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Abbott IJ, Peel TN, Cairns KA, Stewardson AJ. Antibiotic management of urinary tract infections in the post-antibiotic era: a narrative review highlighting diagnostic and antimicrobial stewardship. Clin Microbiol Infect 2023; 29:1254-1266. [PMID: 35640839 DOI: 10.1016/j.cmi.2022.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND As one of the most common indications for antimicrobial prescription in the community, the management of urinary tract infections (UTIs) is both complicated by, and a driver of, antimicrobial resistance. OBJECTIVES To highlight the key clinical decisions involved in the diagnosis and treatment of UTIs in adult women, focusing on clinical effectiveness and both diagnostic and antimicrobial stewardship as we approach the post-antimicrobial era. SOURCES Literature reviewed via directed PubMed searches and manual searching of the reference list for included studies to identify key references to respond to the objectives. A strict time limit was not applied. We prioritised recent publications, randomised trials, and systematic reviews (with or without meta-analyses) where available. Searches were limited to English language articles. A formal quality assessment was not performed; however, the strengths and limitations of each paper were reviewed by the authors throughout the preparation of this manuscript. CONTENT We discuss the management of UTIs in ambulatory adult women, with particular focus on uncomplicated infections. We address the diagnosis of UTIs, including the following: definition and categorisation; bedside assessments and point-of-care tests; and the indications for, and use of, laboratory tests. We then discuss the treatment of UTIs, including the following: indications for treatment, antimicrobial sparing approaches, key considerations when selecting a specific antimicrobial agent, specific treatment scenarios, and duration of treatment. We finally outline emerging areas of interest in this field. IMPLICATIONS The steady increase in antimicrobial resistance among common uropathogens has had a substantial affect on the management of UTIs. Regarding both diagnosis and treatment, the clinician must consider both the patient (clinical effectiveness and adverse effects, including collateral damage) and the community more broadly (population-level antimicrobial selection pressure).
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Affiliation(s)
- Iain J Abbott
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia; Microbiology Unit, Alfred Health, Melbourne, Victoria, Australia.
| | - Trisha N Peel
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kelly A Cairns
- Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew J Stewardson
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Fratoni AJ, Avery LM, Nicolau DP, Asempa TE. In vivo pharmacokinetics and pharmacodynamics of ceftibuten/ledaborbactam, a novel oral β-lactam/β-lactamase inhibitor combination. J Antimicrob Chemother 2022; 78:93-100. [PMID: 36272135 PMCID: PMC10205465 DOI: 10.1093/jac/dkac359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Oral β-lactam treatment options for MDR Enterobacterales are lacking. Ledaborbactam (formerly VNRX-5236) is a novel orally bioavailable β-lactamase inhibitor that restores ceftibuten activity against Ambler Class A-, C- and D-producing Enterobacterales. We assessed the ledaborbactam exposure needed to produce bacteriostasis against ceftibuten-resistant Enterobacterales in the presence of humanized ceftibuten exposures in the neutropenic murine thigh infection model. METHODS Twelve ceftibuten-resistant clinical isolates (six Klebsiella pneumoniae, five Escherichia coli and one Enterobacter cloacae) were utilized. Ceftibuten/ledaborbactam MICs ranged from 0.12 to 2 mg/L (ledaborbactam fixed at 4 mg/L). A ceftibuten murine dosing regimen mimicking ceftibuten 600 mg q12h human exposure was developed and administered alone and in combination with escalating exposures of ledaborbactam. The log10 cfu/thigh change at 24 h relative to 0 h controls was plotted against ledaborbactam fAUC0-24/MIC and the Hill equation was used to determine exposures associated with bacteriostasis. RESULTS The mean ± SD 0 h bacterial burden was 5.96 ± 0.24 log10 cfu/thigh. Robust growth (3.12 ± 0.93 log10 cfu/thigh) was achieved in untreated control mice. Growth of 2.51 ± 1.09 log10 cfu/thigh was observed after administration of humanized ceftibuten monotherapy. Individual isolate exposure-response relationships were strong (mean ± SD R2 = 0.82 ± 0.15). The median ledaborbactam fAUC0-24/MIC associated with stasis was 3.59 among individual isolates and 6.92 in the composite model. CONCLUSIONS Ledaborbactam fAUC0-24/MIC exposures for stasis were quantified with a ceftibuten human-simulated regimen against β-lactamase-producing Enterobacterales. This study supports the continued development of oral ceftibuten/ledaborbactam etzadroxil (formerly ceftibuten/VNRX-7145).
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Affiliation(s)
- Andrew J Fratoni
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
| | | | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
| | - Tomefa E Asempa
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
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Denissen J, Reyneke B, Waso-Reyneke M, Havenga B, Barnard T, Khan S, Khan W. Prevalence of ESKAPE pathogens in the environment: Antibiotic resistance status, community-acquired infection and risk to human health. Int J Hyg Environ Health 2022; 244:114006. [PMID: 35841823 DOI: 10.1016/j.ijheh.2022.114006] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 01/10/2023]
Abstract
The ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens are characterised by increased levels of resistance towards multiple classes of first line and last-resort antibiotics. Although these pathogens are frequently isolated from clinical environments and are implicated in a variety of life-threatening, hospital-associated infections; antibiotic resistant ESKAPE strains have been isolated from environmental reservoirs such as surface water, wastewater, food, and soil. Literature on the persistence and subsequent health risks posed by the ESKAPE isolates in extra-hospital settings is however, limited and the current review aims to elucidate the primary reservoirs of these pathogens in the environment, their antibiotic resistance profiles, and the link to community-acquired infections. Additionally, information on the current state of research regarding health-risk assessments linked to exposure of the ESKAPE pathogens in the natural environment, is outlined.
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Affiliation(s)
- Julia Denissen
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Brandon Reyneke
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Monique Waso-Reyneke
- Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein, 2028, South Africa
| | - Benjamin Havenga
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Tobias Barnard
- Water and Health Research Centre, University of Johannesburg, PO Box 17011, Doornfontein, 7305, South Africa
| | - Sehaam Khan
- Faculty of Health Sciences, University of Johannesburg, PO Box 17011, Doornfontein, 2028, South Africa
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa.
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From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections. Antibiotics (Basel) 2022; 11:antibiotics11020201. [PMID: 35203803 PMCID: PMC8868523 DOI: 10.3390/antibiotics11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.
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Microbiological Characterization of VNRX-5236, a Broad-Spectrum β-Lactamase Inhibitor for Rescue of the Orally Bioavailable Cephalosporin Ceftibuten as a Carbapenem-Sparing Agent against Strains of Enterobacterales Expressing Extended-Spectrum β-Lactamases and Serine Carbapenemases. Antimicrob Agents Chemother 2021; 65:e0055221. [PMID: 34001510 PMCID: PMC8284453 DOI: 10.1128/aac.00552-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is an urgent need for oral agents to combat resistant Gram-negative pathogens. Here, we describe the characterization of VNRX-5236, a broad-spectrum boronic acid β-lactamase inhibitor (BLI), and its orally bioavailable etzadroxil prodrug, VNRX-7145. VNRX-7145 is being developed in combination with ceftibuten, an oral cephalosporin, to combat strains of Enterobacterales expressing extended-spectrum β-lactamases (ESBLs) and serine carbapenemases. VNRX-5236 is a reversible covalent inhibitor of serine β-lactamases, with inactivation efficiencies on the order of 104 M−1 · sec−1, and prolonged active site residence times (t1/2, 5 to 46 min). The spectrum of inhibition includes Ambler class A ESBLs, class C cephalosporinases, and class A and D carbapenemases (KPC and OXA-48, respectively). Rescue of ceftibuten by VNRX-5236 (fixed at 4 μg/ml) in isogenic strains of Escherichia coli expressing class A, C, or D β-lactamases demonstrated an expanded spectrum of activity relative to oral comparators, including investigational penems, sulopenem, and tebipenem. VNRX-5236 rescued ceftibuten activity in clinical isolates of Enterobacterales expressing ESBLs (MIC90, 0.25 μg/ml), KPCs (MIC90, 1 μg/ml), class C cephalosporinases (MIC90, 1 μg/ml), and OXA-48-type carbapenemases (MIC90, 1 μg/ml). Frequency of resistance studies demonstrated a low propensity for recovery of resistant variants at 4× the MIC of the ceftibuten/VNRX-5236 combination. In vivo, whereas ceftibuten alone was ineffective (50% effective dose [ED50], >128 mg/kg), ceftibuten/VNRX-7145 administered orally protected mice from lethal septicemia caused by Klebsiella pneumoniae producing KPC carbapenemase (ED50, 12.9 mg/kg). The data demonstrate potent, broad-spectrum rescue of ceftibuten activity by VNRX-5236 in clinical isolates of cephalosporin-resistant and carbapenem-resistant Enterobacterales.
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Opatowski M, Brun-Buisson C, Touat M, Salomon J, Guillemot D, Tuppin P, Watier L. Antibiotic prescriptions and risk factors for antimicrobial resistance in patients hospitalized with urinary tract infection: a matched case-control study using the French health insurance database (SNDS). BMC Infect Dis 2021; 21:571. [PMID: 34126937 PMCID: PMC8201676 DOI: 10.1186/s12879-021-06287-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Antibiotic resistance is increasing among urinary pathogens, resulting in worse clinical and economic outcomes. We analysed factors associated with antibiotic-resistant bacteria (ARB) in patients hospitalized for urinary tract infection, using the comprehensive French national claims database. METHODS Hospitalized urinary tract infections were identified from 2015 to 2017. Cases (due to ARB) were matched to controls (without ARB) according to year, age, sex, infection, and bacterium. Healthcare-associated (HCAI) and community-acquired (CAI) infections were analysed separately; logistic regressions were stratified by sex. RESULTS From 9460 cases identified, 6468 CAIs and 2855 HCAIs were matched with controls. Over a 12-months window, the risk increased when exposure occurred within the last 3 months. The following risk factors were identified: antibiotic exposure, with an OR reaching 3.6 [2.8-4.5] for men with CAI, mostly associated with broad-spectrum antibiotics; surgical procedure on urinary tract (OR 2.0 [1.5-2.6] for women with HCAI and 1.3 [1.1-1.6] for men with CAI); stay in intensive care unit > 7 days (OR 1.7 [1.2-2.6] for men with HCAI). Studied co-morbidities had no impact on ARB. CONCLUSIONS This study points out the critical window of 3 months for antibiotic exposure, confirms the impact of broad-spectrum antibiotic consumption on ARB, and supports the importance of prevention during urological procedures, and long intensive care unit stays.
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Affiliation(s)
- Marion Opatowski
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Christian Brun-Buisson
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Mehdi Touat
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Jérôme Salomon
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Didier Guillemot
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- French National Health Insurance (Cnam), 50 Avenue du Pr-André-Lemierre, 75986, Paris Cedex 20, France
| | - Laurence Watier
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France.
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France.
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Quan J, Dai H, Liao W, Zhao D, Shi Q, Zhang L, Shi K, Akova M, Yu Y. Etiology and prevalence of ESBLs in adult community-onset urinary tract infections in East China: A prospective multicenter study. J Infect 2021; 83:175-181. [PMID: 34116075 DOI: 10.1016/j.jinf.2021.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Community onset urinary tract infections (COUTIs) drew attention recently owing to their increased prevalence and associations with resistant pathogens. The study is aimed at investigating the etiology of COUTIs as well as prevalence and the related risk factors of extended-spectrum β-lactamase (ESBL) in COUTIs in China. METHODS The prospective study was performed in nineteen hospitals during November 1, 2017 and August 31, 2019. Non-duplicated isolates from COUTIs were included. The ESBL phenotypic confirmation test was performed and whole genomes were sequenced for all the ESBL-positive bacteria for further analysis. The risk factors for ESBL-producing bacterial infections were analyzed using binary logistic regression. RESULTS A total of 1760 COUTI cases were included in this study. Escherichia coli (1332, 75.7%), Klebsiella pneumoniae (110, 6.3%) and Enterococcus faecalis (52, 3.0%) were the top three common pathogens of COUTIs in China. The overall positive rate of ESBLs in Enterobacterales was 37.2% (562/1512). The age (OR=1.007, P = 0.041), solid malignant tumor (OR=1.668, P = 0.016), prostate diseases (OR=2.035, P = 0.010), history of lithotripsy for urinary calculi (OR=2.009, P = 0.030), history of urological surgery (OR=1.869, P = 0.009) and cephalosporin use within 3 months (OR=1.503, P = 0.025) were independent risk factors for ESBL-producing organisms causing COUTIs. The predominant ESBL types were CTX-Ms, among which CTX-M-14, CTX-M-55 and CTX-M-27 were the most common subtypes. ST131 and ST1193 were the predominant sequence types of ESBL-producing E. coli (ESBL-EC). Most of the tested antimicrobial agents showed significantly higher non-susceptible rates in the ESBL positive group as compared with ESBL-negative group (P < 0.05). CONCLUSIONS Enterobacterales, especially E. coli, is the most common pathogen in COUTIs in China and ESBL-producers are highly prevalent. Thus, early prediction depending on risk factors seems to be crucial to determine the appropriate empirical therapy for infections caused by ESBL-producing pathogens.
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Affiliation(s)
- Jingjing Quan
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honglei Dai
- Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weichao Liao
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dongdong Zhao
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiucheng Shi
- Department of Clinical Laboratory, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linghong Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Keren Shi
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Murat Akova
- Department of Infectious Disease, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization in Spain: An Observational Cohort Study. ANTIBIOTICS (BASEL, SWITZERLAND) 2021; 10:antibiotics10050585. [PMID: 34063338 PMCID: PMC8156369 DOI: 10.3390/antibiotics10050585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study that included all adults with a UTI caused by K. pneumoniae that were admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical, and economic data were analyzed. Results: One hundred and seventy-three episodes of UTIs caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 were ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and the time taken to obtain adequate treatment as risk factors for clinical failure during the first seven days. An economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean EUR 6718 vs EUR 3688, respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and the time taken to obtain adequate treatment. Conclusion: UTIs caused by ESBL-producing K. pneumoniae requiring hospitalization and the time taken to obtain adequate antimicrobial therapy are associated with worse clinical and economic outcomes.
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Antibiotic-resistant microorganisms in patients with bloodstream infection of intraabdominal origin: risk factors and impact on mortality. Infection 2021; 49:693-702. [PMID: 33728587 DOI: 10.1007/s15010-021-01592-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Knowledge of resistance patterns is essential to choose empirical treatment. We aimed to determine the risk factors for antibiotic-resistant microorganisms (ARM) in intraabdominal infections (IAI) and their impact on mortality. METHODS Retrospective cohort study of patients with bacteremia from IAI origin in a single hospital between January 2006 and July 2017. RESULTS A total of 1485 episodes were recorded, including 381 (25.6%) due to ARM. Independent predictors of ARM were cirrhosis (OR 2; [95% CI 1.15-3.48]), immunosuppression (OR 1.49; 1.12-1.97), prior ceftazidime exposure (OR 3.7; 1.14-11.9), number of prior antibiotics (OR 2.33; 1.61-3.35 for 1 antibiotic), biliary manipulation (OR 1.53; 1.02-2.96), hospital-acquisition (OR 2.77; 1.89-4) and shock (OR 1.48; 1.07-2). Mortality rate of the whole cohort was 11.1%. Age (OR 1.03; 1.01-1.04), cirrhosis (OR 2.32; 1.07-4.38), urinary catheter (OR 1.99; 1.17-3.38), ultimately (OR 2.28; 1.47-3.51) or rapidly (OR 13.3; 7.12-24.9) fatal underlying disease, nosocomial infection (OR 2.76; 1.6-4.75), peritonitis (OR 1.95, 1.1-3.45), absence of fever (OR 2.17; 1.25-3.77), shock (OR 5.96; 3.89-9.13), and an ARM in non-biliary infections (OR 2.14; 1.19-3.83) were independent predictors of 30-day mortality. Source control (OR 0.24; 0.13-0.44) and 2015-2017 period (OR 0.29; 0.14-0.6) were protective. CONCLUSION Biliary manipulation and septic shock are predictors of ARM. The presence of an ARM from a non-biliary focus is a poor-prognosis indicator. Source control continues to be of paramount importance.
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Liu L, Wang Q, Wu X, Qi H, Das R, Lin H, Shi J, Wang S, Yang J, Xue Y, Mao D, Luo Y. Vancomycin exposure caused opportunistic pathogens bloom in intestinal microbiome by simulator of the human intestinal microbial ecosystem (SHIME). ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 265:114399. [PMID: 32535405 DOI: 10.1016/j.envpol.2020.114399] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Antibiotics are emerging organic pollutants posing high health risks to humans by causing human intestinal microbial disorders with increasing abundances of opportunistic pathogens, and fecal microbiota transplantation (FMT) has been confirmed to restore the dysbiosis of gut flora in many kinds of intestinal disease. However, to date, few studies have focused on the bloomed opportunistic pathogens associated human disease-related pathways as well as antibiotic resistance genes (ARGs) after vancomycin exposure, and there is limited information on using FMT for restoration of intestinal microbiome affected by antibiotics. Therefore, this study investigated effects of vancomycin on the opportunistic pathogens, human disease-related pathways as well as ARGs in human gut, and the restoration of intestinal microbiome by FMT. Results indicated that vancomycin treatment substantially increased human disease-related pathways and decreased abundances of ARGs. Besides, the bloomed opportunistic pathogens including Achromobacter, Klebsiella, and Pseudomonas, caused by vancomycin exposure, were positively correlated with human disease-related pathways. The microbiota abundance and genes of human disease-related pathways and antibiotic resistance showed a remarkable return towards baseline after FMT, but not for natural recovery. These findings suggest that impacts of vancomycin on human gut are profound and FMT will be a promising strategy in clinical application that can restore the dysbiosis of gut microbiota, which may be valuable for directing future work.
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Affiliation(s)
- Lei Liu
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Qing Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China; Hebei Key Laboratory of Air Pollution Cause and Impact (preparatory), College of Energy and Environmental Engineering, Hebei University of Engineering, Handan, 056038, China
| | - Xinyan Wu
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Hongmei Qi
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Ranjit Das
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Huai Lin
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Jingliang Shi
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Siyi Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Jing Yang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China
| | - Yingang Xue
- Key Laboratory of Environmental Protection of Water Environment Biological Monitoring of Jiangsu Province, Changzhou Environmental Monitoring Center, Changzhou, 213001, China
| | - Daqing Mao
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, 300350, China.
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11
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Jeanvoine A, Bouxom H, Leroy J, Gbaguidi-Haore H, Bertrand X, Slekovec C. Resistance to third-generation cephalosporins in Escherichia coli in the French community: The times they are a-changin'? Int J Antimicrob Agents 2020; 55:105909. [DOI: 10.1016/j.ijantimicag.2020.105909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
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12
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Xercavins M, Jiménez E, Padilla E, Riera M, Freixas N, Boix-Palop L, Pérez J, Calbo E. High clonal diversity of ESBL-producing Klebsiella pneumoniae isolates from clinical samples in a non-outbreak situation. A cohort study. Antimicrob Resist Infect Control 2020; 9:5. [PMID: 31911833 PMCID: PMC6942317 DOI: 10.1186/s13756-019-0661-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023] Open
Abstract
Background Klebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. However, some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae. Aim To analyse the transmission dynamics of Extended Spectrum β-Lactamase-producing Klebsiella pneumoniae (ESBL-Kp) in an acute care hospital. Methods In 2015 a prospective cohort study was conducted. All new consecutive adult patients with ESBL-Kp isolates in all clinical samples were included. Patients with a previous known infection/colonization by ESBL-Kp and patients in high risk areas (e.g., intensive care units) were excluded. Cross-transmission was defined as the carriage of a clonally-related ESBL-Kp between newly diagnosed patients who shared the same ward for ≥48 h with another case, within a maximum time window of 4 weeks. ESBL-production was confirmed using the double-disk diffusion method and PCR. Clonal relationships were investigated by rep-PCR and multilocus sequence typing (MLST). Results Sixty ESBL-Kp isolates from 60 patients were included and analysed. Infections and colonizations were classified as hospital-acquired (52%), healthcare-related (40%) or community-acquired (8%).High genetic diversity was detected. When epidemiological clinical data were combined with the rep-PCR, the patterns identified did not show any cases of cross-transmission. ESBL-Kp were detected in 12.5% of environmental samples. No clonal relationship could be established between environmental reservoirs and patients. The genetic mechanism detected in all strains was associated with blaCTX-M genes, and 97% were CTX-M-15. Conclusions The dynamics of ESBL-K. pneumoniae isolated in our setting could not be explained by clonal transmission from an index patient. A polyclonal spread of ESBL-Kp was identified.
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Affiliation(s)
- Mariona Xercavins
- Microbiology Department, CATLAB, Terrassa, Barcelona Spain
- Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona Spain
| | - Elena Jiménez
- Microbiology Department, CATLAB, Terrassa, Barcelona Spain
| | - Emma Padilla
- Microbiology Department, CATLAB, Terrassa, Barcelona Spain
| | - Montserrat Riera
- Infectious Disease Unit. Department of Internal Medicine, Hospital Universitari Mutua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona Spain
| | - Núria Freixas
- Infectious Disease Unit. Department of Internal Medicine, Hospital Universitari Mutua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona Spain
| | - Lucia Boix-Palop
- Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona Spain
- Infectious Disease Unit. Department of Internal Medicine, Hospital Universitari Mutua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona Spain
| | - Josefa Pérez
- Microbiology Department, CATLAB, Terrassa, Barcelona Spain
| | - Esther Calbo
- Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona Spain
- Infectious Disease Unit. Department of Internal Medicine, Hospital Universitari Mutua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona Spain
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13
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Dziri R, Talmoudi A, Barguellil F, Ouzari HI, El Asli MS, Klibi N. Huge Diversity of TEM and SHV β-Lactamases Types Among CTX-M-15-Producing Enterobacteriaceae Species in Tunisia. Microb Drug Resist 2019; 25:1149-1154. [DOI: 10.1089/mdr.2018.0445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Raoudha Dziri
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Arbia Talmoudi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Farouk Barguellil
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Hadda-Imen Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Selim El Asli
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
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14
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Mansouri F, Sheibani H, Javedani Masroor M, Afsharian M. Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and urinary tract infections in pregnant/postpartum women: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13422. [PMID: 31532050 DOI: 10.1111/ijcp.13422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/17/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended-spectrum beta-lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. OBJECTIVES To determine the global prevalence of ESBL-producing (ESBL-P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. DATA SOURCES A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. STUDY SELECTION AND DATA EXTRACTION Studies that reported the frequency of ESBL-P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. SYNTHESIS In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta-analysis was performed using the random-effects model. RESULTS Twenty-three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL-P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). CONCLUSIONS The prevalence of ESBL-P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.
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Affiliation(s)
- Feizollah Mansouri
- Infectious Diseases Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Sheibani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mojgan Javedani Masroor
- Research and Clinical Center of Gynecology and Fertility, Shahid Akbar-Abadi Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mandana Afsharian
- Infectious Diseases Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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15
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Lee Y, Kim YA, Kim D, Shin JH, Uh Y, Shin KS, Shin JH, Jeong SH, Park YS. Risk factors of community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia in South Korea using national health insurance claims data. Int J Antimicrob Agents 2019; 54:723-727. [PMID: 31520781 DOI: 10.1016/j.ijantimicag.2019.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia in South Korea. As such, this study aimed to identify risk factors for community-onset ESBL-KP bacteraemia. METHODS From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (n = 408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included in this study. Risk factors of ESBL-KP BSI were assessed. Polymerase chain reaction and sequencing to identify genes encoding ESBLs and multi-locus sequence typing were performed. RESULTS Of the 408 patients with community-onset KP BSI, 70 (17%) had ESBL-KP BSI. Admission to a long-term-care hospital within the previous 3 months [odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1-15.6; P = 0.001], previous use of trimethoprim/sulfamethoxazole (TMP/SMT; OR 11.5, 95% CI 2.7-48.6; P = 0.001) or extended-spectrum cephalosporin (OR 2.2, 95% CI 1.2-3.9; P = 0.01), and previous use of a urinary catheter (OR 2.3, 95% CI 1.1-4.5; P = 0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1 group ESBL (74%, n = 52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). CONCLUSION Previous admission to a long-term-care hospital, use of a urinary catheter and use of TMP/SMT or extended-spectrum cephalosporin within the previous 3 months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures are needed for long-term-care hospitals.
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Affiliation(s)
- Yongseop Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Soo Park
- Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
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16
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Vargas-Alzate CA, Higuita-Gutiérrez LF, Jiménez-Quiceno JN. Direct medical costs of urinary tract infections by Gram-negative bacilli resistant to beta-lactams in a tertiary care hospital in Medellín, Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:35-49. [PMID: 31529847 DOI: 10.7705/biomedica.v39i1.3981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 06/10/2023]
Abstract
Introduction: Urinary tract infections are very frequent in the hospital environment and given the emergence of antimicrobial resistance, they have made care processes more complex and have placed additional pressure on available healthcare resources. Objective: To describe and compare excess direct medical costs of urinary tract infections due to Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa resistant to beta-lactams. Materials and methods: A cohort study was conducted in a third level hospital in Medellín, Colombia, from October, 2014, to September, 2015. It included patients with urinary tract infections caused by beta-lactam-susceptible bacteria, third and fourth generation cephalosporin-resistant, as well as carbapenem-resistant. Costs were analyzed from the perspective of the health system. Clinical-epidemiological information was obtained from medical records and the costs were calculated using standard tariff manuals. Excess costs were estimated with multivariate analyses. Results: We included 141 patients: 55 (39%) were sensitive to beta-lactams, 54 (38.3%) were resistant to cephalosporins and 32 (22.7%) to carbapenems. The excess total adjusted costs of patients with urinary tract infections due to cephalosporin- and carbapenem-resistant bacteria were US$ 193 (95% confidence interval (CI): US$ -347-734) and US$ 633 (95% CI: US$ -50-1316), respectively, compared to the group of patients with beta-lactam sensitive urinary tract infections. The differences were mainly found in the use of broad-spectrum antibiotics such as meropenem, colistin, and fosfomycin. Conclusion: Our results show a substantial increase in the direct medical costs of patients with urinary tract infections caused by beta-lactam-resistant Gram-negative bacilli (cephalosporins and carbapenems). This situation is of particular concern in endemic countries such as Colombia, where the high frequencies of urinary tract infections and the resistance to beta-lactam antibiotics can generate a greater economic impact on the health sector.
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Affiliation(s)
- Carlos Andrés Vargas-Alzate
- Línea de Epidemiología Molecular Bacteriana, Grupo de Microbiología Básica y Aplicada, Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.
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17
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Honda H, Murakami S, Tagashira Y, Uenoyama Y, Goto K, Takamatsu A, Hasegawa S, Tokuda Y. Efficacy of a Postprescription Review of Broad-Spectrum Antimicrobial Agents With Feedback: A 4-Year Experience of Antimicrobial Stewardship at a Tertiary Care Center. Open Forum Infect Dis 2018; 5:ofy314. [PMID: 30555853 PMCID: PMC6289023 DOI: 10.1093/ofid/ofy314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background An inpatient antimicrobial stewardship program is vital for judicious antimicrobial use. We began a hospital-wide, postprescription review with feedback (PPRF) in 2014; the present study evaluated its impact on antimicrobial consumption and clinical outcomes over 4 years. Methods Once-weekly PPRF for carbapenems and piperacillin/tazobactam was implemented. We tracked the data on each antimicrobial use as days of therapy (DOT) per 1000 patient-days (PD). Changes in the incidence of drug-resistant organisms, in-hospital mortality, and length of hospital stay per month were analyzed by an interrupted time series. Results Carbapenem use continued to decline in the preintervention and intervention periods (−0.73 and −0.003 DOT/1000 PD, respectively), and although monthly average use remained low in the intervention period (8.3 DOT/1000 PD), more importantly, the postintervention change in the slope diminished significantly. Piperacillin/tazobactam use showed a steeper decline in the intervention period, but the change in the slope was not statistically significant (change in slope: −0.20 DOT/1000 PD per month [P = .16]). Postintervention use of narrower-spectrum antimicrobials including ampicillin/sulbactam (change in slope: +0.58 DOT/1000 PD per month [P < .001]) increased. The antimicrobial cost and the monthly average length of hospital stay also declined (−37.4 USD/1000 PD per month [P < .001] and −0.04 days per month [P < .001], respectively), whereas few postintervention changes in the incidence of drug-resistant organisms were observed. Conclusions In our study, the 4-year PPRF for broad-spectrum antimicrobials coincided with a reduction in the use of targeted antimicrobials and resulted in an improvement in 1 patient-centered outcome, thus conferring the additional benefit of reducing expenditures for antimicrobials.
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Affiliation(s)
- Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Shutaro Murakami
- Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Yasuaki Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Yuki Uenoyama
- Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Kaoru Goto
- Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Akane Takamatsu
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
| | - Shinya Hasegawa
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Replace Fuchu, Tokyo
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18
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Dang V, Rajkumar A. Spinal epidural abscess caused by a community acquired extended spectrum beta lactamase producing Klebsiella pneumonia. IDCases 2018; 13:e00438. [PMID: 30128293 PMCID: PMC6092525 DOI: 10.1016/j.idcr.2018.e00438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022] Open
Abstract
Spinal epidural abscess (SEA) can be a medical and surgical emergency. It is encountered in patients with epidural catheter placement, paraspinal injections, diabetes mellitus, alcoholism, HIV infection, trauma, contiguous bony or soft tissue infection, intravenous drug use, hemodialysis, or overt bacteremia, but may occur spontaneously associated with a presumed silent bacteremia. We report here, a case of extensive SEA due to a community-acquired extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae in a diabetic patient. This case highlights the importance of stringent antimicrobial stewardship and also the need for prompt diagnostic evaluation, and early surgical decompression in order to prevent morbidity and mortality.
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Affiliation(s)
- Vinh Dang
- Department of Internal Medicine, Canton Medical Education Foundation & Aultman Hospital, 2600, 6th street SW, Canton, Ohio 44710, United States
| | - Aarthi Rajkumar
- Department of Internal Medicine, North east Ohio Medical University (NEOMED), Canton Medical Education Foundation, 2600, 6th street SW, Canton, Ohio 44710, United States
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