limited for infections because of Acinetobacter baumannii and carbapenem-resistant Enterobacteriaceae (CRE). Study aim was to compare the efficacy of colistin to tigecycline for the treatment of these types of infections. METHODS A retrospective study was conducted at the Detroit Medical Center. Adult patients with infections because of A baumannii or CRE in 2009 who received ≥2 doses of colistin or tigecycline were studied. Risk factors, outcomes, and costs were analyzed. RESULTS There were 82 patients with infections because of A baumannii, 12 with CRE, and 12 with A baumannii and CRE coinfection. Seventy-one patients received colistin, 16 received tigecycline, and 19 received both colistin and tigecycline. Seven isolates were nonsusceptible to colistin and 79 to tigecycline. Patients receiving colistin alone or in combination were more likely to die during their hospitalization than patients receiving only tigecycline (P = .002). However, patients receiving colistin had higher severity of acute illness and had notable delays in initiation of effective antimicrobial therapy (P < .001). CONCLUSION Compared with patients who received tigecycline alone, patients who received colistin alone or in combination had a higher severity of acute illness indices and delays in initiation of effective therapy. This increased severity of illness contributed to the increased rate of mortality among patients treated with colistin for A baumannii or CRE infections.
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57
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Vila J, Pachón J. Therapeutic options forAcinetobacter baumanniiinfections: an update. Expert Opin Pharmacother 2012; 13:2319-36. [DOI: 10.1517/14656566.2012.729820] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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58
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Hayakawa K, Marchaim D, Divine GW, Pogue JM, Kumar S, Lephart P, Risko K, Sobel JD, Kaye KS. Growing prevalence of Providencia stuartii associated with the increased usage of colistin at a tertiary health care center. Int J Infect Dis 2012; 16:e646-8. [PMID: 22818111 DOI: 10.1016/j.ijid.2012.05.1029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022] Open
Abstract
From 2005 to 2009, at Detroit Medical Center, the prevalence of Providencia stuartii increased from 0.52 to 0.91/1000 patient-days (p<0.001). The use of colistin also increased (p<0.001) during the study period. The increase in the prevalence of P. stuartii was associated with an increased use of colistin (p<0.001). Facilities that frequently use colistin and tigecycline should closely monitor the prevalence of P. stuartii along with other Proteeae, since these organisms are intrinsically resistant to colistin and tigecycline.
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Affiliation(s)
- Kayoko Hayakawa
- Division of Infectious Diseases, Detroit Medical Center, Wayne State University, 5 Hudson, Harper University Hospital, 3990 John R Street, Detroit, MI 48201, USA.
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Sowmiya M, Umashankar V, Muthukumaran S, Madhavan HN, Malathi J. Studies on New Delhi Metallo-Beta-Lactamse-1 producing Acinetobacter baumannii isolated from donor swab in a tertiary eye care centre, India and structural analysis of its antibiotic binding interactions. Bioinformation 2012; 8:445-52. [PMID: 22715297 PMCID: PMC3374353 DOI: 10.6026/97320630008445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/23/2022] Open
Abstract
Gram-negative bacilli, Enterobacteriaceae and Non-fermentors with resistance to carbapenems and metallo beta-lactams are the major cause of concern in clinical problems in current human healthcare. The most highly emerging dreadful Metallo Beta-lactamses is New Delhi metallo-beta-lactamase (blaNDM-1) which confers resistance to carbapenems; susceptible only to colistin and, less consistently to tigecycline, leading to no therapeutic options. In the present study, we demonstrate the effects of cephalosporins and carbepenems on biofilm producing A. baumanii clinical isolate and also to infer the probable inhibitory binding mode through molecular docking studies. The result of MIC on Biofilm producing A. baumanii and the docking analysis results were found to be concordant. Moreover, we also found cephalosporins and carbepenem groups to interact with 162-166 region of blaNDM-1, which is unique for NDM-1 and also documented to be a potential drug targeting region.
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Affiliation(s)
- Murali Sowmiya
- L& T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, New.41 (Old.No18), Chennai – 600006
India
| | - Vetrivel Umashankar
- Centre of Bioinformatics, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Hajib Naraharirao Madhavan
- L& T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, New.41 (Old.No18), Chennai – 600006
India
| | - Jambulingam Malathi
- L& T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, New.41 (Old.No18), Chennai – 600006
India
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Yamada K, Yanagihara K, Araki N, Harada Y, Morinaga Y, Akamatsu N, Matsuda J, Izumikawa K, Kakeya H, Yamamoto Y, Hasegawa H, Kohno S, Kamihira S. Clinical characteristics of tertiary hospital patients from whom Acinetobacter calcoaceticus-Acinetobacter baumannii complex strains were isolated. Intern Med 2012; 51:51-7. [PMID: 22214623 DOI: 10.2169/internalmedicine.51.6018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Acinetobacter baumannii is a worldwide nosocomial pathogen that has become increasingly common over the past few decades, and strains of multidrug-resistant A. baumannii have been increasing. The aim of this study was to assess the clinical characteristics of A. calcoaceticus-A. baumannii complex (Acb complex) strains and to determine the risk factors of this infection. METHODS The medical records of 121 patients at Nagasaki University Hospital from whom Acb complex had been isolated between January 2007 and December 2009 were retrospectively reviewed. Patient backgrounds, sensitivity to antibiotics, risk factors for infection, and prognosis were evaluated. RESULTS Lower respiratory isolates accounted for 73% (147 strains) of all 201 isolates. Most of the isolates were sensitive to carbapenems. Of the 121 patients (74 males and 47 females; mean age: 62.1 years), 48 (39.7%) had malignancy and 75 (62.0%) were treated with antibiotics prior to isolation. Thirty-seven of the patients in this study (30.6%) were infected by Acb complex and the most frequent clinical manifestation was pneumonia (18 cases; 48.6%). Approximately 60% of infected patients were treated with β-lactam agent in combination with β-lactamase inhibitors or carbapenems. The mortality rate of infected patients was significantly higher than that of colonized patients (infected: 24.3%, colonized: 6.0%, p<0.05). Risk factors for Acb complex infection include being over 60 years of age, chronic liver disease, and the use of first-generation cephalosporins prior to isolation. CONCLUSION Acb complex was relatively sensitive to antibiotics. The appropriate usage of antibiotics should be continued for the prevention of drug resistance in Acb complex.
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Affiliation(s)
- Koichi Yamada
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Morfin-Otero R, Dowzicky MJ. Changes in MIC within a global collection of Acinetobacter baumannii collected as part of the Tigecycline Evaluation and Surveillance Trial, 2004 to 2009. Clin Ther 2011; 34:101-12. [PMID: 22177546 DOI: 10.1016/j.clinthera.2011.11.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) began in 2004 to monitor global antimicrobial susceptibility to tigecycline and a range of comparator antimicrobials among gram-positive and gram-negative organisms. OBJECTIVE The aim of this study was to report changes in MIC for tigecycline and other antimicrobial agents among 10,149 Acinetobacter baumannii isolates collected globally between 2004 and 2009. METHODS MICs of 10,149 isolates were determined locally using Clinical Laboratory and Standards Institute (CLSI) methodologies. Antimicrobial susceptibility was ascertained according to CLSI interpretive criteria (no interpretive criteria have been approved for tigecycline against Acinetobacter spp). RESULTS Increases in resistance were noted for most antimicrobial agents in all regions. Significant (P < 0.05) increases in percentage resistance were reported for all antimicrobial agents globally. The smallest changes in cumulative geometric mean MICs were reported for tigecycline (0.2 mg/L) and cefepime (3.5 mg/L). MIC(90)s were at the top of their testing ranges for most agents against both multidrug-resistant (MDR) and non-MDR isolates; only tigecycline showed little change in MIC(90) between MDR (2 mg/L) and non-MDR (1 mg/L) isolates. Resistance was higher among isolates from the intensive care unit (ICU) compared with non-ICU isolates. CONCLUSION These findings suggest that resistance is increasing among clinical isolates of A baumannii globally. Although resistance to tigecycline has been reported in the treatment of infections caused by A baumannii, it retains in vitro activity against this pathogen.
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Affiliation(s)
- Rayo Morfin-Otero
- Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
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Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens in nursing homes, in the community, and in the hospital. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Luke F Chen
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359, Hanes House, Durham, NC 27710, USA.
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