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Almohaya A, Fersovich J, Weyant RB, Fernández García OA, Campbell SM, Doucette K, Lotfi T, Abraldes JG, Cervera C, Kabbani D. The impact of colonization by multidrug resistant bacteria on graft survival, risk of infection, and mortality in recipients of solid organ transplant: systematic review and meta-analysis. Clin Microbiol Infect 2024:S1198-743X(24)00167-8. [PMID: 38608872 DOI: 10.1016/j.cmi.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The Global increase in colonization by multidrug-resistant (MDR) bacteria poses a significant concern. The precise impact of MDR colonization in solid organ transplant recipients (SOTR) remains not well established. OBJECTIVES To assess the impact of MDR colonization on SOTR's mortality, infection, or graft loss. METHODS AND DATA SOURCES Data from PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, ProQuest Dissertations, Theses Global, and SCOPUS were systematically reviewed, spanning from inception until 20 March 2023. The study protocol was registered with PROSPERO (CRD42022290011) and followed the PRISMA guidelines. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, INTERVENTIONS, AND ASSESSMENT OF RISK OF BIAS: Cohorts and case-control studies that reported on adult SOTR colonized by Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL) or carbapenem-resistant Enterobacteriaceae. (CRE), or MDR-pseudomonas, and compared to noncolonized, were included. Two reviewers assessed eligibility, conducted a risk of bias evaluation using the Newcastle-Ottawa Scale, and rated certainty of evidence using the GRADE approach. METHODS OF DATA SYNTHESIS We employed RevMan for a meta-analysis, using random-effects models to compute pooled odds ratios (OR) and 95% confidence intervals (CI). Statistical heterogeneity was determined using the I2 statistic. RESULTS 15,202 SOTR (33 cohort, six case-control studies) were included, where liver transplant and VRE colonization (25 and 14 studies) were predominant. MDR colonization significantly increased posttransplant 1-year mortality (OR, 2.35; 95% CI, 1.63-3.38) and mixed infections (OR, 10.74; 95% CI, 7.56-12.26) across transplant types (p < 0.001 and I2 = 58%), but no detected impact on graft loss (p 0.41, I2 = 0). Subgroup analysis indicated a higher association between CRE or ESBL colonization with outcomes (CRE: death OR, 3.94; mixed infections OR, 24.8; ESBL: mixed infections OR, 10.3; no mortality data) compared to MRSA (Death: OR, 2.25; mixed infection: OR, 7.75) or VRE colonization (Death: p 0.20, mixed infections: OR, 5.71). CONCLUSIONS MDR colonization in SOTR, particularly CRE, is associated with increased mortality. Despite the low certainty of the evidence, actions to prevent MDR colonization in transplant candidates are warranted.
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Affiliation(s)
- Abdulellah Almohaya
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jordana Fersovich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - R Benson Weyant
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Oscar A Fernández García
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Alberta, Canada
| | - Karen Doucette
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | - Juan G Abraldes
- Division of Gastroenterology Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Cervera
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Anesi JA, Lautenbach E, Thom KA, Tamma PD, Blumberg EA, Alby K, Bilker WB, Werzen A, Ammazzalorso A, Tolomeo P, Omorogbe J, Pineles L, Han JH. Clinical Outcomes and Risk Factors for Carbapenem-resistant Enterobacterales Bloodstream Infection in Solid Organ Transplant Recipients. Transplantation 2023; 107:254-263. [PMID: 35856636 PMCID: PMC9772065 DOI: 10.1097/tp.0000000000004265] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The clinical outcomes associated with, and risk factors for, carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) in solid organ transplant (SOT) recipients remain ill-defined. METHODS A multicenter retrospective cohort study was performed, including SOT recipients with an Enterobacterales BSI between 2005 and 2018. Exposed subjects were those with a CRE BSI. Unexposed subjects were those with a non-CRE BSI. A multivariable survival analysis was performed to determine the association between CRE BSI and risk of all-cause mortality within 60 d. Multivariable logistic regression analysis was performed to determine independent risk factors for CRE BSI. RESULTS Of 897 cases of Enterobacterales BSI in SOT recipients, 70 (8%) were due to CRE. On multivariable analysis, CRE BSI was associated with a significantly increased hazard of all-cause mortality (adjusted hazard ratio, 2.85; 95% confidence interval [CI], 1.68-4.84; P < 0.001). Independent risk factors for CRE BSI included prior CRE colonization or infection (adjusted odds ratio [aOR] 9.86; 95% CI, 4.88-19.93; P < 0.001)' liver transplantation (aOR, 2.64; 95% CI, 1.23-5.65; P = 0.012)' lung transplantation (aOR, 3.76; 95% CI, 1.40-10.09; P = 0.009)' and exposure to a third-generation cephalosporin (aOR, 2.21; 95% CI, 1.17-4.17; P = 0.015) or carbapenem (aOR, 2.80; 95% CI, 1.54-5.10; P = 0.001) in the prior 6 months. CONCLUSIONS CRE BSI is associated with significantly worse outcomes than more antibiotic-susceptible Enterobacterales BSI in SOT recipients.
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Affiliation(s)
- Judith A. Anesi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kerri A. Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD
| | - Pranita D. Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily A. Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alissa Werzen
- Division of Infectious Diseases, University of Maryland Medical Center, Baltimore, MD
| | - Alyssa Ammazzalorso
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD
| | - Jennifer H. Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bezinover D, Biancofiore G, Falcone M, Karvellas C, Husain S, Saner FH. Multidrug-resistant infections in solid organ transplant recipients: a focus on risk factors, prevention and treatment strategies. Minerva Anestesiol 2022; 88:735-747. [PMID: 35315621 DOI: 10.23736/s0375-9393.22.16124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Solid organ transplantation is the best therapeutic option for patients with end-stage organ disease and, according to the data from international registries, there has been a steady increase in numbers and results. However, post-transplant infections remain a fearsome complication with, in the last decade, an increasing incidence of episodes due to antibiotic-resistant bacteria and opportunistic agents. In this paper, we summarize the most relevant and updated knowledge concerning infections from multidrug-resistant germs in solid organ transplant recipients, focusing on risk factors, treatment and prevention strategies, and antimicrobial pharmacokinetics relevant to this particular population of patients.
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Affiliation(s)
- Dmitri Bezinover
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, AOU Pisana, University of Pisa, Pisa, Italy -
| | - Marco Falcone
- Unit of Infectious Diseases, AOU Pisana, University of Pisa, Pisa, Italy
| | - Costantine Karvellas
- Department of Critical Care Medicine and Gastroenterology/Hepatology, University of Alberta, Edmonton, Canada
| | - Shaid Husain
- Department of Infectious Diseases, Toronto General Hospital Research Institute, Toronto University, Toronto, ON, Canada
| | - Fuat H Saner
- Department of General- and Visceral- and Transplant Surgery, Essen University Medical Center, Essen, Germany
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Ham DC, Mahon G, Bhaurla SK, Horwich-Scholefield S, Klein L, Dotson N, Rasheed JK, McAllister G, Stanton RA, Karlsson M, Lonsway D, Huang JY, Brown AC, Walters MS. Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012-2019. Emerg Infect Dis 2021; 27:2475-2479. [PMID: 34424168 PMCID: PMC8386808 DOI: 10.3201/eid2709.210456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012–April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation.
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Giannella M, Bartoletti M, Conti M, Righi E. Carbapenemase-producing Enterobacteriaceae in transplant patients. J Antimicrob Chemother 2021; 76:i27-i39. [PMID: 33534881 DOI: 10.1093/jac/dkaa495] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are a serious public health concern and represent a major threat to immunocompromised hosts, including solid organ (SOT) and stem cell transplant (HSCT) recipients. Transplant patients are at particular risk of developing CPE colonization and/or infection due to their frequent exposure to prolonged courses of broad-spectrum antibiotics, altered immunocompetence and exposure to invasive procedures and immunosuppressive drugs. Gut colonization with CPE, in particular carbapenem-resistant Klebsiella pneumoniae, may occur before or after SOT in 2%-27% of patients and among 2%-9% of HSCT and has been associated with increased risk of developing CPE infections. In endemic areas, CPE infections occur in up to 18% of SOT, and HSCT patients can account for 5%-18% of all patients with CPE bacteraemia. Mortality rates up to 70% have been associated with CPE infections in both patient populations. The rapid initiation of an active therapy against CPE is advocated in these infections. Therapeutic options, however, are limited by the paucity of novel compounds that are currently available and by potential antibiotic-associated toxicities. Therefore, a multidisciplinary approach involving infection control and antimicrobial stewardship programmes still represents the mainstay for the management of CPE infections among transplant patients. The evidence for the use of prevention strategies such as CPE-targeted perioperative prophylaxis or gut decolonization is still scarce. Large, multicentre trials are required to better define prevention strategies and to guide the management of CPE infections in the transplant setting.
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Affiliation(s)
- Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Michela Conti
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elda Righi
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Loqman S, Soraa N, Diene SM, Rolain JM. Dissemination of Carbapenemases (OXA-48, NDM and VIM) Producing Enterobacteriaceae Isolated from the Mohamed VI University Hospital in Marrakech, Morocco. Antibiotics (Basel) 2021; 10:antibiotics10050492. [PMID: 33925772 PMCID: PMC8145435 DOI: 10.3390/antibiotics10050492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022] Open
Abstract
The emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) represent a major clinical problem and raise serious health concerns. The present study aimed to investigate and ascertain the occurrence of CRE among hospitalized patients of Mohamed VI University Hospital, Marrakech, Morocco. Biological samples were collected over a one-year period (2018). The bacterial isolates were identified by MALDI-TOF-MS. Antibiotic susceptibility testing was performed using disc diffusion and Etest. The modified Hodge test and combined disc diffusion test were used for phenotypic detection. CRE hydrolyzing enzyme encoding genes: blaOXA-48, blaKPC, blaIMP, blaVIM, and blaNDM were characterized by PCR and DNA sequencing. In total, 131 non-duplicate CRE clinical strains resistant to Ertapenem were isolated out of 1603 initial Enterobacteriaceae. Klebsiella pneumoniae was the most common species (59%), followed by Enterobacter cloacae (24%), E. coli (10%), Citrobacter freundii (3%), Klebsiellaoxycota (2%), Serratia marcescens (1%), and Citrobacter braakii (1%). Of these, 56.49%, 21.37%, 15.27%, 3.38%, and 3.05% were collected from blood, urine, pus, catheters and respiratory samples, respectively. Approximately 85.5% (112/131) of the isolates were carbapenemase producers (40 blaOXA-48, 27 blaNDM, 38 blaOXA-48 + blaNDM and 7 blaVIM). All metallo-β-lactamases isolates were NDM-1 and VIM-1 producers. This is the first documentation of blaOXA-48 genes from C. freundii and C. braakii in Morocco.
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Affiliation(s)
- Souad Loqman
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, Marrakech 40000, Morocco;
- Laboratoire de Microbiologie, CHU Mohammed VI, Av Ibn Sina Amerchich, BP 2360, Marrakech 40000, Morocco
- Correspondence: ; Tel.: +212-6-6105-0497
| | - Nabila Soraa
- Laboratoire de Lutte Contre les Maladies Infectieuses, Faculté de Médecine et de Pharmacie, Université Cadi Ayyad, Marrakech 40000, Morocco;
- Laboratoire de Microbiologie, CHU Mohammed VI, Av Ibn Sina Amerchich, BP 2360, Marrakech 40000, Morocco
| | - Seydina M. Diene
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Mediterranée Infection, 13385 Marseille, France; (S.M.D.); (J.-M.R.)
| | - Jean-Marc Rolain
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Mediterranée Infection, 13385 Marseille, France; (S.M.D.); (J.-M.R.)
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Coppola PE, Gaibani P, Sartor C, Ambretti S, Lewis RE, Sassi C, Pignatti M, Paolini S, Curti A, Castagnetti F, Ursi M, Cavo M, Stanzani M. Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients. Microorganisms 2020; 8:microorganisms8122055. [PMID: 33371496 PMCID: PMC7767535 DOI: 10.3390/microorganisms8122055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-month period within the same hematology ward. Four cases were associated with rapid progression despite piperacillin-tazobactam or meropenem therapy, and three patients developed sepsis or extensive skin/soft tissue necrosis. In three of the four cases, patients were empirically switched from meropenem to ceftolozane/avibactam before carbapenem susceptibility test results were available, and all four patients underwent extensive surgical debridement or amputation of affected tissues and survived. Further investigation revealed a common bathroom source of MDR P. aeruginosa clonal subtypes ST175 and ST235 that harbored genes for type III secretion system expression and elaboration of ExoU or ExoS exotoxin. We conclude that ceftolozane/tazobactam plus early source control was critical for control of rapidly progressing skin and soft infection in these neutropenic patients caused by highly virulent ST175 and ST235 clones of MDR P. aeruginosa.
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Affiliation(s)
- Paolo E. Coppola
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Paolo Gaibani
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Chiara Sartor
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Simone Ambretti
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Russell E. Lewis
- Infectious Diseases, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy
| | - Claudia Sassi
- Radiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marco Pignatti
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
- Plastic Surgery, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefania Paolini
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Antonio Curti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Fausto Castagnetti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Margherita Ursi
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Michele Cavo
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marta Stanzani
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Correspondence:
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Rostkowska OM, Zgliczyński WS, Jankowski M, Kuthan R, Pinkas J, Durlik M. Hand Hygiene Among Doctors in Transplant Departments in Poland: A Cross-sectional Survey. Transplant Proc 2020; 52:1964-1976. [PMID: 32359828 DOI: 10.1016/j.transproceed.2020.01.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/22/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Hand hygiene (HH) is often under-discussed in clinical work, but it is hard to overestimate its role in preventing health care associated infections (HCAIs), especially among immunocompromised populations such as transplant patients. OBJECTIVES This study aimed to investigate the compliance of doctors in transplant departments in Poland with HH and other selected infection control measures. MATERIAL AND METHODS An on-line cross-sectional survey was carried out among doctors from all Polish transplant departments listed by POLTRANSPLANT. The questionnaire addressed HH in different clinical settings and based on the World Health Organization (WHO) "My 5 Moments for Hand Hygiene." RESULTS Completed questionnaires were obtained from 204 physicians (49% women; response rate: 24.7%). The lowest proportion of doctors who always comply with HH was observed in 2 out of 5 critical moments for hand hygiene: "before touching a patient" (40.2%) and "after contact with patient surroundings" (21.6%). Most respondents declared correct HH action that they would apply in a particular clinical situation as listed in the survey. More than half of doctors (57.4%) declared disinfecting stethoscopes "before and/or after each use." The lack of alcohol-based hand-rub nearby or nonfunctional containers, daily rush, and occurring emergencies were identified as the main reasons for noncompliance with HH recommendations. CONCLUSION Doctors in transplant departments in Poland have a satisfactory level of knowledge about HH in various situations. However, further organizational and educational activities are needed to promote compliance with HH recommendations in health care facilities.
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Affiliation(s)
- Olga Maria Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Robert Kuthan
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Elshamy AA, Aboshanab KM. A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options. Future Sci OA 2020; 6:FSO438. [PMID: 32140243 PMCID: PMC7050608 DOI: 10.2144/fsoa-2019-0098] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
Carbapenems are a class of antimicrobial agents reserved for infections caused by multidrug-resistant microorganisms. The emergence of carbapenem resistance has become a serious public health threat. This type of antimicrobial resistance is spreading at an alarming rate, resulting in major outbreaks and treatment failure of community-acquired and nosocomial infections caused by the clinically relevant carbapenem-producing Enterobacteriaceae or carbapenem-resistant Enterobacteriaceae. This review is focused on carbapenem resistance, including mechanisms of resistance, history and epidemiology, phenotypic and genotypic detection in the clinically relevant bacterial pathogens and the possible treatment options available.
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Affiliation(s)
- Ann A Elshamy
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, POB 11566, Cairo, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, POB 11566, Cairo, Egypt
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Bunsow E, Los-Arcos I, Martin-Gómez MT, Bello I, Pont T, Berastegui C, Ferrer R, Nuvials X, Deu M, Peghin M, González-López JJ, Lung M, Román A, Gavaldà J, Len O. Donor-derived bacterial infections in lung transplant recipients in the era of multidrug resistance. J Infect 2019; 80:190-196. [PMID: 31843689 DOI: 10.1016/j.jinf.2019.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Our aim was to analyze the prevalence of multidrug-resistant bacterial infections in lung transplant donors and to evaluate its influence on donor-derived bacterial infections. METHODS We conducted a retrospective study of adult patients who underwent lung transplantation (2013-2016) at our hospital. Donor-derived bacterial infection was defined as the isolation of the same bacteria with identical antibiotic susceptibility patterns in the recipient and the perioperative cultures from the donor during the first month posttransplantation. We utilized a preventive antibiotic strategy adapted to the bacteria identified in donor cultures using systemic and nebulized antibiotics. RESULTS 252 lung transplant recipients and 243 donors were included. In 138/243 (56.8%) donors, one bacterial species was isolated from at least one sample; graft colonization (118/243; 48.6%), blood cultures (5/243; 2.1%) and the contamination of preservation fluids (56/243; 23%). Multidrug-resistant bacteria were isolated from 12/243 (4.9%) donors; four Enterobacterales, four Stenotrophomonas maltophilia, three Pseudomonas aeruginosa and one methicillin-resistant Staphylococcus aureus. There was no transmission of these multidrug-resistant bacteria. Donor-derived infections, primarily tracheobronchitis due to non-MDR bacteria, were diagnosed in 7/253 (2.9%) recipients, with good clinical outcomes. CONCLUSIONS The lungs of donors colonized with multidrug-resistant bacteria may be safely used when recipients receive prompt tailored antibiotic treatment.
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Affiliation(s)
| | - Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Irene Bello
- Thoracic Surgery Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Teresa Pont
- Transplant Coordination Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ricard Ferrer
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Nuvials
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María Deu
- Thoracic Surgery Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maddalena Peghin
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan José González-López
- Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Román
- Lung Transplant Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Gavaldà
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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