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Codru IR, Sava M, Vintilă BI, Bereanu AS, Bîrluțiu V. A Study on the Contributions of Sonication to the Identification of Bacteria Associated with Intubation Cannula Biofilm and the Risk of Ventilator-Associated Pneumonia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1058. [PMID: 37374262 DOI: 10.3390/medicina59061058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/27/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Ventilator-associated pneumonia is one of the most severe complications of critically ill patients that need mechanical respiratory support, as it poses a significant risk of prolonging hospitalization, disability, and even death. This is why physicians worldwide target newer methods for prevention, early diagnosis, and early target treatment for this condition. There are few methods for a quick etiological diagnosis of pneumonia, especially point of care, and most are only readily available in some intensive care units. This is why a new, simple, and cheap method is needed for determining the bacteria that might be infectious in a particular patient. The manner in question is sonication. Method: In this prospective, observational, single-center study, endotracheal cannula specimens will be collected from at least 100 patients in our intensive care unit. This specimen will be submitted to a specific sonication protocol for bacteria to dislodge the biofilm inside the cannula. The resulting liquid will be seeded on growth media, and then a comparison will be made between the germs in the biofilm and the ones in the tracheal secretion of the patient. The primary purpose is to determine the bacteria before the appearance of a manifest infection.
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Affiliation(s)
- Ioana Roxana Codru
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Mihai Sava
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Bogdan Ioan Vintilă
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Alina Simona Bereanu
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
| | - Victoria Bîrluțiu
- Faculty of Medicine, Lucian Blaga University, 2A, Lucian Blaga Str., 550169 Sibiu, Romania
- County Clinical Emergency Hospital, 2-4, Corneliu Coposu Bld., 550245 Sibiu, Romania
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GÜRBÜZ M, ÇİMKE P, ALTUNKARA H, ALTINKAYA FU, ŞEN G. Evaluation of Pathogens and Antibiotic Resistance Profiles Isolated from Lower Respiratory Tract Samples. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2023. [DOI: 10.30934/kusbed.1083430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: In this study, we aimed to guide clinicians in planning empirical treatment and contribute to regional data by presenting bacterial lower respiratory tract infection agents and antibiotic resistance profiles.
Methods: All lower respiratory tract samples from patients admitted to our laboratory between January 01 and December 31, 2021 were evaluated retrospectively. Bacterial identification and susceptibility tests were performed using the VITEK 2 automated system and evaluated in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST).
Results: Significant growth was detected in 461 of 923 lower respiratory tract samples. Antibiotic susceptibility test results of 340 samples were evaluated after excluding the repeated samples of same patient. Gram negative bacteria was isolated in 309 (90.9%), Staphylococcus aureus in 17 (5%) and Candida albicans in 14 (4.1%) of 340 samples. The most frequently isolated Gram-negative bacteria were Pseudomonas aeruginosa (121, 39.2%), Acinetobacter baumannii (88, 28.5%), Klebsiella pneumoniae (64, 20.7%) and Escherichia coli (36, 11.6%), respectively. Resistance rates of A. baumannii isolates to carbapenems, piperacillin/tazobactam, ceftazidime and fluoroquinolones were found to be over 90%, and higher resistance was observed in intensive care units (ICU) than in wards.
Conclusion: The increased antibiotic resistance observed in lower respiratory tract infections from hospitalized patients in ICUs, is remarkable. As a result, knowing the causative agents and current resistance profiles is important, especially for hospitalized patients in ICUs, in order to initiate appropriate empirical treatment and to ensure treatment success. The data obtained from our study will guide clinicians in planning empirical treatment.
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Affiliation(s)
| | - Pınar ÇİMKE
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR
| | - Hacer ALTUNKARA
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR
| | | | - Gülce ŞEN
- AFYONKARAHİSAR SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR
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Hernandez A, Zhou J, Bohannon JK, McBride MA, Gibson-Corley KN, Patil NK, Owen AM, Burelbach KR, Sherwood ER. INTRAPULMONARY TREATMENT WITH A NOVEL TLR4 AGONIST CONFERS PROTECTION AGAINST KLEBSIELLA PNEUMONIA. Shock 2022; 58:295-303. [PMID: 36018281 PMCID: PMC9647733 DOI: 10.1097/shk.0000000000001977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Objectives: Nosocomial pneumonia is a common complication in critically ill patients. The goal of this study was to examine the efficacy of the Toll-like receptor 4 agonist 3-deacyl phosphorylated hexacyl disaccharide (3D PHAD), in a clinically relevant murine model of pneumonia, and assess the cellular mechanisms that mediate the protective response. Design: Mice received intrapulmonary 3D PHAD (20 μg) or vehicle for 2 consecutive days before challenge with intrapulmonary Klebsiella pneumoniae (2.3 × 10 3 colony-forming units). Mice were followed for 14-day survival, pulmonary K. pneumoniae burden, lung leukocyte profile, leukocyte phagocytic capacity, and cytokine production. Pneumonia severity and leukocyte recruitment were further assessed by histological evaluation. Setting: Research laboratory. Subjects: Wild-type, male C57BL/6 J mice. Interventions: Intrapulmonary treatment with 20 μg 3D PHAD for 2 consecutive days. Measurements and main results: Intrapulmonary treatment with 3D PHAD decreased lung K. pneumoniae colony-forming units and pneumonia severity with an associated improvement in survival compared with mice treated with vehicle. The numbers of neutrophils, monocytes, and macrophages in the lungs of 3D PHAD-treated mice were higher than those in vehicle-treated mice before infection but were not significantly different from vehicle-treated mice at 48 h after K. pneumoniae challenge. Lung innate leukocytes from 3D PHAD-treated mice had increased phagocytic capacity. Treatment with 3D PHAD alone increased cytokines in the lungs but decreased cytokines in plasma during K. pneumoniae pneumonia as compared with control. Conclusions: Intrapulmonary treatment with 3D PHAD augments innate immunity in the lung and facilitates resistance to K. pneumoniae pneumonia.
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Affiliation(s)
- Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jing Zhou
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia K. Bohannon
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret A. McBride
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine N. Gibson-Corley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naeem K. Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allison M. Owen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine R. Burelbach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward R. Sherwood
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Pérez-Cobas AE, Baquero F, de Pablo R, Soriano MC, Coque TM. Altered Ecology of the Respiratory Tract Microbiome and Nosocomial Pneumonia. Front Microbiol 2022; 12:709421. [PMID: 35222291 PMCID: PMC8866767 DOI: 10.3389/fmicb.2021.709421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
Nosocomial pneumonia is one of the most frequent infections in critical patients. It is primarily associated with mechanical ventilation leading to severe illness, high mortality, and prolonged hospitalization. The risk of mortality has increased over time due to the rise in multidrug-resistant (MDR) bacterial infections, which represent a global public health threat. Respiratory tract microbiome (RTM) research is growing, and recent studies suggest that a healthy RTM positively stimulates the immune system and, like the gut microbiome, can protect against pathogen infection through colonization resistance (CR). Physiological conditions of critical patients and interventions as antibiotics administration and mechanical ventilation dramatically alter the RTM, leading to dysbiosis. The dysbiosis of the RTM of ICU patients favors the colonization by opportunistic and resistant pathogens that can be part of the microbiota or acquired from the hospital environments (biotic or built ones). Despite recent evidence demonstrating the significance of RTM in nosocomial infections, most of the host-RTM interactions remain unknown. In this context, we present our perspective regarding research in RTM altered ecology in the clinical environment, particularly as a risk for acquisition of nosocomial pneumonia. We also reflect on the gaps in the field and suggest future research directions. Moreover, expected microbiome-based interventions together with the tools to study the RTM highlighting the "omics" approaches are discussed.
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Affiliation(s)
- Ana Elena Pérez-Cobas
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain
| | - Fernando Baquero
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Raúl de Pablo
- Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - María Cruz Soriano
- Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Teresa M Coque
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain.,CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
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Mitidieri E, Visaggio D, Frangipani E, Turnaturi C, Vanacore D, Provenzano R, Costabile G, Sorrentino R, Ungaro F, Visca P, d'Emmanuele di Villa Bianca R. Intra-tracheal administration increases gallium availability in lung: implications for antibacterial chemotherapy. Pharmacol Res 2021; 170:105698. [PMID: 34058327 DOI: 10.1016/j.phrs.2021.105698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
The emergence of pan-resistant strains in nosocomial settings underscores the urgent need of novel therapies targeting vital bacterial functions. Bacterial iron metabolism is a fascinating target for new antimicrobials. Iron mimetic metal Ga(III) has been repurposed as an antimicrobial drug, in pre-clinical studies and recent clinical studies have raised the possibility of using Ga(III) for the treatment of P. aeruginosa pulmonary infection. Ga(III) has been approved by FDA for the treatment of cancer, autoimmune and bone resorption disorders. However, some critical issues affect the therapeutic schedule of Ga(III), principally the intra-venous (i.v.) administration, and the nephrotoxicity caused by prolonged administration. Ga(III) aerosolization could represent a viable alternative for treatment of lung infections, since delivery of antimicrobial agents to the airways maximizes drug concentration at the site of infection, improves the therapeutic efficacy, and alleviates systemic toxic effects. We demonstrate the advantage of inhaled vs i.v. administered Ga(III), in terms of bio-distribution and lung acute toxicity, by using a rat model. In vivo results support the use of Ga(III) for inhalation since intra-tracheal Ga(III) delivery improved its persistence in the lung, while the i.v. administration caused rapid clearance and did not allow to attain a significant Ga(III) concentration in this organ. Moreover, local and systemic acute toxicity following intra-tracheal administration was not observed, since no significant signs of inflammation were found. At this stage of evidence, the direct administration of Ga(III) to the lung appears feasible and safe, boosting the development of Ga(III)-based drugs for inhalation therapy.
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Affiliation(s)
- Emma Mitidieri
- Department of Pharmacy, School of Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | | | - Emanuela Frangipani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Carlotta Turnaturi
- Department of Pharmacy, School of Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - Domenico Vanacore
- Department of Pharmacy, School of Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - Romina Provenzano
- Department of Pharmacy, School of Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - Gabriella Costabile
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genoa, Italy
| | - Raffaella Sorrentino
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, Italy.
| | - Francesca Ungaro
- Department of Pharmacy, School of Medicine and Surgery, University of Napoli Federico II, Napoli, Italy
| | - Paolo Visca
- Department of Science, Roma Tre University, Rome, Italy
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COVID-19: Measles and Antibiotic Resistance Are a Matter of Concern. Pathogens 2021; 10:pathogens10040449. [PMID: 33918683 PMCID: PMC8069701 DOI: 10.3390/pathogens10040449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
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Xuan G, Lü C, Xu H, Chen Z, Li K, Liu H, Liu H, Xia Y, Xun L. Sulfane Sulfur is an intrinsic signal activating MexR-regulated antibiotic resistance in Pseudomonas aeruginosa. Mol Microbiol 2020; 114:1038-1048. [PMID: 32875640 DOI: 10.1111/mmi.14593] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023]
Abstract
Pseudomonas aeruginosa PAO1, an opportunistic human pathogen, deploys several strategies to resist antibiotics. It uses multidrug efflux pumps, including the MexAB-OprM pump, for antibiotic resistance, and it also produces hydrogen sulfide (H2 S) that provides some defense against antibiotics. MexR functions as a transcriptional repressor of the mexAB-oprM operon. MexR responds to oxidative stresses caused by antibiotic exposure, and it also displays a growth phase-dependent derepression of the mexAB-oprM operon. However, the intrinsic inducer has not been identified. Here, we report that P. aeruginosa PAO1 produced sulfane sulfur, including glutathione persulfide and inorganic polysulfide, produced from either H2 S oxidation or from L-cysteine metabolism. Sulfane sulfur directly reacted with MexR, forming di- and trisulfide cross-links between two Cys residues, to derepress the mexAB-oprM operon. Levels of cellular sulfane sulfur and mexAB-oprM expression varied during growth, and both reached the maximum during the stationary phase of growth. Thus, self-produced H2 S and sulfane sulfur may facilitate antibiotic resistance via inducing the expression of antibiotic resistance genes.
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Affiliation(s)
- Guanhua Xuan
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Chuanjuan Lü
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Huangwei Xu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Zhigang Chen
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Kai Li
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Honglei Liu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Huaiwei Liu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Yongzhen Xia
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China
| | - Luying Xun
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, People's Republic of China.,School of Molecular Biosciences, Washington State University, Pullman, WA, USA
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Shedko ED, Timoshina O, Azyzov IS. Molecular epidemiology of mcr gene group. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2020. [DOI: 10.36488/cmac.2020.4.287-300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Colistin and polymyxin B are the “last reserve” antimicrobials for the treatment of extensively drug-resistant Gram-negative bacterial infections. The rapidly increasing prevalence of polymyxin resistance mediated by the mcr gene localized on plasmid DNA currently poses a high epidemiological threat. In order to control a distribution of mcr genes, it is necessary to develop highly accurate, highly sensitive and easy-to-use diagnostic tools. This paper provides a review of the most relevant studies on the molecular epidemiology as well as current approaches to microbiological and molecular detection of mcr group genes.
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Factors influencing mortality in hospital-acquired pneumonia caused by Gram-negative bacteria in China. J Infect Public Health 2019; 12:630-633. [PMID: 30824328 DOI: 10.1016/j.jiph.2019.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 02/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. The emergence of Gram-negative bacteria (GNB) is of major concern. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in HAP with GNB. METHODS We performed a retrospective, single-center analysis of HAP patients with GNB occurring from January 2014 and December 2017. Univariate and multivariate analyses were performed to identify the risk factors for mortality. RESULTS During the observational period, there were 1472 cases of HAP; 314 cases were bacterial culture-positive, 269 cases were caused by GNB, with a predominance of Acinetobacter baumannii and Pseudomonas aeruginosa. The mortality related to GNB was 14.5% (39 deaths).In the multivariate logistic regression analysis, the risk factors for mortality were age >70 years, intensive care unit (ICU) admission, blood lymphocyte count < 0.8 × 109/L, multidrug-resistant Gram-negative bacteria(MDR-GNB) infection, and elevation of blood urea nitrogen(BUN) level. We identified these factors as significant predictors of GNB related mortality; the area under the receiver operating characteristic (ROC) curves was 0.836. CONCLUSION The results provided can help clinicians in identifying individuals who are at risk of infection-related 30-day mortality in HAP with GNB.
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Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-518. [PMID: 29982303 PMCID: PMC6336913 DOI: 10.1093/cid/ciy543] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/31/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.
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Affiliation(s)
- Ana Bonell
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | - Vu Thi Lan Huong
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Thanh Le Viet
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | | | | | - Heiman Wertheim
- Department of Medical Microbiology, Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Sonia Lewycka
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
| | - Behzad Nadjm
- Oxford Clinical Research Unit Hanoi, National Hospital for Tropical Diseases, Vietnam
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11
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Trends of Incidence and Risk Factors of Ventilator-Associated Pneumonia in Elderly Patients Admitted to French ICUs Between 2007 and 2014*. Crit Care Med 2018; 46:869-877. [DOI: 10.1097/ccm.0000000000003019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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12
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Pepper IL, Brooks JP, Gerba CP. Antibiotic Resistant Bacteria in Municipal Wastes: Is There Reason for Concern? ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:3949-3959. [PMID: 29505255 DOI: 10.1021/acs.est.7b04360] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recently, there has been increased concern about the presence of antibiotic resistant bacteria (ARB) and antibiotic resistant genes (ARG), in treated domestic wastewaters, animal manures and municipal biosolids. The concern is whether these additional sources of ARB contribute to antibiotic resistance levels in the environment, that is, "environmental antibiotic resistance." ARB and ARG occur naturally in soil and water, and it remains unclear whether the introduction of ARB in liquid and solid municipal and animal wastes via land application have any significant impact on the background levels of antibiotic resistance in the environment, and whether they affect human exposure to ARB. In this current review, we examine and re-evaluate the incidence of ARB and ARG resulting from land application activities, and offer a new perspective on the threat of antibiotic resistance to public health via exposure from nonclinical environmental sources. Based on inputs of ARBs and ARGs from land application, their fate in soil due to soil microbial ecology principles, and background indigenous levels of ARBs and ARGs already present in soil, we conclude that while antibiotic resistance levels in soil are increased temporally by land application of wastes, their persistence is not guaranteed and is in fact variable, and often contradictory based on application site. Furthermore, the application of wastes may not produce the most direct impact of ARGs and ARB on public health. Further investigation is still warranted in agriculture and public health, including continued scrutiny of antibiotic use in both sectors.
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Affiliation(s)
- Ian L Pepper
- Water and Energy Sustainable Technology Center (WEST) , The University of Arizona , 2959 W. Calle Agua Nueva , Tucson , Arizona 85745 , United States
| | - John P Brooks
- Genetics and Sustainable Agriculture Research Unit, USDA ARS , Mississippi State , Mississippi , 39762 , United States
| | - Charles P Gerba
- Water and Energy Sustainable Technology Center (WEST) , The University of Arizona , 2959 W. Calle Agua Nueva , Tucson , Arizona 85745 , United States
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Pássaro L, Harbarth S, Landelle C. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review. Antimicrob Resist Infect Control 2016; 5:43. [PMID: 27895901 PMCID: PMC5109660 DOI: 10.1186/s13756-016-0150-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/09/2016] [Indexed: 01/28/2023] Open
Abstract
Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP). Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high-quality studies are required to evaluate the impact of specific measures on HAP prevention in non-ventilated adult patients.
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Affiliation(s)
- Leonor Pássaro
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Caroline Landelle
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland ; Infection Control Unit, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, CS 10217, 38043 Grenoble Cedex 9, France ; ThEMAS TIM-C UMR 5525, University Grenoble Alpes/CNRS, Grenoble, France
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Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals. Eur J Clin Microbiol Infect Dis 2016; 35:1531-9. [PMID: 27272120 DOI: 10.1007/s10096-016-2694-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.
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A Case-Control Study Assessing the Impact of Nonventilated Hospital-Acquired Pneumonia on Patient Outcomes. Chest 2016; 150:1008-1014. [PMID: 27102181 PMCID: PMC7094544 DOI: 10.1016/j.chest.2016.04.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/09/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022] Open
Abstract
Background Nonventilated hospital-acquired pneumonia (NVHAP) is a serious nosocomial infection that is increasingly attributed to antibiotic-resistant bacteria. Methods This is a retrospective case-control study comparing patients with and those without NVHAP from January 1, 2014 to December 31, 2014 at Barnes-Jewish Hospital, a 1,300-bed urban academic medical center in St. Louis, Missouri. Results One hundred seventy-four consecutive patients with NVHAP were enrolled. A random sample of 696 control patients matched by age, sex, race, and hospital admission date were selected from a total of 5,322 potential matched control subjects. NVHAP was pathogen-negative in 98 cases (56.3%). Respiratory viruses were identified in 42 patients (24.1%), gram-negative bacteria were seen in 25 patients (14.4%), and gram-positive bacteria were identified in 20 patients (11.5%). Individuals in whom NVHAP developed were more likely to die (15.5% vs 1.6%; P < .01), to require intensive care (56.3% vs 22.8%; P < .01) or mechanical ventilation (19.0% vs 3.9%; P < 0.01), and to have a longer hospital length of stay (15.9 days [range, 9.8-26.3 days] vs 4.4 days [range, 2.9-7.3 days]; P < 0.01). This case-control study identified a strong association between hospital mortality and NVHAP, with patients who acquired NVHAP having an 8.4 times greater odds of death (95% CI, 5.6-12.5). Conclusions The occurrence of NVHAP was associated with significant increases in mortality, the use of intensive care and mechanical ventilation, and hospital length of stay. We also found that respiratory viruses were an important cause of NVHAP. These findings suggest that efforts aimed at the successful prevention of NVHAP could improve patient outcomes and reduce health-care costs.
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Dreier J, Ruggerone P. Interaction of antibacterial compounds with RND efflux pumps in Pseudomonas aeruginosa. Front Microbiol 2015; 6:660. [PMID: 26217310 PMCID: PMC4495556 DOI: 10.3389/fmicb.2015.00660] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/16/2015] [Indexed: 01/14/2023] Open
Abstract
Pseudomonas aeruginosa infections are becoming increasingly difficult to treat due to intrinsic antibiotic resistance and the propensity of this pathogen to accumulate diverse resistance mechanisms. Hyperexpression of efflux pumps of the Resistance-Nodulation-Cell Division (RND)-type multidrug efflux pumps (e.g., MexAB-OprM), chromosomally encoded by mexAB-oprM, mexCD-oprJ, mexEF-oprN, and mexXY (-oprA) is often detected in clinical isolates and contributes to worrying multi-drug resistance phenotypes. Not all antibiotics are affected to the same extent by the aforementioned RND efflux pumps. The impact of efflux on antibiotic activity varies not only between different classes of antibiotics but also between members of the same family of antibiotics. Subtle differences in physicochemical features of compound-pump and compound-solvent interactions largely determine how compounds are affected by efflux activity. The combination of different high-resolution techniques helps to gain insight into the functioning of these molecular machineries. This review discusses substrate recognition patterns based on experimental evidence and computer simulations with a focus on MexB, the pump subunit of the main RND transporter in P. aeruginosa.
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Affiliation(s)
- Jürg Dreier
- Basilea Pharmaceutica International Ltd.,Basel, Switzerland
| | - Paolo Ruggerone
- Dipartimento di Fisica, Università di Cagliari – Cittadella UniversitariaMonserrato, Italy
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