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Aretha D, Rizopoulou S, Leonidou L, Kefala S, Karamouzos V, Lagadinou M, Spiliopoulou A, Marangos M, Fligou F, Kolonitsiou F, Paliogianni F, Assimakopoulos SF. Incidence of Carbapenem-Resistant Gram-Negative Bacterial Infections in Critically Ill Patients with COVID-19 as Compared to Non-COVID-19 Patients: A Prospective Case-Control Study. Crit Care Res Pract 2024; 2024:7102082. [PMID: 38947882 PMCID: PMC11214592 DOI: 10.1155/2024/7102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Critically ill COVID-19 patients hospitalized in intensive care units (ICU) are immunosuppressed due to SARSCoV-2-related immunological effects and are administered immunomodulatory drugs. This study aimed to determine whether these patients carry an increased risk of multi-drug resistant (MDR) and especially carbapenem-resistant Gram-negative (CRGN) bacterial infections compared to other critically ill patients without COVID-19. Materials and Methods A prospective case-control study was conducted between January 2022 and August 2023. The ICU patients were divided into two groups (COVID-19 and non-COVID-19). Differences in the incidence of CRGN infections from Klebsiella pneumoniae, Acinetobacter spp., and Pseudomonas aeruginosa were investigated. In addition, an indicator of the infection rate of the patients during their ICU stay was calculated. Factors independently related to mortality risk were studied. Results Forty-two COVID-19 and 36 non-COVID-19 patients were analyzed. There was no statistically significant difference in the incidence of CRGN between COVID-19 and non-COVID-19 patients. The infection rate was similar in the two groups. Regarding the aetiological agents of CRGN infections, Pseudomonas aeruginosa was significantly more common in non-COVID-19 patients (p=0.007). COVID-19 patients had longer hospitalisation before ICU admission (p=0.003) and shorter ICU length of stay (LOS) (p=0.005). ICU COVID-19 patients had significantly higher mortality (p < 0.001) and sequential organ failure assessment (SOFA) score (p < 0.001) compared to non-COVID-19 patients. Μortality secondary to CRGN infections was also higher in COVID-19 patients compared to non-COVID-19 patients (p=0.033). Male gender, age, ICU LOS, and hospital LOS before ICU admission were independent risk factors for developing CRGN infections. Independent risk factors for patients' mortality were COVID-19 infection, obesity, SOFA score, total number of comorbidities, WBC count, and CRP, but not infection from CRGN pathogens. Conclusions The incidence of CRGN infections in critically ill COVID-19 patients is not different from that of non-COVID-19 ICU patients. The higher mortality of COVID-19 patients in the ICU is associated with higher disease severity scores, a higher incidence of obesity, and multiple underlying comorbidities, but not with CRGN infections.
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Affiliation(s)
- Diamanto Aretha
- Department of Anesthesiology and Intensive Care MedicineUniversity of Patras Medical School, Patras, Greece
| | - Sotiria Rizopoulou
- Department of Anesthesiology and Intensive Care MedicineUniversity of Patras Medical School, Patras, Greece
| | - Leonidia Leonidou
- Department of Internal MedicineUniversity of Patras Medical School, Patras, Greece
| | - Sotiria Kefala
- Department of Anesthesiology and Intensive Care MedicineUniversity of Patras Medical School, Patras, Greece
| | - Vasilios Karamouzos
- Department of Anesthesiology and Intensive Care MedicineUniversity of Patras Medical School, Patras, Greece
| | - Maria Lagadinou
- Department of Internal MedicineUniversity of Patras Medical School, Patras, Greece
| | | | - Markos Marangos
- Department of Internal MedicineUniversity of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care MedicineUniversity of Patras Medical School, Patras, Greece
| | | | - Fotini Paliogianni
- Department of MicrobiologyUniversity of Patras Medical School, Patras, Greece
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Rabagliati R, Salazar G, Pérez-Lazo G, Iturrieta MP, Portillo D, Soria-Segarra C, Ojeda MJ, Flores J, Galarza M, Sandoval-Ahumada R, Cartes Aguilera P, Dimitrakis L, Avelga Reinoso F, Garcia P. An Emergent Change in Epidemiologic and Microbiological Characteristics of Bloodstream Infections in Adults With Febrile Neutropenia Resulting From Chemotherapy for Acute Leukemia and Lymphoma at Reference Centers in Chile, Ecuador, and Peru. Open Forum Infect Dis 2024; 11:ofae052. [PMID: 38444817 PMCID: PMC10913838 DOI: 10.1093/ofid/ofae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Background Febrile neutropenia is a life-threatening condition commonly observed in patients with hematologic malignancies. The aim of this article is to provide updated knowledge about bloodstream infections in febrile neutropenia episodes within the Andean region of Latin America. Method This retrospective study was based in 6 hospitals in Chile, Ecuador, and Peru and included adult patients with acute leukemia or lymphoma and febrile neutropenia between January 2019 and December 2020. Results Of the 416 febrile neutropenia episodes, 38.7% had a bloodstream infection, 86% of which were caused by gram-negative rods, with Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa being the most frequently identified bacteria. K pneumoniae isolates were more frequently resistant than E coli to cefotaxime (65% vs 39.6%), piperacillin-tazobactam (56.7% vs 27.1%), and imipenem (35% vs 2.1%) and were more frequently multidrug resistant (61.7% vs 12.5%). Among P aeruginosa, 26.7% were resistant to ceftazidime, piperacillin-tazobactam, and imipenem, and 23.3% were multidrug resistant. Overall 30-day mortality was 19.8%, being higher with vs without a bloodstream infection (26.7% vs 15.3%, P = .005). Fever duration was also significantly longer, as well as periods of neutropenia and length of hospital stay for patients with bloodstream infection. Additionally, the 30-day mortality rate was higher for episodes with inappropriate vs appropriate empirical antibiotic therapy (41.2% vs 26.6%, P = .139). Conclusions Considering the high rates of bacteria-resistant infection and 30-day mortality, it is imperative to establish strategies that reduce the frequency of bloodstream infections, increasing early identification of patients at higher risks of multidrug bacteria resistance, and updating existing empirical antibiotic recommendations.
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Affiliation(s)
- Ricardo Rabagliati
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Grace Salazar
- Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | | | | | - Diana Portillo
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | | | - María José Ojeda
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jimena Flores
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | | | - Lady Dimitrakis
- Laboratorio Microbiología, Sociedad Lucha contra el Cáncer SOLCA, Guayaquil, Ecuador
| | | | - Patricia Garcia
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Al Mana H, Abdel Hadi H, Wilson G, Almaslamani MA, Abu Jarir SH, Ibrahim E, Eltai NO. Antimicrobial Resistance in Qatar: Prevalence and Trends before and Amidst the COVID-19 Pandemic. Antibiotics (Basel) 2024; 13:203. [PMID: 38534638 DOI: 10.3390/antibiotics13030203] [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: 01/03/2024] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial resistance (AMR) is a global healthcare challenge with substantial morbidity, mortality, and management costs. During the COVID-19 pandemic, there was a documented increase in antimicrobial consumption, particularly for severe and critical cases, as well as noticeable travel and social restriction measures that might influenced the spectrum of AMR. To evaluate the problem, retrospective data were collected on bacterial infections and antimicrobial susceptibility patterns in Qatar before and after the pandemic from 1 January 2019 to 31 December 2021, covering 53,183 pathogens isolated from reported infection episodes. The findings revealed a significant resistance pattern for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-EBC), carbapenem-resistant Enterobacteriaceae (CR-EBC), and carbapenem-resistant Pseudomonas aeruginosa (CRPA), ciprofloxacin-resistant Salmonella and methicillin-resistant Staphylococcus aureus (MRSA). For correlation with social restrictions, ESBL-EBC and MRSA were positively correlated with changing patterns of international travel (ρ = 0.71 and 0.67, respectively; p < 0.05), while CRPA was moderately correlated with the number of COVID-19 hospitalized patients (ρ = 0.49; p < 0.05). CREBC and CRPA respiratory infections were associated with hospitalized patients (OR: 3.08 and 2.00, respectively; p < 0.05). The findings emphasize the challenges experienced during the COVID-19 pandemic and links to international travel, which probably will influence the local epidemiology of AMR that needs further surveillance and control strategies.
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Affiliation(s)
- Hassan Al Mana
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
| | - Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Godwin Wilson
- Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Muna A Almaslamani
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Sulieman H Abu Jarir
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Emad Ibrahim
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
- Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Nahla O Eltai
- Biomedical Research Center, Qatar University, Doha P.O. Box 2713, Qatar
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Koupaei M, Asadi A, Mahdizade Ari M, Seyyedi ZS, Mohammadi F, Afifi Rad R, Ghanavati R, Rezaei Khozani N, Darbandi A, Masjedian Jazi F. Secondary Klebsiella pneumoniae infection in patients with COVID-19: A systematic review. Diagn Microbiol Infect Dis 2024; 108:116105. [PMID: 38147789 DOI: 10.1016/j.diagmicrobio.2023.116105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 12/28/2023]
Abstract
This study aims to investigate the development of secondary bacterial infection and risk factors associated with it in critical COVID-19 patients, and to identify the most common pathogen groups in them. All the cohort studies were retrieved from Scopus, Google Scholar, Web of Science, and MEDLINE from the inception of COVID-19 to 2022 for the following keywords: 'Klebsiella" AND "COVID-19". The most common comorbidities among the patients with COVID-19 were respiratory disease (33.62%), obesity (28.99%), and heart disease or cardiovascular disease (16.31%). We report 42.91% rate of Klebsiella spp co-infection in ICU admission patients, mostly related to K. pneumonia (26.81%), K. aerogenes (9.4%), and K. oxytoca (6.7%). The overall incidence of bacterial infection in hospitalized COVID-19 patients is estimated at 15.5% and in 32.5% of cases of co-infection patients deceased. The threat of carbapenem-resistant K. pneumoniae infections in patients with COVID-19 is imminent, therefore rational antibiotic therapy based on antibiotic sensitivity test should be implemented.
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Affiliation(s)
- Maryam Koupaei
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Arezoo Asadi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medica Sciences, Tehran, Iran
| | - Marzie Mahdizade Ari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Seyyedi
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Fahime Mohammadi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roghayeh Afifi Rad
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nahid Rezaei Khozani
- Department of immunology and microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Atieh Darbandi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Molecular Microbiology Research Center, Shahed University, Tehran, Iran.
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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5
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Lee YL, Hsueh PR. Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis. Curr Opin Infect Dis 2023; 36:481-494. [PMID: 37548375 DOI: 10.1097/qco.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis . RECENT FINDINGS Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia . Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis , there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis . The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. SUMMARY Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis , but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital
- School of Medicine, Chung Shan Medical University
- PhD Program in Medical Biotechnology, National Chung-Hsing University
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital
- School of Medicine
- PhD Program for Aging, School of Medicine, China Medical University, Taichung
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Fatima N, Ahmed S, Shameem M, Ahmed A, Hasan W, Khan PA. Rhino-orbito-cerebral mucormycosis during Covid-19 pandemic- a prospective observational study. Indian J Med Microbiol 2023; 46:100467. [PMID: 37651764 DOI: 10.1016/j.ijmmb.2023.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE An unprecedented rise in mucormycosis cases; apparently called 'an epidemic within a pandemic' was seen worldwide. Therefore, the following study was conducted to know the epidemiology, underlying risk factors, diagnostic approach, and possible outcome of mucormycosis during the Covid-19 pandemic. METHODS A prospective observational study was conducted on patients with a high index of clinical suspicion of mucormycosis Data about demographics, co-morbidities, laboratory investigations, radiology, management, and outcomes were collected. RESULTS We got 45 cases of proven Rhino-orbital-cerebral-mucormycosis (ROCM) from clinically suspected cases. Covid-19 was the most common underlying risk factor (n = 41, 91.11%) followed by Diabetes mellitus (DM) (n = 39; 86.67%). Steroids and oxygen usage were noted in 53.66% (n = 22) and 41.46% (n = 17) respectively. Among the 51 suspected cases of mucormycosis, 47 were supported by radiodiagnosis. Histopathology diagnosed the highest number of mucormycosis cases (n = 44; 97.78%), followed by KOH examination (n = 36; 80%) and Culture (n = 28; 62.22%). The most common species isolated from the tissue samples was Rhizopus species (n = 17; 60.71%), followed by Mucor species (n = 7; 25%). The mortality rate was 17.14%. CONCLUSION DM, Covid-19, and corticosteroids are the chief underlying risk factor for ROCM. Rhizopus spp. was the most dominant etiological agent. Early diagnosis and management with combined medical & surgical intervention have a better survival rate.
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Affiliation(s)
- Nazish Fatima
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Shariq Ahmed
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India.
| | - Mohammad Shameem
- Department of TB and Respiratory Disease, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Aftab Ahmed
- Department of Oto-Rhino-Laryngology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Wasil Hasan
- Department of Biochemistry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
| | - Parvez A Khan
- Department of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India
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Gual-de-Torrella A, López-Causape C, Alejo-Cancho I, Rojo-Molinero E, Sanchez-García G, Cortés-Lara S, Rodríguez Moral MB, Berdonces-Gonzalez P, Lopez de Goikoetxea MJ, Oliver A. Molecular characterization of a suspected IMP-type carbapenemase-producing Pseudomonas aeruginosa outbreak reveals two simultaneous outbreaks in a tertiary-care hospital. Infect Control Hosp Epidemiol 2023; 44:1801-1808. [PMID: 37138359 DOI: 10.1017/ice.2023.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To describe IMP-type carbapenemase-producing Pseudomonas aeruginosa outbreaks at Galdakao University Hospital between March 2021 to December 2021. DESIGN Outbreak report. SETTING Galdakao University Hospital is a tertiary-care hospital in the Basque Country (northern Spain). PATIENTS All patients with a positive IMP-type carbapenemase producing Pseudomonas aeruginosa (IMP-PA) culture were included in this study, both colonization and infection cases. METHODS An outbreak investigation was conducted, in which molecular epidemiology analysis [pulsed-field gel electrophoresis and whole-genome sequencing (WGS)] and environmental screenings were performed. RESULTS Between March and December 2021, 21 cases of IMP-PA were detected in Galdakao University Hospital: 18 infection cases and 3 colonization cases. In total, 4 different pulsotypes were detected belonging to 4 clones according to WGS: ST175 (n = 14), ST633 (n = 3), ST179 (n = 3), and ST348 (n = 1). IMP-13 was detected in most isolates belonging to the ST175 clone and in all ST179 and ST348 clones, whereas IMP-29 was detected in isolates belonging to the ST633 clone. Clinical isolates belonging to the ST175 clone were isolated mainly from patients admitted to the respiratory ward, and isolates belonging to the ST633 clone from patients admitted to the ICU. Two environmental isolates belonging to the ST175 clone were detected in the respiratory ward. CONCLUSIONS Molecular and genomic epidemiology revealed that there had been 2 independent IMP-PA outbreaks, one of long duration in the respiratory ward and the other more limited in the ICU.
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Affiliation(s)
- Ana Gual-de-Torrella
- Servicio de Microbiología, Hospital Universitario Usansolo-Galdakao, Galdakao, Bizkaia, Spain
| | - Carla López-Causape
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Illes Balears, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Copmunidad de Madrid, Spain
| | - Izaskun Alejo-Cancho
- Servicio de Microbiología, Hospital Universitario Usansolo-Galdakao, Galdakao, Bizkaia, Spain
| | - Estrella Rojo-Molinero
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Illes Balears, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Copmunidad de Madrid, Spain
| | - Gonzalo Sanchez-García
- Servicio de Medicina Preventiva, Hospital Universitario Usansolo-Galdakao, Galdakao, Bizkaia, Spain
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Bizkaia, Spain
| | - Sara Cortés-Lara
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Illes Balears, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Copmunidad de Madrid, Spain
| | - María B Rodríguez Moral
- Servicio de Medicina Preventiva, Hospital Universitario Usansolo-Galdakao, Galdakao, Bizkaia, Spain
| | | | | | - Antonio Oliver
- Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Illes Balears, Spain
- CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Copmunidad de Madrid, Spain
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Alghamdi M, Al-Judaibi E, Al-Rashede M, Al-Judaibi A. Comparative De Novo and Pan-Genome Analysis of MDR Nosocomial Bacteria Isolated from Hospitals in Jeddah, Saudi Arabia. Microorganisms 2023; 11:2432. [PMID: 37894090 PMCID: PMC10609288 DOI: 10.3390/microorganisms11102432] [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: 07/03/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Multidrug-resistant (MDR) bacteria are one of the most serious threats to public health, and one of the most important types of MDR bacteria are those that are acquired in a hospital, known as nosocomial. This study aimed to isolate and identify MDR bacteria from selected hospitals in Jeddah and analyze their antibiotic-resistant genes. Bacteria were collected from different sources and wards of hospitals in Jeddah City. Phoenix BD was used to identify the strains and perform susceptibility testing. Identification of selected isolates showing MDR to more than three classes on antibiotics was based on 16S rRNA gene and whole genome sequencing. Genes conferring resistance were characterized using de novo and pan-genome analyses. In total, we isolated 108 bacterial strains, of which 75 (69.44%) were found to be MDR. Taxonomic identification revealed that 24 (32%) isolates were identified as Escherichia coli, 19 (25.3%) corresponded to Klebsiella pneumoniae, and 17 (22.67%) were methicillin-resistant Staphylococcus aureus (MRSA). Among the Gram-negative bacteria, K. pneumoniae isolates showed the highest resistance levels to most antibiotics. Of the Gram-positive bacteria, S. aureus (MRSA) strains were noticed to exhibit the uppermost degree of resistance to the tested antibiotics, which is higher than that observed for K. pneumoniae isolates. Taken together, our results illustrated that MDR Gram-negative bacteria are the most common cause of nosocomial infections, while MDR Gram-positive bacteria are characterized by a wider antibiotic resistance spectrum. Whole genome sequencing found the appearance of antibiotic resistance genes, including SHV, OXA, CTX-M, TEM-1, NDM-1, VIM-1, ere(A), ermA, ermB, ermC, msrA, qacA, qacB, and qacC.
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Affiliation(s)
- Molook Alghamdi
- Department of Biological Sciences, Microbiology Section, Faculty of Science, Jeddah University, Jeddah 21959, Saudi Arabia; (M.A.); (E.A.-J.)
| | - Effat Al-Judaibi
- Department of Biological Sciences, Microbiology Section, Faculty of Science, Jeddah University, Jeddah 21959, Saudi Arabia; (M.A.); (E.A.-J.)
| | | | - Awatif Al-Judaibi
- Department of Biological Sciences, Microbiology Section, Faculty of Science, Jeddah University, Jeddah 21959, Saudi Arabia; (M.A.); (E.A.-J.)
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Singh N, Mishra S, Mondal A, Sharma D, Jain N, Aseri GK. Potential of Desert Medicinal Plants for Combating Resistant Biofilms in Urinary Tract Infections. Appl Biochem Biotechnol 2023; 195:5568-5582. [PMID: 35666381 DOI: 10.1007/s12010-022-03950-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
Urinary tract infections (UTIs) are among the most prevalent bacterial infections worldwide, with 11% of the global population getting infected every year. These infections are largely attributed to quorum sensing (QS)-dependent ability of pathogens to form biofilms in the urinary tract. Antimicrobial resistance is increasing, and the use of antimicrobial medicines in the future is yet uncertain. The desert medicinal plants have great potential to treat several diseases as per the available ethnobotanical database. Some of these plants have been used in folklore medicines to treat urinary tract infections also. There are many bioactive compounds derived from these desert medicinal plants that have been documented to possess antimicrobial as well as antibiofilm activity against uropathogens. The minimum biofilm inhibitory concentration (MBIC) of these plant extracts have been reported in the range of 31.5-250 μg/mL. The rising prevalence of drug-resistant diseases necessitates standardised modern analytical technologies to detect and isolate novel bioactive compounds from medicinal plants. This review seeks to combine the studies of desert plants with antimicrobial and anti-quorum sensing properties, supporting their sustainable use in treatment of urinary tract infections.
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Affiliation(s)
- Neha Singh
- Amity Institute of Microbial Technology, Amity University Rajasthan, Jaipur, 303002, India
| | - Shivam Mishra
- Kusuma School of Biological Sciences, India Institute of Technology Delhi, New Delhi, 110016, India
| | - Asmita Mondal
- Amity Institute of Microbial Technology, Amity University Rajasthan, Jaipur, 303002, India
| | - Deepansh Sharma
- Amity Institute of Microbial Technology, Amity University Rajasthan, Jaipur, 303002, India
| | - Neelam Jain
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, 303002, India.
| | - G K Aseri
- Amity Institute of Microbial Technology, Amity University Rajasthan, Jaipur, 303002, India.
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10
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Burnside JS, Buchthal OV, Patil U. A Systematic Review of Antimicrobial Resistance During the COVID-19 Pandemic. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:188-193. [PMID: 37559691 PMCID: PMC10407777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Antimicrobial-resistant pathogens, or "superbugs," cause more than 35 000 deaths and more than 2.8 million antibiotic-resistant infections in the US each year. Worldwide, antimicrobial resistance (AMR) has claimed at least 700 000 lives per year, including 230 000 from multi-drug resistant (MDR) tuberculosis. AMR-related deaths are projected to increase to 10 million by the year 2050. The use of biocides, improper prescribing of antibiotics for viral infections, prolonged hospital stays, and other issues contribute to AMR. The purpose of this study was to determine whether the COVID-19 pandemic has had an impact on the rates of AMR globally. While it is still early for the results of research studies, 4 articles indicated an increase, 2 found a decrease, and 2 had mixed results. It is possible that this pandemic may be contributing to an increase of medication-resistant infections.
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Affiliation(s)
| | | | - Uday Patil
- Office of Public Health Studies, University of Hawai‘i at Maānoa, Honolulu, HI
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Mangioni D, Chatenoud L, Colombo J, Palomba E, Guerrero FA, Bolis M, Bottino N, Breda G, Chiaruttini MV, Fior G, Marotta M, Massobrio G, Matinato C, Muscatello A, Previtali P, Santambrogio S, Tardini F, Zuglian G, Grasselli G, Fumagalli R, Gori A, Stocchetti N, Monti G, Bandera A. Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated COVID-19 Patients 1. Emerg Infect Dis 2023; 29:1598-1607. [PMID: 37486196 PMCID: PMC10370845 DOI: 10.3201/eid2908.230115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p<0.001). Previous exposure to antimicrobial drugs within the ICU was higher in MDRO patients than in non-MDRO patients (116/197 [58.9%] vs. 18/140 [12.9%]; p<0.001). Our findings might serve as warnings for future respiratory viral pandemics and call for increased measures of antimicrobial stewardship and infection control.
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12
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de Souza GHDA, de Oliveira AR, Dos Santos Barbosa M, Rossato L, da Silva Barbosa K, Simionatto S. Multidrug-resistant gram-negative bacteria in patients with COVID-19: An epidemiological and clinical study. J Infect Public Health 2023; 16:1184-1192. [PMID: 37271099 DOI: 10.1016/j.jiph.2023.05.017] [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: 02/10/2023] [Revised: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023] Open
Abstract
Epidemiological data regarding the incidence of secondary multidrug-resistant (MDR) Gram-negative infection in patients with coronavirus disease (COVID-19) in Brazil are still ambiguous. Thus, a case-control study was designed to determine factors associated with the acquisition of MDR Gram-negative bacteria (GNB) in patients with and without COVID-19 and describe the mortality rates and clinical features associated with unfavorable outcomes. In total, we assessed 280 patients admitted to Brazilian intensive care units from March/2020 to December/2021. During the study, 926 GNB were isolated. Out of those, 504 were MDR-GNB, representing 54.4% of the resistance rate. In addition, out of 871 patients positive for COVID-19, 73 had secondary MDR-GNB infection, which represented 8.38% of documented community-acquired GNB-MDR infections. The factors associated with patients COVID-19-MDR-GNB infections were obesity, heart failure, use of mechanical ventilation, urinary catheter, and previous use of β-lactams. Several factors associated with mortality were identified among patients with COVID-19 infected with MDR-GNB, including the use of a urinary catheter; renal failure; and the origin of bacterial cultures such as tracheal secretion, exposure to carbapenem antibiotics, and polymyxin. Mortality was significantly higher in patients with COVID-19-MDR-GNB (68.6%) compared to control groups, where COVID-19 was 35.7%, MDR-GNB was 50%, and GNB was 21.4%. Our findings demonstrate that MDR-GNB infection associated with COVID-19 has an expressive impact on increasing the case fatality rate, reinforcing the importance of minimizing the use of invasive devices and prior exposure to antimicrobials to control the bacterial spread in healthcare environments to improve the prognosis among critical patients.
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Affiliation(s)
| | - Alexandre Ribeiro de Oliveira
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grosso do Sul, Brazil
| | - Marcelo Dos Santos Barbosa
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grosso do Sul, Brazil
| | - Luana Rossato
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grosso do Sul, Brazil
| | - Kerly da Silva Barbosa
- Hospital Universitário da Universidade Federal da Grande Dourados - HU/UFGD/EBSERH, Dourados, Mato Grosso do Sul, Brazil
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grosso do Sul, Brazil.
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Pace MC, Corrente A, Passavanti MB, Sansone P, Petrou S, Leone S, Fiore M. Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit. World J Clin Cases 2023; 11:2874-2889. [PMID: 37215420 PMCID: PMC10198073 DOI: 10.12998/wjcc.v11.i13.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Intensive care units (ICU) for various reasons, including the increasing age of admitted patients, comorbidities, and increasingly complex surgical procedures (e.g., transplants), have become "the epicenter" of nosocomial infections, these are characterized by the presence of multidrug-resistant organisms (MDROs) as the cause of infection. Therefore, the perfect match of fragile patients and MDROs, as the cause of infection, makes ICU mortality very high. Furthermore, carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs; unfortunately, nowadays carbapenem resistance, mainly among Gram-negative pathogens, is a matter of the highest concern for worldwide public health. This comprehensive review aims to outline the problem from the intensivist's perspective, focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs (Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales) to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases.
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Affiliation(s)
- Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Antonio Corrente
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
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14
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Bongiovanni M, Barda B. Pseudomonas aeruginosa Bloodstream Infections in SARS-CoV-2 Infected Patients: A Systematic Review. J Clin Med 2023; 12:jcm12062252. [PMID: 36983256 PMCID: PMC10056033 DOI: 10.3390/jcm12062252] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Bacterial co-infections increase the severity of respiratory viral infections and are frequent causes of mortality in COVID-19 infected subjects. During the COVID-19 period, especially at the beginning of the pandemic, an inappropriate use of broad-spectrum antibiotic treatments has been frequently described, mainly due to prolonged hospitalization, especially in intensive care unit departments, and the use of immune-suppressive treatments as steroids. This misuse has finally led to the occurrence of infections by multi-drug resistant (MDR) bacteria in hospitalized COVID-19 patients. Although different reports assessed the prevalence of Gram-negative infections in COVID-19 infected patients, scarce data are currently available on bloodstream infections caused by Pseudomonas aeruginosa in hospitalized COVID-19 patients. The aim of our systematic review is to describe data on this specific population and to discuss the possible implications that these co-infections could have in the management of COVID-19 pandemics in the future. We systematically analysed the current literature to find all the relevant articles that describe the occurrence of P. aeruginosa bloodstream infections in COVID-19 patients. We found 40 papers that described in detail P. aeruginosa HAIs-BSI in COVID-19 patients, including 756,067 patients overall. The occurrence of severe infections due to MDR bacteria had a significant impact in the management of hospitalized patients with COVID-19 infections, leading to a prolonged time of hospitalization and to a consequent increase in mortality. In the near future, the increased burden of MDR bacteria due to the COVID-19 pandemic might partially be reduced by maintaining the preventive measures of infection control implemented during the acute phase of the COVID-19 pandemic. Finally, we discuss how the COVID-19 pandemic changed the role of antimicrobial stewardship in healthcare settings, according to the isolation of MDR bacteria and how to restore on a large scale the optimization of antibiotic strategies in COVID-19 patients.
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Aldardeer NF, Shukairi ANAL, Nasser ME, Al Musawa M, Kalkatawi BS, Alsahli RM, Ramdan AME, Qushmaq I, Aldhaeefi M. Continuation Versus De-escalation of Broad-Spectrum Antibiotic Therapy in Critically Ill COVID-19 Patients. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2023. [PMCID: PMC9972303 DOI: 10.1007/s44229-023-00027-0] [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] [Indexed: 03/06/2023] Open
Abstract
Background Antibiotic de-escalation (ADE) is a stewardship initiative that aims to reduce exposure to antimicrobials, thus limiting their unwanted effect, including antimicrobial resistance. Our study aims to describe the impact of ADE compared with the continuation of therapy on the outcome of critically ill coronavirus disease 2019 (COVID-19) patients. Material and Methods A single-center retrospective study included critically ill COVID-19 adult patients admitted between January 1, 2019 and August 31, 2021, and started on broad-spectrum antibiotics. The primary outcome was intensive care unit (ICU) mortality. In addition, other clinical outcomes were evaluated, including ICU readmissions, length of stay, and superinfection. Results The study included 73 patients with a mean age of 61.0 ± 19.4, and ADE was performed in 10 (13.6%) of these. In the ADE group, 8/10 (80%) cultures were positive. ICU mortality was not statistically different between ADE and continuation of therapy groups (60 vs. 41.3%, respectively, P = 0.317). Superinfection occurred in 4 (5.4%) patients. Hospital mortality, length of stay, and ICU readmission rates did not differ significantly between groups. Conclusion De-escalation of broad-spectrum antibiotics in critically ill covid-19 patients was not associated with higher mortality. A larger cohort is needed to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s44229-023-00027-0.
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Affiliation(s)
| | - Abeer Nizar A. L. Shukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia ,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohannad E. Nasser
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mohammad Al Musawa
- Medication Safety/Clinical Support Pharmacy, King Faisal Specialist Hospital and Research Centre (Gen. Org.), Jeddah, Saudi Arabia
| | | | | | | | - Ismael Qushmaq
- Section of Critical Care Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center (Gen. Org.), Jeddah, Saudi Arabia
| | - Mohammed Aldhaeefi
- Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, USA
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Efficacy in Galleria mellonella Larvae and Application Potential Assessment of a New Bacteriophage BUCT700 Extensively Lyse Stenotrophomonas maltophilia. Microbiol Spectr 2023; 11:e0403022. [PMID: 36700630 PMCID: PMC9927281 DOI: 10.1128/spectrum.04030-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In recent years, Stenotrophomonas maltophilia (S. maltophilia) has become an important pathogen of clinically acquired infections accompanied by high pathogenicity and high mortality. Moreover, infections caused by multidrug-resistant S. maltophilia have emerged as a serious challenge in clinical practice. Bacteriophages are considered a promising alternative for the treatment of S. maltophilia infections due to their unique antibacterial mechanism and superior bactericidal ability compared with traditional antibiotic agents. Here, we reported a new phage BUCT700 that has a double-stranded DNA genome of 43,214 bp with 70% GC content. A total of 55 ORFs and no virulence or antimicrobial resistance genes were annotated in the genome of phage BUCT700. Phage BUCT700 has a broad host range (28/43) and can lyse multiple ST types of clinical S. maltophilia (21/33). Furthermore, bacteriophage BUCT700 used the Type IV fimbrial biogenesis protein PilX as an adsorption receptor. In the stability test, phage BUCT700 showed excellent thermal stability (4 to 60°C) and pH tolerance (pH = 4 to 12). Moreover, phage BUCT700 was able to maintain a high titer during long-term storage. The adsorption curve and one-step growth curve showed that phage BUCT700 could rapidly adsorb to the surface of S. maltophilia and produce a significant number of phage virions. In vivo, BUCT700 significantly increased the survival rate of S. maltophilia-infected Galleria mellonella (G. mellonella) larvae from 0% to 100% within 72 h, especially in the prophylactic model. In conclusion, these findings indicate that phage BUCT700 has promising potential for clinical application either as a prophylactic or therapeutic agent. IMPORTANCE The risk of Stenotrophomonas maltophilia infections mediated by the medical devices is exacerbated with an increase in the number of ICU patients during the Corona Virus Disease 2019 (COVID-19) epidemic. Complications caused by S. maltophilia infections could complicate the state of an illness, greatly extending the length of hospitalization and increasing the financial burden. Phage therapy might be a potential and promising alternative for clinical treatment of multidrug-resistant bacterial infections. Here, we investigated the protective effects of phage BUCT700 as prophylactic and therapeutic agents in Galleria mellonella models of infection, respectively. This study demonstrates that phage therapy can provide protection in targeting S. maltophilia-related infection, especially as prophylaxis.
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Che Yusof R, Norhayati MN, Mohd Azman Y. Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis. PeerJ 2023; 11:e15265. [PMID: 37128208 PMCID: PMC10148641 DOI: 10.7717/peerj.15265] [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: 01/27/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023] Open
Abstract
Background There were a few studies on bacterial coinfection in hospitalized COVID-19 patients worldwide. This systematic review aimed to provide the pooled prevalence of bacterial coinfection from published studies from 2020 to 2022. Methods Three databases were used to search the studies, and 49 studies from 2,451 identified studies involving 212,605 COVID-19 patients were included in this review. Results The random-effects inverse-variance model determined that the pooled prevalence of bacterial coinfection in hospitalized COVID-19 patients was 26.84% (95% CI [23.85-29.83]). The pooled prevalence of isolated bacteria for Acinetobacter baumannii was 23.25% (95% CI [19.27-27.24]), Escherichia coli was 10.51% (95% CI [8.90-12.12]), Klebsiella pneumoniae was 15.24% (95% CI [7.84-22.64]), Pseudomonas aeruginosa was 11.09% (95% CI [8.92-13.27]) and Staphylococcus aureus (11.59% (95% CI [9.71-13.46])). Meanwhile, the pooled prevalence of antibiotic-resistant bacteria for extended-spectrum beta-lactamases producing Enterobacteriaceae was 15.24% (95% CI [7.84-22.64]) followed by carbapenem-resistant Acinetobacter baumannii (14.55% (95% CI [9.59-19.52%])), carbapenem-resistant Pseudomonas aeruginosa (6.95% (95% CI [2.61-11.29])), methicillin-resistant Staphylococcus aureus (5.05% (95% CI [3.49-6.60])), carbapenem-resistant Enterobacteriaceae (4.95% (95% CI [3.10-6.79])), and vancomycin-resistant Enterococcus (1.26% (95% CI [0.46-2.05])). Conclusion All the prevalences were considered as low. However, effective management and prevention of the infection should be considered since these coinfections have a bad impact on the morbidity and mortality of patients.
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Affiliation(s)
- Ruhana Che Yusof
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yacob Mohd Azman
- Medical Development Division, Ministry of Health, Putrajaya, Malaysia
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18
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Jeck J, Wingen-Heimann SM, Jakobs F, Franz J, Baltin CT, Kron A, Böll B, Kochanek M, Cornely OA, Kron F. Last Resort Antibiotics Costs and Reimbursement Analysis of Real-Life ICU Patients with Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Germany. Healthcare (Basel) 2022; 10:healthcare10122546. [PMID: 36554068 PMCID: PMC9778355 DOI: 10.3390/healthcare10122546] [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: 11/18/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.
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Affiliation(s)
- Julia Jeck
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Sebastian M. Wingen-Heimann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Jennifer Franz
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Christoph T. Baltin
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Anna Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Oliver A. Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 269, 50935 Cologne, Germany
- Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Correspondence: ; Tel.: +49-176-6200-3950
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CANOĞLU K, AYTEN O. The effect of immunosuppressive therapy on the development of ventilator-associated pneumonia in patients with COVID-19. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1136479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: It remains unclear whether immunosuppressive treatments such as corticosteroids and IL-6 receptor blockers have an effect on the development of ventilator-associated pneumonia (VAP). The aim of this study was to investigate the effect of immunosuppressive therapy on the development of VAP in critically ill patients with COVID-19.
Material and Method: Two hundred thirty five patients with critically ill patients with COVID-19, who were treated in the intensive care unit (ICU) and received mechanical ventilator support, were evaluated retrospectively. VAP development, secondary infections, microorganisms isolated, and resistance patterns were compared between the groups that received and did not receive immunosuppressive therapy, and also the groups that did not receive immunosuppressive therapy, received only corticosteroid, received only tocilizumab, and received corticosteroid plus tocilizumab were compared in the subgroup analysis.
Results: In the immunosuppressive treatment group, VAP development (40.2% vs. 21.2%; p=0.001), secondary infection development (48.4% vs. 29.2%; p=0.003), at least one drug resistant bacteria growth (46.7% vs. 27.4%; p=0.001), extensively-drug resistant (XDR) microorganism growth (89.8% vs. 72.7%; p=0.033) were higher than the group that did not receive immunosuppressive treatment. VAP (53.3%; p=0.004), secondary infection (73.3%; p=0.0002), the growth of bacteria resistant to at least one drug (70%; p=0.0003) were highest in the corticosteroid plus tocilizumab group in the subgroup analysis. In addition, XDR (95.5% vs. 72.7%; p=0.032) and pan-drug resistant (PDR) microorganism growth (31.8% vs. 9.1% p=0.032) were higher in the corticosteroid plus tocilizumab group than the no immunosuppressive therapy group. There was no difference between the groups in terms of mortality (p>0.05).
Conclusion: Immunosuppressive therapy has been found to potentially enhance the risk of VAP and secondary infections in critically ill patients with COVID-19 pneumonia as well as the growth of bacteria resistant to at least one drug, the length of stay in hospital and ICUs. In addition, it has been evaluated that there may be an increase in the growth of XDR and PDR microorganisms when corticosteroid and tocilizumab are used together. Although there was no difference in mortality, using immunosuppressive therapy may require careful use of targeted antibiotics and longer-term antimicrobial therapy.
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Affiliation(s)
- Kadir CANOĞLU
- İSTANBUL SULTAN ABDÜLHAMİD HAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Omer AYTEN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SULTAN ABDÜLHAMİD HAN SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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20
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Effects of Aerosol Inhalation Combined with Intravenous Drip of Polymyxin B on Bacterial Clearance, Symptoms Improvement, and Serum Infection Indexes in Patients with Pneumonia Induced by Multidrug-Resistant Gram-Negative Bacteria. Emerg Med Int 2022; 2022:5244538. [PMID: 36072613 PMCID: PMC9441374 DOI: 10.1155/2022/5244538] [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: 05/25/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
In recent years, the incidence of pneumonia caused by multidrug-resistant (MDR) Gram-negative bacteria (G−) has increased year by year. Polymyxin B has a good clinical effect in the treatment of MDR, but there is controversy about the administration route of this drug. In this study, we retrospectively analyzed the clinical data of 84 cases of MDR Gram-negative bacterial pneumonia, and aimed to explore the effects of aerosol inhalation combined with intravenous polymyxin B infusion on the bacterial clearance, symptom improvement, and serum infection indexes of MDR patients on the patients with Gram-negative (G−) bacterial pneumonia. The results show that aerosol inhalation combined with intravenous drip of polymyxin B can improve bacterial clearance rate, reduce levels of serum inflammatory factors, and improve clinical symptoms in patients with pneumonia induced by MDR G-bacteria.
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21
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Superinfección por Stenotrophomonas maltophilia en pacientes con COVID-19 críticamente enfermos. Análisis de una serie de casos. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC8685231 DOI: 10.1016/j.acci.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
En pacientes con neumonía por SARS-CoV-2 el aumento de infección secundaria por microorganismos nosocomiales ha alertado al sistema de salud. Esto debido, al incrementar la estancia hospitalaria y el desenlace fatal en los pacientes críticamente enfermos. La siguiente serie de casos se realizó teniendo como objetivo evaluar en muestras de secreción bronquial el aislamiento de la Stenotrophomonas maltophilia en pacientes hospitalizados con COVID-19. Se encontraron siete pacientes asociados a una excesiva prescripción de antibióticos con baja susceptibilidad para Stenotrophomonas maltophilia y la presencia de infección secundaria bacteriana por este microorganismo asociado al uso de ventilación mecánica invasiva. Esto genera un dilema en las estrategias y recomendaciones médicas utilizadas en muchas instituciones para los pacientes con neumonía por SARS-CoV-2 con necesidad de unidad de cuidados intensivos.
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The Clinical Manifestation of SARS-CoV-2 in Critically Ill Patients with Klebsiella pneumoniae NDM Hospitalized in the ICU of a Modular Hospital during the Third Wave of the Pandemic in Poland—An Observational Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12051118. [PMID: 35626274 PMCID: PMC9139503 DOI: 10.3390/diagnostics12051118] [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: 03/26/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
There is limited information on the clinical characteristics of critically ill patients infected with SARS-CoV-2 and Klebsiella pneumoniae NDM. The objective of this study was to describe such a group of patients hospitalised in the intensive care unit of a large academic hospital during the third wave of the COVID-19 pandemic in Poland. Between 1 March and 30 June 2021, 103 patients were hospitalised, of whom 23 (22.3%) were positive for K. pneumoniae NDM; 14 (61%) of those patients died. Their hospitalisation time varied between 9 and 47 days. Five of the 23 patients (21.7%) were otherwise healthy. In contrast, the others suffered from cardiovascular problems (11, 47.8%), obesity (6, 26.1%), diabetes (5, 21.7%), neurological problems (4, 17.4%), or kidney disease (1, 4.3%); 4 (17.4%) were heavy smokers, and 1 (4.3%) had a history of alcohol abuse. K. pneumoniae NDM was isolated from urine samples of all patients. In 17 patients (73.9%), it was also isolated from other sources: from the respiratory tract in 10 (43.8%), from the blood in 2 (8.7%), and the central venous catheter was contaminated in 1 case (4.3%). Fourteen of the patients (60.9%) were colonised K. pneumoniae NDM. In four patients (17.4%), bacterial and fungal coinfection occurred. In one case (4.4%), two fungal species, Candida albicans and Candida glabrata, were isolated simultaneously. The most frequently administered antimicrobial agent was colistin (60.9%), followed by meropenem (47.8%), vancomycin (47.8%), ceftriaxone (34.8%), linezolid (30.4%), piperacillin/tazobactam (30.4%), and trimethoprim/sulfamethoxazole (30.4%). Other less-frequently administered agents included amikacin, amoxicillin/clavulanate, tigecycline, ciprofloxacin, fosfomycin, clindamycin, and cloxacillin. Fluconazole was administered in 14 patients (60.7%) and micafungin was administered in 2 (8.7%).
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Kariyawasam RM, Julien DA, Jelinski DC, Larose SL, Rennert-May E, Conly JM, Dingle TC, Chen JZ, Tyrrell GJ, Ronksley PE, Barkema HW. Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021). Antimicrob Resist Infect Control 2022; 11:45. [PMID: 35255988 PMCID: PMC8899460 DOI: 10.1186/s13756-022-01085-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR). OBJECTIVES We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings. METHODS We searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences. RESULTS Of 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0.2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI 8-40%; n = 25 studies: I2 = 99%) and 0.3% (95% CI 0.1-0.6%; n = 8 studies: I2 = 78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and multi-drug resistant Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated > 50% (n = 58) mortality, whereby all but 6 patients were infected with a resistant organism. CONCLUSIONS During the first 18 months of the pandemic, AMR prevalence was high in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally.
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Affiliation(s)
- Ruwandi M Kariyawasam
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Danielle A Julien
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Dana C Jelinski
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Samantha L Larose
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Elissa Rennert-May
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Departments of Medicine, Microbiology, Immunology and Infectious Diseases, and Community Health Sciences, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - John M Conly
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Departments of Medicine, Pathology and Laboratory Medicine, Microbiology, Immunology and Infectious Diseases, O'Brien Institute for Public Health, Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Tanis C Dingle
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Justin Z Chen
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gregory J Tyrrell
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Paul E Ronksley
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Herman W Barkema
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.
- Departments of Production Animal Health and Community Health Sciences,, One Health at UCalgary, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Canada.
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WHO Critical Priority Escherichia coli as One Health Challenge for a Post-Pandemic Scenario: Genomic Surveillance and Analysis of Current Trends in Brazil. Microbiol Spectr 2022; 10:e0125621. [PMID: 35234515 PMCID: PMC8941879 DOI: 10.1128/spectrum.01256-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The dissemination of carbapenem-resistant and third generation cephalosporin-resistant pathogens is a critical issue that is no longer restricted to hospital settings. The rapid spread of critical priority pathogens in Brazil is notably worrying, considering its continental dimension, the diversity of international trade, livestock production, and human travel. We conducted a nationwide genomic investigation under a One Health perspective that included Escherichia coli strains isolated from humans and nonhuman sources, over 45 years (1974–2019). One hundred sixty-seven genomes were analyzed extracting clinically relevant information (i.e., resistome, virulome, mobilome, sequence types [STs], and phylogenomic). The endemic status of extended-spectrum β-lactamase (ESBL)-positive strains carrying a wide diversity of blaCTX-M variants, and the growing number of colistin-resistant isolates carrying mcr-type genes was associated with the successful expansion of international ST10, ST38, ST115, ST131, ST354, ST410, ST648, ST517, and ST711 clones; phylogenetically related and shared between human and nonhuman hosts, and polluted aquatic environments. Otherwise, carbapenem-resistant ST48, ST90, ST155, ST167, ST224, ST349, ST457, ST648, ST707, ST744, ST774, and ST2509 clones from human host harbored blaKPC-2 and blaNDM-1 genes. A broad resistome to other clinically relevant antibiotics, hazardous heavy metals, disinfectants, and pesticides was further predicted. Wide virulome associated with invasion/adherence, exotoxin and siderophore production was related to phylogroup B2. The convergence of wide resistome and virulome has contributed to the persistence and rapid spread of international high-risk clones of critical priority E. coli at the human-animal-environmental interface, which must be considered a One Health challenge for a post-pandemic scenario. IMPORTANCE A One Health approach for antimicrobial resistance must integrate whole-genome sequencing surveillance data of critical priority pathogens from human, animal and environmental sources to track hot spots and routes of transmission and developing effective prevention and control strategies. As part of the Grand Challenges Explorations: New Approaches to Characterize the Global Burden of Antimicrobial Resistance Program, we present genomic data of WHO critical priority carbapenemase-resistant, ESBL-producing, and/or colistin-resistant Escherichia coli strains isolated from humans and nonhuman sources in Brazil, a country with continental proportions and high levels of antimicrobial resistance. The present study provided evidence of epidemiological and clinical interest, highlighting that the convergence of wide virulome and resistome has contributed to the persistence and rapid spread of international high-risk clones of E. coli at the human-animal-environmental interface, which must be considered a One Health threat that requires coordinated actions to reduce its incidence in humans and nonhuman hosts.
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da Costa RL, Lamas CDC, Simvoulidis LFN, Espanha CA, Moreira LPM, Bonancim RAB, Weber JVLA, Ramos MRF, Silva ECDF, de Oliveira LP. Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance. Rev Inst Med Trop Sao Paulo 2022; 64:e6. [PMID: 35137900 PMCID: PMC8815857 DOI: 10.1590/s1678-9946202264006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022] Open
Abstract
Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.
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Affiliation(s)
- Rafael Lessa da Costa
- Hospital Unimed-Rio, Unidade de Terapia Intensiva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil
- Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Unigranrio, Rio de Janeiro, Rio de Janeiro, Brazil
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Lu LY, Feng PH, Yu MS, Chen MC, Lin AJH, Chen JL, Yu LHL. Current utilization of interferon alpha for the treatment of coronavirus disease 2019: A comprehensive review. Cytokine Growth Factor Rev 2022; 63:34-43. [PMID: 35115233 PMCID: PMC8755267 DOI: 10.1016/j.cytogfr.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Recent studies have identified an association between perturbed type I interferon (IFN) responses and the severity of coronavirus disease 2019 (COVID-19). IFNα intervention may normalize the dysregulated innate immunity of COVID-19. However, details regarding its utilization and therapeutic evidence have yet to be systematically evaluated. The aim of this comprehensive review was to summarize the current utilization of IFNα for COVID-19 treatment and to explore the evidence on safety and efficacy. A comprehensive review of clinical studies in the literature prior to December 1st, 2021, was performed to identify the current utilization of IFNα, which included details on the route of administration, the number of patients who received the treatment, the severity at the initiation of treatment, age range, the time from the onset of symptoms to treatment, dose, frequency, and duration as well as safety and efficacy. Encouragingly, no evidence was found against the safety of IFNα treatment for COVID-19. Early intervention, either within five days from the onset of symptoms or at hospital admission, confers better clinical outcomes, whereas late intervention may result in prolonged hospitalization.
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Affiliation(s)
- Ling-Ying Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying District, Kaohsiung City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan
| | - Ming-Sun Yu
- Division of Hematology, Conde S. Januário Hospital, Estrada do Visconde de São Januário, Macau, China
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, Taiwan
| | - Alex Jia-Hong Lin
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Justin L. Chen
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Lennex Hsueh-Lin Yu
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan,Corresponding author
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Papst L, Luzzati R, Carević B, Tascini C, Gorišek Miksić N, Vlahović Palčevski V, Djordjevic ZM, Simonetti O, Sozio E, Lukić M, Stevanović G, Petek D, Beović B. Antimicrobial Use in Hospitalised Patients with COVID-19: An International Multicentre Point-Prevalence Study. Antibiotics (Basel) 2022; 11:antibiotics11020176. [PMID: 35203779 PMCID: PMC8868464 DOI: 10.3390/antibiotics11020176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Studies suggest that the incidence of coinfections in patients with the coronavirus disease 2019 (COVID-19) is low, but a large number of patients receive antimicrobials during hospitalisation. This may fuel a rise in antimicrobial resistance (AMR). We conducted a multicentre point-prevalence survey in seven tertiary university hospitals (in medical wards and intensive care units) in Croatia, Italy, Serbia and Slovenia. Of 988 COVID-19 patients, 521 were receiving antibiotics and/or antifungals (52.7%; range across hospitals: 32.9–85.6%) on the day of the study. Differences between hospitals were statistically significant (χ2 (6, N = 988) = 192.57, p < 0.001). The majority of patients received antibiotics and/or antifungals within 48 h of admission (323/521, 62%; range across hospitals: 17.4–100%), their most common use was empirical (79.4% of prescriptions), and pneumonia was the main indication for starting the treatment (three-quarters of prescriptions). The majority of antibiotics prescribed (69.9%) belonged to the “Watch” group of the World Health Organization AWaRe classification. The pattern of antimicrobial use differed across hospitals. The data show that early empiric use of broad-spectrum antibiotics is common in COVID-19 patients, and that the pattern of antimicrobial use varies across hospitals. Judicious use of antimicrobials is warranted to prevent an increase in AMR.
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Affiliation(s)
- Lea Papst
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Roberto Luzzati
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini 50, 34148 Trieste, Italy; (R.L.); (O.S.)
| | - Biljana Carević
- Department of Hospital Epidemiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (B.C.); (G.S.)
| | - Carlo Tascini
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Via Pozzuolo 33, 33100 Udine, Italy; (C.T.); (E.S.)
| | - Nina Gorišek Miksić
- Department of Infectious Diseases, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.G.M.); (D.P.)
| | - Vera Vlahović Palčevski
- Unit of Clinical Pharmacology, Clinical Hospital Center Rijeka, Krešimirova ulica 42, 51000 Rijeka, Croatia;
| | - Zorana M. Djordjevic
- Department of Hospital Infections Control, University Clinical Centre Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia;
| | - Omar Simonetti
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini 50, 34148 Trieste, Italy; (R.L.); (O.S.)
| | - Emanuela Sozio
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Via Pozzuolo 33, 33100 Udine, Italy; (C.T.); (E.S.)
| | - Milica Lukić
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Goran Stevanović
- Department of Hospital Epidemiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (B.C.); (G.S.)
| | - Davor Petek
- Department of Infectious Diseases, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.G.M.); (D.P.)
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Evaluation of Bacterial Coinfection and Antibiotic Resistance in Patients with COVID-19 Under Mechanical Ventilation. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:19. [PMID: 35013721 PMCID: PMC8733817 DOI: 10.1007/s42399-021-01114-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/15/2022]
Abstract
Patients with confirmed SARS-CoV-2 are principally at risk of emerging superinfections, particularly those caused by Gram-negative bacteria. Therefore, in this retrospective cohort study, we investigated the presence of bacteria in endotracheal aspirate samples in severe COVID-19 patients under mechanical ventilation between 20 February 2020 and 21 September 2020 in Mazandaran Heart Center Hospital, Iran. Outcomes were compared between ICU patients with confirmed SARS-CoV-2 (corona group) and those who suffer from other disease (non-corona group). Out of 38 subjects who met the diagnostic criteria for ventilator-associated pneumonia (VAP) in ICU, 22 and 16 patients in corona and non-corona groups, respectively, were enrolled in the study. Hospital length of stay in 27% of case in corona group was > 10 days. Also, SOFA score was > 10 in 64% and 25% of corona and non-corona groups, respectively (P < 0.05). Moreover, the number of death was significantly higher among corona patients (45%) than non-corona group (6%) in ICU (P < 0.05). Acinetobacter spp. were the most common bacteria in nine corona patients (41%) that were 100% resistant to amikacin, gentamycin, cefixime, and imipenem antibiotics. The prevalence of antibiotic resistance among pathogens isolated from patients with COVID-19 under mechanical ventilation in ICU highlighted the importance of preventing coinfections caused by this pathogen, suggesting an essential standardized approach to antibiotic stewardship in patients with COVID-19 for successful treatment.
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de Macedo V, Dos Santos GDS, da Silva RN, Couto CNDM, Bastos C, Viecelli E, Mateus MDN, Graf ME, Gonçalves RB, da Silva MA, Bernardini PDB, Grando RSP, Boaventura VP, Pereira HSR, Levin AS. The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19. Clinics (Sao Paulo) 2022; 77:100130. [PMID: 36283138 PMCID: PMC9576217 DOI: 10.1016/j.clinsp.2022.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). METHODS This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. RESULTS Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). CONCLUSIONS Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.
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Affiliation(s)
- Viviane de Macedo
- Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, PR, Brazil; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | - Camila Bastos
- Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil
| | - Eloize Viecelli
- Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil
| | | | - Maria Esther Graf
- Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil
| | | | | | | | | | | | | | - Anna S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Kumar S, Choudhary R, Pandey VP. "MuCovid-21" study: Mucormycosis at an Indian tertiary care centre during the COVID-19 pandemic. J R Coll Physicians Edinb 2021; 51:352-358. [PMID: 34882132 DOI: 10.4997/jrcpe.2021.407] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis has been reported in several Indian states with the second wave of COVID-19 from January 2021 onwards. This prospective study was conducted with the objective of defining the contribution or association of various known and many suspected factors in the incidence of this disease during the ongoing pandemic. METHOD The study included 464 adults with mucormycosis. Basic demographic data were collected. Patient history of COVID infection, its severity, duration of treatment, and oxygen use was taken to assess the association. History of use of antibiotics, steroids, antivirals, biologicals, and other complementary treatments was sought. History of diabetes and other comorbidities was noted. Patients were investigated for mucor confirmation using a nasal swab KOH mount, nasal endoscopy with biopsy, and radiological investigations were done to assess the extent. RESULTS Out of 464 patients, 175 were known diabetics, and 157 were treated with steroids during COVID infection. Out of 287 post-COVID patients, 125 (44%) had rhino-mucormycosis (RM), 102 (35%) had rhino-oculo-mucormycosis (ROM) and 60 (21%) had rhino-oculo-cerebral-mucormycosis (ROCM). 162 did not have a history of COVID, of which 93 (57%) had RM, 48 (30%) had ROM and 21 (13%) had ROCM. CONCLUSION This study has showed that COVID was not the only factor contributing to mucor, rather other factors such as diabetes, steroid use etc. were also contributory. Many patients who were suffering from mucormycosis did not have a history of COVID. Advanced age, ROCM, and ICU admission were associated with increased mortality.
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Affiliation(s)
- Sumeet Kumar
- Department of Medicine, Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India,
| | - Rupal Choudhary
- Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao and associated Group of Hospitals, Indore, Madhya Pradesh, India
| | - Ved Prakash Pandey
- Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao and associated Group of Hospitals, Indore, Madhya Pradesh, India
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Alfonso-Sanchez JL, Agurto-Ramirez A, Chong-Valbuena MA, De-Jesús-María I, Julián-Paches P, López-Cerrillo L, Piedrahita-Valdés H, Giménez-Azagra M, Martín-Moreno JM. The Influence of Infection and Colonization on Outcomes in Inpatients With COVID-19: Are We Forgetting Something? Front Public Health 2021; 9:747791. [PMID: 34869165 PMCID: PMC8632619 DOI: 10.3389/fpubh.2021.747791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 epidemic has been a great challenge to health systems and especially hospitals. A prospective observational epidemiological study was planned as of February 26, 2020 in a tertiary hospital in the Valencia region. The total number of patients followed up with complete information during the first year was 2,448. Among other variables, the comorbidities of the patients were collected (and grouped in the Charson index), the stay in the intensive care unit (ICU), the co-infections, and the colonizations. Data on nosocomial infections due to said virus were also collected. The median days from the onset of symptoms to diagnosis were 4 + 4.6, while an additional 4.4 days had to pass for the patients to be admitted to the ICU. The factors associated with a higher risk of death were those with coinfection, especially with Candida auris [odds ratio (OR): 4.6], a situation that also occurred in the ICU (OR: 3.18). Charlson Index comorbidity and C. auris colonization were also very important both in general hospitalization and in the ICU.
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Affiliation(s)
- Jose Luis Alfonso-Sanchez
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain.,Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
| | - Adriana Agurto-Ramirez
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - María A Chong-Valbuena
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - Isabel De-Jesús-María
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - Paula Julián-Paches
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis López-Cerrillo
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Martina Giménez-Azagra
- Preventive Medicine Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - José María Martín-Moreno
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain.,Biomedical Research Institute INCLIVA, Hospital Clinico Universitario de Valencia, Valencia, Spain
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Aljuhani O, Al Sulaiman K, Alshabasy A, Eljaaly K, Al Shaya AI, Noureldeen H, Aboudeif M, Al Dosari B, Alkhalaf A, Korayem GB, Aleissa MM, Badreldin HA, Al Harbi S, Alhammad A, Vishwakarma R. Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study. BMC Infect Dis 2021; 21:1127. [PMID: 34724920 PMCID: PMC8559694 DOI: 10.1186/s12879-021-06813-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits the IL-6 receptor. Several randomized clinical trials have evaluated its safety and efficacy in patients with coronavirus disease 2019 (COVID-19), and these studies demonstrate conflicting results. Our study aimed to determine the association between tocilizumab treatment and microbial isolation and emergence of multidrug-resistant bacteria in critically ill patients with COVID-19. METHODS A multicenter retrospective cohort study was conducted at two tertiary government hospitals in Saudi Arabia. All critically ill patients admitted to intensive care units with a positive COVID-19 PCR test between March 1 and December 31, 2020, who met study criteria were included. Patients who received tocilizumab were compared to those who did not receive it. RESULTS A total of 738 patients who met our inclusion criteria were included in the analysis. Of these, 262 (35.5%) received tocilizumab, and 476 (64.5%) were included in the control group. Patients who received tocilizumab had higher odds for microbial isolation (OR 1.34; 95% CI 0.91-1.94, p = 0.13); however, the difference was not statistically significant. Development of resistant organisms (OR 1.00; 95% CI 0.51-1.98, p = 0.99) or detection of carbapenem-resistant Enterobacteriaceae (CRE) (OR 0.67; 95% CI 0.29-1.54, p = 0.34) was not statistically significant between the two groups. CONCLUSIONS Tocilizumab use in critically ill patients with COVID-19 is not associated with higher microbial isolation, the emergence of resistant organisms, or the detection of CRE organisms.
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Affiliation(s)
- Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P. O. Box 80260, Jeddah, 21589, Saudi Arabia.
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Adel Alshabasy
- Department of Anesthesia and Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P. O. Box 80260, Jeddah, 21589, Saudi Arabia
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Abdulrahman I Al Shaya
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Haytham Noureldeen
- Department of Anesthesia and Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
| | - Mohammed Aboudeif
- Department of Anesthesia and Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bodoor Al Dosari
- Pharmaceutical Care Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Amina Alkhalaf
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P. O. Box 80260, Jeddah, 21589, Saudi Arabia
| | - Ghazwa B Korayem
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Muneera M Aleissa
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Brigham and Women's Hospital, Boston, MA, USA
| | - Hisham A Badreldin
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shmeylan Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ramesh Vishwakarma
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Rizk NA, Moghnieh R, Haddad N, Rebeiz MC, Zeenny RM, Hindy JR, Orlando G, Kanj SS. Challenges to Antimicrobial Stewardship in the Countries of the Arab League: Concerns of Worsening Resistance during the COVID-19 Pandemic and Proposed Solutions. Antibiotics (Basel) 2021; 10:antibiotics10111320. [PMID: 34827257 PMCID: PMC8614706 DOI: 10.3390/antibiotics10111320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic is expected to worsen the global problem of antimicrobial resistance (AMR). There is a heightened interest in understanding this effect and to develop antimicrobial stewardship (AMS) interventions accordingly to curb this threat. Our paper aims to evaluate the potential magnitude of COVID-19 on AMR and AMS with a focus on the countries of the Arab league, given the social, political, and economic environments. We also evaluate obstacles in applying the rational use of antibiotics, monitoring resistance trends in the midst of the pandemic, and evaluating the impact of the economic crisis in some countries. We aim to raise awareness about the potential effects of antibiotic overuse during the pandemic and to propose practical approaches to tackle this issue.
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Affiliation(s)
- Nesrine A. Rizk
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut P.O. Box 11-6301, Lebanon;
| | - Nisrine Haddad
- Pharmacy Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (R.M.Z.)
| | - Marie-Claire Rebeiz
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Rony M. Zeenny
- Pharmacy Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (R.M.Z.)
| | - Joya-Rita Hindy
- Division of Infectious Diseases, Internal Medicine Department, Mayo Clinic, Rochester, MN 55902, USA;
| | - Gabriella Orlando
- Infectious Disease Clinic, Policlinico University Hospital, 41122 Modena, Italy;
| | - Souha S. Kanj
- Division of Infectious Diseases, Internal Medicine Department, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
- Correspondence:
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Son HJ, Kim T, Lee E, Park SY, Yu S, Hong HL, Kim MC, Hong SI, Bae S, Kim MJ, Kim SH, Yun JH, Jo KM, Lee YM, Lee S, Park JW, Jeon MH, Kim TH, Choo EJ. Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study. Am J Infect Control 2021; 49:1256-1261. [PMID: 34146624 PMCID: PMC8251653 DOI: 10.1016/j.ajic.2021.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
Objectives Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment. Methods All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated. Results Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P = .001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P = .004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P = .048) were associated with MDRO isolation. Conclusions MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.
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Affiliation(s)
- Hyo-Ju Son
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Shinae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Min-Chul Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Sun In Hong
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hyun Yun
- Department of Infectious Diseases, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Kyeong Min Jo
- Division of Infectious Disease, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yu-Mi Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seungjae Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Wan Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
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Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study. BMC Infect Dis 2021; 21:933. [PMID: 34496787 PMCID: PMC8424166 DOI: 10.1186/s12879-021-06647-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients. Methods This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs. Results Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs. Conclusion We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.
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High Prevalence of Antibiotic Resistance among Opportunistic Pathogens Isolated from Patients with COVID-19 under Mechanical Ventilation: Results of a Single-Center Study. Antibiotics (Basel) 2021; 10:antibiotics10091080. [PMID: 34572662 PMCID: PMC8467890 DOI: 10.3390/antibiotics10091080] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 01/17/2023] Open
Abstract
The effect of the COVID-19 pandemic on antibiotic resistance diffusion in healthcare settings has not been fully investigated. In this study we evaluated the prevalence of antibiotic resistance among opportunistic pathogens isolated from patients with COVID-19 under mechanical ventilation. An observational, retrospective, analysis was performed on confirmed cases of COVID-19 patients who were admitted to the ICU department of San Salvatore Hospital in Pesaro, Italy, from 1 February 2021 to 31 May 2021. We considered all consecutive patients aged ≥ 18, under mechanical ventilation for longer than 24 h. Eighty-nine patients, 66 (74.1%) men and 23 (25.9%) women, with a median age of 67.1 years, were recruited. Sixty-eight patients (76.4%) had at least one infection, and 11 patients (12.3%) were colonized, while in the remaining 10 patients (11.2%) neither colonization nor infection occurred. In total, 173 microorganisms were isolated. There were 73 isolates (42.2%) causing bacterial or fungal infections while the remaining 100 isolates (57.8%) were colonizers. Among Gram-negative bacteria, E. coli, A. baumannii and K. pneumoniae were the most common species. Among Gram-positive bacteria, S. aureus and E. faecalis were the most common species. Overall, there were 58/105 (55.2%) and 22/59 (37.2%) MDR isolates among Gram-negative and Gram-positive bacteria, respectively. The prevalence of an MDR microorganism was significantly higher in those patients who had been exposed to empiric antibiotic treatment before ICU admission. In conclusion, we found a high prevalence of antibiotic resistance among opportunistic pathogens isolated from patients with COVID-19 under mechanical ventilation.
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Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19. Microorganisms 2021; 9:microorganisms9081773. [PMID: 34442852 PMCID: PMC8402127 DOI: 10.3390/microorganisms9081773] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.
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Effectors of the Stenotrophomonas maltophilia Type IV Secretion System Mediate Killing of Clinical Isolates of Pseudomonas aeruginosa. mBio 2021; 12:e0150221. [PMID: 34182776 PMCID: PMC8262851 DOI: 10.1128/mbio.01502-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Previously, we documented that Stenotrophomonas maltophilia encodes a type IV secretion system (T4SS) that allows the organism to kill, in contact-dependent fashion, heterologous bacteria, including wild-type Pseudomonas aeruginosa. Bioinformatic screens based largely on the presence of both a C-terminal consensus sequence and an adjacent gene encoding a cognate immunity protein identified 13 potential antibacterial effectors, most of which were highly conserved among sequenced strains of S. maltophilia. The immunity proteins of two of these proved especially capable of protecting P. aeruginosa and Escherichia coli against attack from the Stenotrophomonas T4SS. In turn, S. maltophilia mutants lacking the putative effectors RS14245 and RS14255 were impaired for killing not only laboratory E. coli but clinical isolates of P. aeruginosa, including ones isolated from the lungs of cystic fibrosis patients. That complemented mutants behaved as wild type did confirmed that RS14245 and RS14255 are required for the bactericidal activity of the S. maltophilia T4SS. Moreover, a mutant lacking both of these proteins was as impaired as a mutant lacking the T4SS apparatus, indicating that RS14245 and RS14255 account for (nearly) all of the bactericidal effects seen. Utilizing an interbacterial protein translocation assay, we determined that RS14245 and RS14255 are bona fide substrates of the T4SS, a result confirmed by examination of mutants lacking both the T4SS and the individual effectors. Delivery of the cloned 14245 protein (alone) into the periplasm resulted in the killing of target bacteria, indicating that this effector, a putative lipase, is both necessary and sufficient for bactericidal activity.
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Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, Savio J, Sethuraman N, Madan S, Shastri P, Thangaraju D, Marak R, Tadepalli K, Savaj P, Sunavala A, Gupta N, Singhal T, Muthu V, Chakrabarti A. Multicenter Epidemiologic Study of Coronavirus Disease-Associated Mucormycosis, India. Emerg Infect Dis 2021; 27:2349-2359. [PMID: 34087089 PMCID: PMC8386807 DOI: 10.3201/eid2709.210934] [Citation(s) in RCA: 269] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
During September-December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)-associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September-December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.
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Mędrzycka-Dąbrowska W, Lange S, Zorena K, Dąbrowski S, Ozga D, Tomaszek L. Carbapenem-Resistant Klebsiella pneumoniae Infections in ICU COVID-19 Patients-A Scoping Review. J Clin Med 2021; 10:jcm10102067. [PMID: 34066031 PMCID: PMC8150615 DOI: 10.3390/jcm10102067] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: The spread of multidrug-resistant pathogens is a serious problem and challenge for the whole medical community. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in immunocompromised patients have a severe course and may be fatal. Increasingly, these bacteria are exhibiting resistance to carbapenem antibiotics, which have been used as so-called drugs of last resort. The emergence of the new coronavirus and the pandemic that it has caused require changes to protect against the spread of the new SARS-CoV-2. These changes paradoxically may contribute to the spread of other infections. Methods: PubMed, Cochrane Library databases were searched using relevant keywords. A literature review of carbapenem-resistant Klebsiella pneumoniae infection in patients hospitalized for COVID-19 was conducted according to PRISMA recommendations. A written review protocol was not prepared. Results: 1016 studies in scientific databases were searched. After rejecting duplicate studies, 964 results were obtained. Inclusion and exclusion criteria were then applied, and studies were qualitatively analyzed. Finally, 11 studies were included in the review. The results of infected patients were from six countries. The prevalence of CRKP in Covid-19 patients ranged from 0.35–53%. The majority of CRKP infected patients were male (85%), with a mean age of 61 years. Among isolates, the predominant genes were KPC, OXY-48, CTX-M, TEM, NDM and SHV. Conclusion: The results presented in our review indicate the necessity of paying attention to carbapenem-resistant Klebsiella pneumoniae infections in patients with COVID-19. In order to prevent the increase of bacterial resistance, rational antibiotic therapy should be used, as well as continuous control and surveillance of hospital infections caused by multidrug-resistant organisms.
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Affiliation(s)
- Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
- Correspondence:
| | - Sandra Lange
- Department of Anesthesiology and Intensive Care, Hospitals Tczewskie SA, 30 Stycznia 57, 83-110 Tczew, Poland;
| | - Katarzyna Zorena
- Department of Immunobiology and Environment Microbiology, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Sebastian Dąbrowski
- Departament of Medical Rescue, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland;
| | - Dorota Ozga
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, St. Warzywna1A, 35-310 Rzeszow, Poland;
| | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Kraków Academy of Andrzej Frycz Modrzewski, St. Gustawa Herlinga-Grudzińskiego 1, 30-705 Kraków, Poland;
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Abstract
The current frequency of COVID-19 in a pandemic era ensures that co-infections with a variety of co-pathogens will occur. Generally, there is a low rate of bonafide co-infections in early COVID-19 pulmonary infection as currently appreciated. Reports of high co-infection rates must be tempered by limitations in current diagnostic methods since amplification technologies do not necessarily confirm live pathogen and may be subject to considerable laboratory variation. Some laboratory methods may not exclude commensal microbes. Concurrent serodiagnoses have long been of concern for accuracy in these contexts. Presumed virus co-infections are not specific to COVID-19. The association of influenza viruses and SARS-CoV-2 in co-infection has been considerably variable during influenza season. Other respiratory virus co-infections have generally occurred in less than 10% of COVID-19 patients. Early COVID-19 disease is more commonly associated with bacterial co-pathogens that typically represent usual respiratory micro-organisms. Late infections, especially among severe clinical presentations, are more likely to be associated with nosocomial or opportunistic pathogens given the influence of treatments that can include antibiotics, antivirals, immunomodulating agents, blood products, immunotherapy, steroids, and invasive procedures. As anticipated, hospital care carries risk for multi-resistant bacteria. Overall, co-pathogen identification is linked with longer hospital stay, greater patient complexity, and adverse outcomes. As for other viral infections, a general reduction in the use of empiric antibiotic treatment is warranted. Further insight into co-infections with COVID-19 will contribute overall to effective antimicrobial therapies and disease control.
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Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada.,Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Vancouver, B.C. V6H3V4 Canada
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Medhi B, Bhattacharyya A, Sarma P, Kaur H, Kumar S, Bhattacharyya J, Prajapat M, Prakash A, Sharma S, Reddy D, Thota P, Bansal S, Gautam B. COVID-19–associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis. Indian J Pharmacol 2021; 53:499-510. [PMID: 34975140 PMCID: PMC8764981 DOI: 10.4103/ijp.ijp_839_21] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: Till now, no meta-analysis is available to address the clinical profile, risk factors, different interventions, and outcomes among COVID-19–associated rhino-orbito-cerebral mucormycosis (C-ROCM) cases. MATERIALS AND METHODS: Eight literature databases were screened using appropriate keywords from November 1, 2019, to June 30, 2021. The objectives were to analyze the clinical and microbiological profile, risk factor/comorbidity, intervention, and outcome. “R-metafor package” was used for analysis. RESULTS: A total of 23 studies were included. The mean age of presentation of C-ROCM was 54.6 years. The most common presentation was ptosis (72.7%), lid edema (60.6%), proptosis (60.6%), ophthalmoplegia (57.3%), loss of vision (53.7%), facial edema (34.7%), and nasal-blockage (11.8%). Evidence of intracranial spread was seen in 42.8% of cases. Rhizopus was the most common fungus (57.1%) isolated in fungal culture. Among C-ROCM patients, diabetes was the commonest comorbid condition, and the use of corticosteroids related to COVID-19 treatment was the most common risk factor (85.75%). Compared to controlled diabetics, C-ROCM was significantly higher among uncontrolled diabetics (odds ratio [OR] 0.15, 95% confidence interval [C.I.] 0.041–0.544, P = 0.0010). However, no significant association was seen between C-ROCM and COVID-19 severity (OR 0.930, 95% C.I. 0.212–4.087, P = 0.923). For treatment, amphotericin-B was the most common antifungal drug used which was followed by surgical options. However, mortality was high (prevalence 0.344, 95% C.I. 0.205–0.403) despite treatment. CONCLUSION: Although local rhino-orbito symptoms were the first to appear, rapid intracranial extension was seen in a significant number of C-ROCM cases. Uncontrolled diabetes and excessive use of corticosteroid were the most common risk factors present among the C-ROCM cases. High index clinical suspicion is imperative (specifically among COVID-19 patients with diabetes), and routine screening may be helpful.
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