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Sharaf M, Zahra AA, Alharbi M, Mekky AE, Shehata AM, Alkhudhayri A, Ali AM, Al Suhaimi EA, Zakai SA, Al Harthi N, Liu CG. Bee chitosan nanoparticles loaded with apitoxin as a novel approach to eradication of common human bacterial, fungal pathogens and treating cancer. Front Microbiol 2024; 15:1345478. [PMID: 38559346 PMCID: PMC10978808 DOI: 10.3389/fmicb.2024.1345478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
Antimicrobial resistance is one of the largest medical challenges because of the rising frequency of opportunistic human microbial infections across the globe. This study aimed to extract chitosan from the exoskeletons of dead bees and load it with bee venom (commercially available as Apitoxin [Api]). Then, the ionotropic gelation method would be used to form nanoparticles that could be a novel drug-delivery system that might eradicate eight common human pathogens (i.e., two fungal and six bacteria strains). It might also be used to treat the human colon cancer cell line (Caco2 ATCC ATP-37) and human liver cancer cell line (HepG2ATCC HB-8065) cancer cell lines. The x-ray diffraction (XRD), Fourier transform infrared (FTIR), and dynamic light scattering (DLS) properties, ζ-potentials, and surface appearances of the nanoparticles were evaluated by transmission electron microscopy (TEM). FTIR and XRD validated that the Api was successfully encapsulated in the chitosan nanoparticles (ChB NPs). According to the TEM, the ChB NPs and the ChB NPs loaded with Apitoxin (Api@ChB NPs) had a spherical shape and uniform size distribution, with non-aggregation, for an average size of approximately 182 and 274 ± 3.8 nm, respectively, and their Zeta potential values were 37.8 ± 1.2 mV and - 10.9 mV, respectively. The Api@ChB NPs had the greatest inhibitory effect against all tested strains compared with the ChB NPs and Api alone. The minimum inhibitory concentrations (MICs) of the Api, ChB NPs, and Api@ChB NPs were evaluated against the offer mentioned colony forming units (CFU/mL), and their lowest MIC values were 30, 25, and 12.5 μg mL-1, respectively, against Enterococcus faecalis. Identifiable morphological features of apoptosis were observed by 3 T3 Phototox software after Api@ChB NPs had been used to treat the normal Vero ATCC CCL-81, Caco2 ATCC ATP-37, and HepG2 ATCC HB-8065 cancer cell lines for 24 h. The morphological changes were clear in a concentration-dependent manner, and the ability of the cells was 250 to 500 μg mL-1. These results revealed that Api@ChB NPs may be a promising natural nanotreatment for common human pathogens.
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Affiliation(s)
- Mohamed Sharaf
- Department of Biochemistry and Molecular Biology, College of Marine Life Sciences, Ocean University of China, Qingdao, China
- Department of Biochemistry, Faculty of Agriculture, AL-Azhar University, Cairo, Egypt
| | - Abdullah A. Zahra
- Department of Plant Protection, Faculty of Agriculture, AL-Azhar University, Cairo, Egypt
| | - Maha Alharbi
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Alsayed E. Mekky
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Abdelrazeq M. Shehata
- Department of Animal Production, Faculty of Agriculture, Al-Azhar University, Cairo, Egypt
| | - Abdulsalam Alkhudhayri
- Department of Biology, College of Sciences, University of Hafr Al Batin, Hafar Al Batin, Saudi Arabia
| | - Ahmed M. Ali
- Department of Biology, Shaqra University, Shaqra, Saudi Arabia
| | - Ebtesam A. Al Suhaimi
- Vice Presidency for Scientific Research and Innovation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Abdulaziz and his Companions Foundation for Giftedness and Creativity “Mawhiba”, Riyadh, Saudi Arabia
| | - Shadi A. Zakai
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Norah Al Harthi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Chen-Guang Liu
- Department of Biochemistry and Molecular Biology, College of Marine Life Sciences, Ocean University of China, Qingdao, China
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Haque S, Ahmed A, Islam N, Haque FKM. High Prevalence of Multidrug-Resistant Bacteria in the Trachea of Intensive Care Units Admitted Patients: Evidence from a Bangladeshi Hospital. Antibiotics (Basel) 2024; 13:62. [PMID: 38247621 PMCID: PMC10812536 DOI: 10.3390/antibiotics13010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024] Open
Abstract
Recent research has shown that antibiotic-resistant microorganisms are becoming more prevalent in intensive care units (ICUs) at an exponential rate. Patients in the ICU can get infected by pathogens due to invasive operation procedures and critical health conditions. This study primarily emphasized tracheal samples from ICU patients due to their reliance on ventilators, increasing their susceptibility to Ventilator-Associated Pneumonia (VAP). Moreover, the rise of multidrug-resistant (MDR) pathogens makes treatment strategies more challenging for these patients. In this study, we tested 200 tracheal specimens to determine the prevalence of microorganisms and analyzed the antibiotic susceptibility of these isolates against regular antibiotics, including 4th generation drugs. Among the 273 isolates, 81% were gram-negative bacteria, 10% were gram-positive bacteria, and 9% were fungi. The most prevalent gram-negative bacteria were Acinetobacter spp. (34%), Klebsiella spp. (22%), Pseudomonas spp. (14%), and Escherichia coli (9.2%). The most prevalent gram-positive bacteria were Staphylococcus aureus (5.9%), and the fungi were Candida spp. (7.3%). Among the most prevalent bacteria, except Staphylococcus aureus isolates, around 90% were resistant to multiple drugs, whereas 60% of Acinetobacter spp. and Pseudomonas spp. were extensively drug resistant. Sensitivity analysis against the gram-negative and gram-positive drug panel using a one-way ANOVA test followed by Tukey's post hoc test showed that in the in vitro assay, colistin was the most effective antibiotic against all gram-negative bacteria. In contrast, linezolid, vancomycin, and fusidic acid were most effective against all gram-positive bacteria. Regular monitoring of nosocomial infections and safe management of highly resistant bacteria can help prevent future pandemics.
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Affiliation(s)
- Sabrina Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh; (S.H.); (A.A.)
| | - Akash Ahmed
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh; (S.H.); (A.A.)
| | - Nazrul Islam
- IBN SINA Diagnostic and Imaging Center, Dhaka 1209, Bangladesh;
| | - Fahim Kabir Monjurul Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka 1212, Bangladesh; (S.H.); (A.A.)
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Kalın G, Alp E, Chouaikhi A, Roger C. Antimicrobial Multidrug Resistance: Clinical Implications for Infection Management in Critically Ill Patients. Microorganisms 2023; 11:2575. [PMID: 37894233 PMCID: PMC10609422 DOI: 10.3390/microorganisms11102575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The increasing incidence of antimicrobial resistance (AMR) worldwide represents a serious threat in the management of sepsis. Due to resistance to the most common antimicrobials prescribed, multidrug-resistant (MDR) pathogens have been associated with delays in adequate antimicrobial therapy leading to significant increases in mortality, along with prolonged hospital length of stay (LOS) and increases in healthcare costs. In response to MDR infections and the delay of microbiological results, broad-spectrum antibiotics are frequently used in empirical antimicrobial therapy. This can contribute to the overuse and misuse of antibiotics, further promoting the development of resistance. Multiple measures have been suggested to combat AMR. This review will focus on describing the epidemiology and trends concerning MDR pathogens. Additionally, it will explore the crucial aspects of identifying patients susceptible to MDR infections and optimizing antimicrobial drug dosing, which are both pivotal considerations in the fight against AMR. Expert commentary: The increasing AMR in ICUs worldwide makes the empirical antibiotic therapy challenging in septic patients. An AMR surveillance program together with improvements in MDR identification based on patient risk stratification and molecular rapid diagnostic tools may further help tailoring antimicrobial therapies and avoid unnecessary broad-spectrum antibiotics. Continuous infusions of antibiotics, therapeutic drug monitoring (TDM)-based dosing regimens and combination therapy may contribute to optimizing antimicrobial therapy and limiting the emergence of resistance.
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Affiliation(s)
- Gamze Kalın
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri 38280, Türkiye
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara 06760, Türkiye;
| | - Arthur Chouaikhi
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, CEDEX 9, 30029 Nîmes, France;
| | - Claire Roger
- Department of Anesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Place du Professeur Robert Debré, CEDEX 9, 30029 Nîmes, France;
- UR UM 103 IMAGINE, Faculty of Medicine, Montpellier University, Chemin du Carreau de Lanes, 30029 Nîmes, France
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Frattari A, Polilli E, Rapacchiale G, Coladonato S, Ianniruberto S, Mazzotta E, Patarchi A, Battilana M, Ciulli R, Moretta A, Visocchi L, Savini V, Spacone A, Zocaro R, Carinci F, Parruti G. Predictors of bacteremia and death, including immune status, in a large single-center cohort of unvaccinated ICU patients with COVID-19 pneumonia. Eur J Med Res 2023; 28:219. [PMID: 37400898 DOI: 10.1186/s40001-023-01166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/11/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND We investigated the possible role of the immune profile at ICU admission, among other well characterized clinical and laboratory predictors of unfavorable outcome in COVID-19 patients assisted in ICU. METHODS Retrospective analysis of clinical and laboratory data collected for all consecutive patients admitted to the ICUs of the General Hospital of Pescara (Abruzzo, Italy), between 1st March 2020 and 30th April 2021, with a confirmed diagnosis of COVID-19 respiratory failure. Logistic regressions were used to identify independent predictors of bacteremia and mortality. RESULTS Out of 431 patients included in the study, bacteremia was present in N = 191 (44.3%) and death occurred in N = 210 (48.7%). After multivariate analysis, increased risk of bacteremia was found for viral reactivation (OR = 3.28; 95% CI:1.83-6.08), pronation (3.36; 2.12-5.37) and orotracheal intubation (2.51; 1.58-4.02). Increased mortality was found for bacteremia (2.05; 1.31-3.22), viral reactivation (2.29; 1.29-4.19) and lymphocytes < 0.6 × 103c/µL (2.32; 1.49-3.64). CONCLUSIONS We found that viral reactivation, mostly due to Herpesviridae, was associated with increased risk of both bacteremia and mortality. In addition, pronation and intubation are strong predictors of bacteremia, which in turn together with severe lymphocytopenia due to SARS-CoV2 was associated with increased mortality. Most episodes of bacteremia, even due to Acinetobacter spp, were not predicted by microbiological evidence of colonization.
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Affiliation(s)
| | - Ennio Polilli
- Clinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | | | | | | | - Elena Mazzotta
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | | | | | - Raffaella Ciulli
- Unit of Intensive Care, Pescara General Hospital, Pescara, Italy
| | - Angelo Moretta
- Unit of Intensive Care, Pescara General Hospital, Pescara, Italy
| | - Lina Visocchi
- Unit of Intensive Care, Pescara General Hospital, Pescara, Italy
| | - Vincenzo Savini
- Microbiology and Virology Unit, Pescara General Hospital, Pescara, Italy
| | | | - Rosamaria Zocaro
- Unit of Intensive Care, Pescara General Hospital, Pescara, Italy
| | - Fabrizio Carinci
- Department of Statistical Sciences, Università Di Bologna, Bologna, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
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Papanikolopoulou A, Gargalianos-Kakolyris P, Stoupis A, Moussas N, Pangalis A, Theodoridou K, Chronopoulou G, Pantazis N, Kantzanou M, Maltezou HC, Tsakris A. Carbapenem-Resistant Pseudomonas aeruginosa Bacteremia, through a Six-Year Infection Control Program in a Hospital. Microorganisms 2023; 11:1315. [PMID: 37317288 DOI: 10.3390/microorganisms11051315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a life-threatening healthcare-associated infection affecting especially patients with immunosuppression and comorbidities. We investigated the association between the incidence of CRPA bacteremia, antibiotic consumption, and infection control measures in a hospital during 2013-2018. METHODS We prospectively recorded the incidence of CRPA bacteremia, antibiotic consumption, use of hand-hygiene solutions, and isolation rates of multidrug-resistant (MDR) carrier patients. FINDINGS The consumption of colistin, aminoglycosides, and third-generation cephalosporins decreased significantly in the total hospital and its divisions (p-value < 0.001 for all comparisons) while the consumption of carbapenems decreased significantly in the adults ICU (p-value = 0.025). In addition, the incidence of CRPA significantly decreased in the total hospital clinics and departments (p-values = 0.027 and 0.042, respectively) and in adults clinics and departments (p-values = 0.031 and 0.051, respectively), while in the adults ICU, the incidence remained unchanged. Increased isolation rates of MDR carrier patients, even two months before, significantly correlated with decreased incidence of CRPA bacteremia (IRR: 0.20, 95% CI: 0.05-0.73, p-value = 0.015) in the adults ICU. Interestingly, when the use of hand-hygiene solutions (alcohol and/or scrub) increased, the consumption of advanced, nonadvanced, and all antibiotics decreased significantly. CONCLUSION In our hospital, multimodal infection control interventions resulted in a significant reduction of CRPA bacteremia, mostly due to the reduction of all classes of antibiotics.
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Affiliation(s)
- Amalia Papanikolopoulou
- Clinical Pharmacology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | | | - Athina Stoupis
- Clinical Infectious Diseases Department, Athens Medical Center, 1 Delfon Str., 15125 Marousi, Greece
| | - Nikos Moussas
- Clinical Infectious Diseases Department, Athens Medical Center, 1 Delfon Str., 15125 Marousi, Greece
| | - Anastasia Pangalis
- Biopathology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
- Department of Microbiology, Andreas Syggros Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Genovefa Chronopoulou
- Biopathology Department, Athens Medical Center, 5-7 Distomou Str., 15125 Marousi, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Str., 15123 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
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Loaiza WM, Ruiz AKR, Patiño CCO, Vivas MC. Bacterial Resistance in Hospital-Acquired Infections Acquired in the Intensive Care Unit: A Systematic Review. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:1-10. [PMID: 37384803 DOI: 10.14712/18059694.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
PURPOSE In this review we present the status of the prevalence of bacteria resistant to antibiotics and the main antibiotic resistance genes that are reported in infections acquired in intensive care units (ICU) around the world. METHODS A systematic review based on the PRISMA guide was carried out, from the Science Direct, Redalyc, Scopus, Hinari, Scielo, Dialnet, PLOS, ProQuest, Taylor, Lilacs and PubMed/Medline databases. Inclusion criteria of this review were original research study published in a scientific journal in a 10-year time span from 1 January 2017 and 30 April 2022. RESULTS A total of 1686 studies were identified, but only 114 studies were considered eligible for inclusion. Klebsiella pneumoniae and Escherichia coli resistant to carbapenems and producers of extended-spectrum β-lactamases (ESBL) are the most frequently isolated pathogens in ICUs in Asia, Africa and Latin America. The blaOXA and blaCTX were antibiotic resistance genes (ARG) most commonly reported in different geographic regions (in 30 and 28 studies, respectively). Moreover, multidrug-resistant (MDR) strains were reported in higher frequency in hospital-acquired infections. Reports of MDR strains vary between continents, with the majority of publications being in Asia and between countries, with Egypt and Iran being highlighted. There is a predominance of few bacterial clones with MDR phenotype, for example, clonal complex 5 Methicillin-Resistant Staphylococcus aureus (CC5-MRSA) circulates frequently in hospitals in the United States, clone ST23-K. pneumoniae is reported in India and Iran, and clone ST260 carbapenemase-producing P. aeruginosa in the United States and Estonia. CONCLUSION Our systematic review reveals that ESBL- and carbapenemase-producing K. pneumoniae and E. coli are the most problematic bacteria that are reported, mainly in tertiary hospitals in Asia, Africa, and Latin America. We have also found propagation of dominant clones with a high degree of MDR, becoming a problem due to its high capacity to cause morbidity, mortality and additional hospital costs.
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Affiliation(s)
| | | | | | - Mónica Chavez Vivas
- Investigation Group GIMMEIN, Colombia.
- Medicine Program, Faculty of Health Sciences, Universidad Libre, Cali, Colombia.
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Mandelli G, Dore F, Langer M, Garbero E, Alagna L, Bianchin A, Ciceri R, Di Paolo A, Giani T, Giugni A, Gori A, Lefons U, Muscatello A, Olivieri C, Pan A, Pedeferri M, Rossi M, Rossolini GM, Russo E, Silengo D, Viaggi B, Bertolini G, Finazzi S. Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs. J Clin Med 2022; 11:jcm11154409. [PMID: 35956026 PMCID: PMC9369193 DOI: 10.3390/jcm11154409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p < 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients’ safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions.
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Affiliation(s)
- Giulia Mandelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
| | - Francesca Dore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Correspondence:
| | - Martin Langer
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Emergency-Ong, 20128 Milano, Italy
| | - Elena Garbero
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
| | - Laura Alagna
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
| | - Andrea Bianchin
- Anesthesia and Intensive Care, Ospedale Civile San Valentino di Montebelluna, 31044 Montebelluna, Italy;
| | - Rita Ciceri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale Alessandro Manzoni di Lecco, 23900 Lecco, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Università di Pisa, 56126 Pisa, Italy;
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, Università di Firenze, 50134 Firenze, Italy; (T.G.); (G.M.R.)
- Clinical Microbiology and Virology Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Aimone Giugni
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Department of Intensive Care and Emergency Medical Services, Ospedale Maggiore, 40133 Bologna, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20122 Milan, Italy
| | - Ugo Lefons
- Anesthesia and Intensive Care, Ospedale Alta Val d’Elsa di Poggibonsi, 53036 Poggibonsi, Italy;
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (L.A.); (A.G.); (A.M.)
| | - Carlo Olivieri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale Sant’Andrea, ASL VC Vercelli, 13100 Vercelli, Italy
| | - Angelo Pan
- Infectious Diseases Unit, Istituti Ospitalieri di Cremona, 26100 Cremona, Italy;
| | - Matteo Pedeferri
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Presidio Ospedaliero San Leopoldo Mandić, 23807 Merate, Italy
| | - Marianna Rossi
- Division of Infectious Diseases, “San Gerardo” Hospital, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, Università di Firenze, 50134 Firenze, Italy; (T.G.); (G.M.R.)
- Clinical Microbiology and Virology Unit, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care, Ospedale Maurizio Bufalini di Cesena, 47521 Cesena, Italy;
| | - Daniela Silengo
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Anesthesia and Intensive Care, Ospedale San Giovanni Bosco, 10154 Turin, Italy
| | - Bruno Viaggi
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
- Neuro Intensive Care Unit, Department of Anesthesiology, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy; (G.M.); (E.G.); (G.B.); (S.F.)
- Associazione GiViTI—Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva, 24020 Ranica, Italy; (M.L.); (R.C.); (A.G.); (C.O.); (M.P.); (D.S.); (B.V.)
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8
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Scaglione V, Reale M, Davoli C, Mazzitelli M, Serapide F, Lionello R, La Gamba V, Fusco P, Bruni A, Procopio D, Garofalo E, Longhini F, Marascio N, Peronace C, Giancotti A, Gallo L, Matera G, Liberto MC, Cesana BM, Costa C, Trecarichi EM, Quirino A, Torti C. Prevalence of Antibiotic Resistance Over Time in a Third-Level University Hospital. Microb Drug Resist 2021; 28:425-435. [PMID: 34910885 PMCID: PMC9058886 DOI: 10.1089/mdr.2021.0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study evaluated the spread and possible changes in resistance patterns of ESKAPE bacteria to first-choice antibiotics from 2015 to 2019 at a third-level university hospital after persuasive stewardship measures were implemented. Isolates were divided into three groups (group 1, low drug-resistant; group 2, multidrug/extremely drug-resistant; and group 3, pan-resistant bacteria) and a chi-squared test (χ2) was applied to determine differences in their distributions. Among the 2,521 isolates, Klebsiella pneumoniae was the most frequently detected (31.1%). From 2015 to 2019, the frequency of isolates in groups 2 and 3 decreased from 70.1% to 48.6% (χ2 = 63.439; p < 0.0001). Stratifying isolates by bacterial species, for K. pneumoniae, the frequency of PDR isolates decreased from 20% to 1.3% (χ2 = 15.885; p = 0.003). For Acinetobacter baumannii, a statistically significant decrease was found in groups 2 and 3: from 100% to 83.3% (χ2 = 27.721; p < 0.001). Also, for Pseudomonas aeruginosa and Enterobacter spp., the frequency of groups 2 and 3 decreased from 100% to 28.3% (χ2 = 225.287; p < 0.001) and from 75% to 48.7% (χ2 = 15.408; p = 0.003), respectively. These results indicate that a program consisting of persuasive stewardship measures, which were rolled out during the time frame of our study, may be useful to control drug-resistant bacteria in a hospital setting.
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Affiliation(s)
- Vincenzo Scaglione
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Mariaconcetta Reale
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Chiara Davoli
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria Mazzitelli
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Francesca Serapide
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Rosaria Lionello
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Valentina La Gamba
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Paolo Fusco
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Andrea Bruni
- Unit of Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Daniela Procopio
- Unit of Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Eugenio Garofalo
- Unit of Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Federico Longhini
- Unit of Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Cinzia Peronace
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Aida Giancotti
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Luigia Gallo
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria Carla Liberto
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Bruno Mario Cesana
- Unit of Medical Statistics, Biometrics and Bioinformatics "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Chiara Costa
- Unit of Infectious and Tropical Diseases, "Mater Domini" Teaching Hospital, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
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9
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Gnanasekaran C, Alobaidi AS, Govindan R, Chelliah CK, Muhammad Zubair S, Alagarsamy S, Alharbi NS, Kadaikunnan S, Govindan R, Manoharan N. Piperacillin/tazobactum and cefotaxime decrease the effect of beta lactamase production in multi-drug resistant K. pneumoniae. J Infect Public Health 2021; 14:1777-1782. [PMID: 34772638 DOI: 10.1016/j.jiph.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/09/2021] [Accepted: 10/17/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Worldwide, multi-drug resistant Klebsiella pneumoniae (K. pneumonia) and their virulence's were contributed more in the multi-drug resistant effect. According to the World Health organization report, it is an emerging thread in developing countries and also comes under first ever critical list. In this context, the current study was concentrated on detection of extended spectrum beta lactamase (ESBL) producing strain and their antimicrobial susceptibility study of K. pneumoniae. MATERIALS AND METHODS Firstly, the multi-drug resistant effect of the K. pneumoniae was identified from specific CLSI guidelines recommended antibiotics by disc diffusion method. Consecutively, the primary ESBL identification test was performed using ceftazidime and cefotaxime, followed by double disc combination and phenotypic confirmation tests using ceftazidime/clavulanic acid and cefotaxime/clavulanic acid. Finally, the minimum inhibition concentration of some important sensitive antibiotics were performed against selected K. pneumoniae was confirmed by micro broth dilution method. RESULTS AND CONCLUSIONS The current result was most favorable to selected K. pneumoniae with more multi drug resistant characteristic nature. All the performed antibiotics were almost more sensitive to selected K. pneumoniae. The effective antibiotics of piperacillin was also exhibited more resistant effect against tested bacteria and it cleaved the bacterial enzyme clearly. The present result of primary ESBL identification test result was exhibited with ≤22 mm and ≤27 mm against ceftazidime and cefotaxime were observed respectively. Followed result of double disc combination and phenotypic confirmation experiments results were clearly stated that the selected K. pneumoniae was ESBL producer. The ceftazidime, cefotaxime and ceftazidime/clavulanic acid and cefotaxime/clavulanic acid were exhibited with merged zones and ≥5 mm zones around the combination disc when compared with disc alone were observed. All the ESBL detection test results were clearly indicated that the selected K. pneumoniae strain was ESBL producer.
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Affiliation(s)
| | - Ahmed S Alobaidi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ramachandran Govindan
- Department of Marine Science, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India
| | - Chenthis Kanisha Chelliah
- Department of Nanotechnology, Noorul Islam Centre for Higher Education, Kumaracoil, Kanyakumary, Tamil Nadu 629180, India
| | - Siddiqi Muhammad Zubair
- Department of Biotechnology, Hankyong National University, 327 Jungang Road, Gyeonggi-do 17579, South Korea
| | - Shanmugarathinam Alagarsamy
- Department of Pharmaceutical Technology, University College of Engineering, BIT Campus, Anna University, Tamil Nadu, India
| | - Naiyf S Alharbi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Shine Kadaikunnan
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Rajivgandhi Govindan
- Department of Marine Science, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India.
| | - Natesan Manoharan
- Department of Marine Science, Bharathidasan University, Tiruchirappalli 620024, Tamil Nadu, India.
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10
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Li L, Wang Y, Liu K, Yang L, Zhang B, Luo Q, Luo R, Wang Y. Nanoparticles-stacked superhydrophilic coating supported synergistic antimicrobial ability for enhanced wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 132:112535. [DOI: 10.1016/j.msec.2021.112535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
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11
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Resistance Patterns of Gram-Negative Bacteria Recovered from Clinical Specimens of Intensive Care Patients. Microorganisms 2021; 9:microorganisms9112246. [PMID: 34835378 PMCID: PMC8619277 DOI: 10.3390/microorganisms9112246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Intensive care units are complex environments favoring high resistance in microorganisms. This study evaluated the resistance and the distribution dynamics of resistant Gram-negative bacteria (GNB) in patients admitted to intensive care units. This retrospective, record-based, cross-sectional study analyzed all of the antibiograms of patients admitted to the ICUs. The BD Phoenix system (BD Diagnostics, Sparks, MD, USA) was used for bacterial identification and antimicrobial testing. Clinical and Laboratory Standard Institute recommendations were used for antimicrobial testing. Frequencies and percentages of multidrug and pan-drug resistance were calculated. A total of 570 bacterial growths were observed, out of which 437 (76.7%) were of GNB. K. pneumoniae (21.0%), P. aeruginosa (11.8%), and Staphylococcus aureus (13.2%) were the most frequent disease-causing bacteria in intensive care patients. Resistance rates of 73.2% and 70.1% were observed for third- and fourth-generation cephalosporins, respectively, while 48.2% carbapenem and > 65% fluoroquinolones resistance rates were observed. Amikacin was the most effective antibiotic, with a sensitivity rate of 69.5%. A total of 372 (85.1%) of GNB were multidrug resistant. The majority of infections in intensive care patients are caused by multidrug-resistant (MDR) Gram-negative bacteria. Female gender and advancing age are factors favoring MDR. Enhanced surveillance and strengthening of the antimicrobial stewardship program are warranted.
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12
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Dai Y, Meng T, Wang X, Tang B, Wang F, Du Y, Qiu Y, Liu J, Tan R, Qu H. Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study. Front Med (Lausanne) 2021; 8:692813. [PMID: 34307419 PMCID: PMC8292674 DOI: 10.3389/fmed.2021.692813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To verify the effects of comprehensive infection prevention and control (IPC) interventions for the prevention of the cross-transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within intensive care units (ICUs) in an epidemic region. Methods: A historical control, quasi-experimental design was performed. The study was conducted between January 2017 and December 2019, following the implementation of a multimodal IPC bundle. The baseline period was established from January 2013 to June 2013, when only basic IPC measures were applied. Results: A total of 748 patients were enrolled during the entire study. The incidence of ICU-acquired CRKP colonization/infection was 1.16 per 1,000 patient-days during the intervention period, compared with 10.19 per 1,000 patient-days during the baseline period (p = 0.002). The slope of the monthly incidence of CRKP at admission showed an increasing trend (p = 0.03). The incidence of ICU-acquired catheter-related bloodstream infections caused by CRKP decreased from 2.54 to 0.96 per 1,000 central-line-days (p = 0.08). Compliance with contact precautions and terminal room disinfection improved during the intervention period. All environmental surface culture samples acquired after terminal room disinfection were negative for CRKP. Conclusion: Our findings suggest that in epidemic settings, multimodal IPC intervention strategies and consistent monitoring of compliance, may limit the spread of CRKP in ICUs.
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Affiliation(s)
- Yunqi Dai
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianjiao Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Tang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Feng Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Du
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuzhen Qiu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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13
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Carrara E, Conti M, Meschiari M, Mussini C. The role of antimicrobial stewardship in preventing KPC-producing Klebsiella pneumoniae. J Antimicrob Chemother 2021; 76:i12-i18. [PMID: 33534879 DOI: 10.1093/jac/dkaa493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Antimicrobial stewardship programmes are widely considered to be a core component of the response to the antimicrobial resistance threat. However, a positive impact of these interventions in terms of microbiological outcomes remains difficult to demonstrate, especially when focusing on specific resistant phenotypes. The first part of this review aims to explore the complex relationship between antibiotic exposure and resistance development in KPC-producing Klebsiella pneumoniae. In the second part we aim to summarize published examples of antimicrobial stewardship interventions intended to impact on the epidemiology of KPC-producing K. pneumoniae. For this purpose, a literature search was performed and seven studies were included in the review. Both restrictive and non-restrictive interventions were associated with an overall reduction in antibiotic consumption, and a decrease in carbapenem resistance rates was observed in five studies. The overall quality of the evidence was low, mainly due to the poor reporting of microbiological outcomes, lack of a control group and suboptimal study design. Although the link between antibiotic use and resistance development is supported by strong evidence, demonstrating the impact of antimicrobial stewardship interventions on microbiological outcomes remains difficult. Studies with adequate design and appropriate outcome measures are needed to further promote antimicrobial stewardship and elucidate which interventions are more successful for controlling the spread of KPC-producing K. pneumoniae.
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Affiliation(s)
- Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Michela Conti
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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14
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Fernández P, Moreno L, Yagüe G, Andreu E, Jara R, Segovia M. Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic. Med Intensiva 2021; 45:313-315. [PMID: 34059221 PMCID: PMC8086975 DOI: 10.1016/j.medine.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/14/2021] [Indexed: 11/02/2022]
Affiliation(s)
- P Fernández
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - L Moreno
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - G Yagüe
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - E Andreu
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - R Jara
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Segovia
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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15
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Fernández P, Moreno L, Yagüe G, Andreu E, Jara R, Segovia M. [Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic]. Med Intensiva 2021; 45:313-315. [PMID: 34054174 PMCID: PMC7945882 DOI: 10.1016/j.medin.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P Fernández
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - L Moreno
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - G Yagüe
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.,Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, España.,Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
| | - E Andreu
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - R Jara
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M Segovia
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.,Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, España.,Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
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16
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Abstract
PURPOSE OF REVIEW Antimicrobial resistance (AMR) is increasing in ICUs around the world, but the prevalence is variable. We will review recent literature and try to answer the question whether this is a myth or a new reality, as well as discuss challenges and potential solutions. RECENT FINDINGS AMR is diverse, and currently Gram-negative multidrug-resistant organisms (MDROs) are the main challenge in ICUs worldwide. Geographical variation in prevalence of MDROs is substantial, and local epidemiology should be considered to assess the current threat of AMR. ICU patients are at a high risk of infection with MDRO because often multiple risk factors are present. Solutions should focus on reducing the risk of cross-transmission in the ICU through strict infection prevention and control practices and reducing exposure to antimicrobials as the major contributor to the development of AMR. SUMMARY AMR is a reality in most ICUs around the world, but the extent of the problem is clearly highly variable. Infection prevention and control as well as appropriate antimicrobial use are the cornerstones to turn the tide.
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17
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Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program. Ther Adv Infect Dis 2020; 7:2049936120933187. [PMID: 32612826 PMCID: PMC7307277 DOI: 10.1177/2049936120933187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
Regardless of one's opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
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Affiliation(s)
- Fredrik Resman
- Department of Translational Medicine, Clinical
Infection Medicine, Lund University, Rut Lundskogs Gata 3, Plan 6, Malmö, 20502,
Sweden
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