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Kaye KS, Engemann JJ, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2004; 18:467-511, viii. [PMID: 15308273 DOI: 10.1016/j.idc.2004.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens and resistance traits in nursing homes, the community, as well as in hospitals. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Keith S Kaye
- Department of Medicine, Duke University Medical Center, Box 3152, Durham, NC 27710, USA.
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2
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Rutala WA, Weber DJ. Registration of disinfectants based on relative microbicidal activity. Infect Control Hosp Epidemiol 2004; 25:333-41. [PMID: 15108732 DOI: 10.1086/502401] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- William A Rutala
- Division of Infectious Disease, University of North Carolina (UNC) School of Medicine, Department of Hospital Epidemiology, MPH, CB #7030 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7030, USA
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3
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Paradisi F, Corti G, Cinelli R. Streptococcus pneumoniae as an agent of nosocomial infection: treatment in the era of penicillin-resistant strains. Clin Microbiol Infect 2002; 7 Suppl 4:34-42. [PMID: 11688532 DOI: 10.1046/j.1469-0691.2001.00056.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Streptococcus pneumoniae is a well-known agent of community-acquired infections such as sinusitis, otitis media, pneumonia, bacterial meningitis, bacteremia and acute exacerbations of chronic bronchitis. However, the role of S. pneumoniae as a cause of nosocomial infections of respiratory tract, bloodstream and central nervous system is more and more recognized, primarily in high-risk patients with depression of their immune function. Therapy of pneumococcal infections is made difficult by the emergence and spread of bacterial resistance to penicillin and other beta-lactams as well as to a number of antimicrobials such as macrolides, chloramphenicol, tetracyclines and sulfonamides. This epidemiological situation is a cause for concern world-wide, but it primarily affects some European countries, North America, South Africa and the Far East. The main consequence on therapeutic grounds is that in severe infections such as bacterial meningitis, the addition of vancomycin to a third-generation cephalosporin is advisable while awaiting laboratory test results, even in areas with low prevalence of penicillin-resistant pneumococci. However, a beta-lactam agent can also be a valid choice in the presence of potentially lethal infections such as pneumonia or in the case of penicillin intermediately resistant isolates. In recent years, new alternative molecules have been introduced into clinical practice for therapy of infections caused by penicillin-resistant pneumococci. In both in vivo and in vitro studies, drugs of the classes of fluoroquinolones (levofloxacin, moxifloxacin, gatifloxacin), streptogramins (quinupristin/dalfopristin) and oxazolidinones (linezolid) have shown good microbiologic and clinical efficacy against penicillin-resistant pneumococci. In this era of world-wide spread of penicillin-resistant pneumococci, use of polysaccaride or conjugated vaccines is highly recommended.
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Affiliation(s)
- F Paradisi
- Infectious Disease Unit, University of Florence School of Medicine, Italy
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Ruiz J, Simarro E, Gómez J. [Resistance and therapy of Streptococcus pneumoniae]. Enferm Infecc Microbiol Clin 2001; 19:191-5. [PMID: 11333616 DOI: 10.1016/s0213-005x(01)72610-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Ruiz
- Servicios de Microbiología, Hospital Virgen de la Arrixaca, Murcia.
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5
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Gotfried M, Freeman C. An update on community-acquired pneumonia in adults. COMPREHENSIVE THERAPY 2001; 26:283-93. [PMID: 11126100 DOI: 10.1007/s12019-000-0031-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality, despite effective therapies. Guidelines for CAP management vary widely in their approach. Resistance of S pneumoniae to penicillins and other antibiotics has prompted evaluation of the new fluoroquinolones.
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Affiliation(s)
- M Gotfried
- University of Arizona Medical College, USA
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McCormack JG. Penicillin use in pneumococcal disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000; 30:439-40. [PMID: 10985507 DOI: 10.1111/j.1445-5994.2000.tb02048.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perez Mato S, Bégué CR, English MR, Bégué RE. Drug-resistant Streptococcus pneumoniae spinal epidural abscess in a toddler. Pediatr Infect Dis J 2000; 19:664-6. [PMID: 10917231 DOI: 10.1097/00006454-200007000-00021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Perez Mato
- Department of Pediatrics, Louisiana State University School of Medicine and Children's Hospital, New Orleans, USA
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Kaye KS, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents. Epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2000; 14:293-319. [PMID: 10829257 DOI: 10.1016/s0891-5520(05)70249-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The emergence of resistance to antimicrobial agents continues to be a major problem in the nosocomial setting and now in nursing homes and the community as well. Bacteria use a variety of strategies to avoid the inhibitory effects of antibiotic agents and have evolved highly efficient means for the dissemination of resistance traits. Control of antibiotic-resistant pathogens provides a major challenge for both the medical community and society in general. To control the emergence of resistant pathogens, CDC and infection control guidelines must be adhered to, and antibiotics must be used more judiciously.
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Affiliation(s)
- K S Kaye
- Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Geographic Variation in Penicillin Resistance in Streptococcus pneumoniae: Selected Sites, United States, 1997. Ann Emerg Med 2000; 35:506-508. [DOI: 10.1067/mem.2000.106386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fiore AE, Moroney JF, Farley MM, Harrison LH, Patterson JE, Jorgensen JH, Cetron M, Kolczak MS, Breiman RF, Schuchat A. Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance. Clin Infect Dis 2000; 30:71-7. [PMID: 10619736 DOI: 10.1086/313606] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Limited data are available on clinical outcomes of meningitis due to cefotaxime-nonsusceptible Streptococcus pneumoniae. We analyzed data from 109 cases of pneumococcal meningitis in Atlanta, Baltimore, and San Antonio, which were identified through population-based active surveillance from November 1994 to April 1996. Pneumococcal isolates from 9% of the cases were resistant to cefotaxime, and isolates from 11% had intermediate susceptibility. Children were more likely to have cephalosporin-nonsusceptible pneumococcal meningitis, but mortality was significantly higher among adults aged 18-64 years. Vancomycin was given upon admission to 29% of patients, and within 48 h of admission to 52%. Nonsusceptibility to cefotaxime was not associated with the following outcomes: increased mortality, prolonged length of hospital or intensive care unit (ICU) stay, requirement of intubation or oxygen, ICU care, discharge to another medical or long-term-care facility, or neurological deficit. Empirical use of vancomycin, current prevalence of drug-resistant S. pneumoniae, and degree of nonsusceptibility to cefotaxime may have influenced these findings.
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Affiliation(s)
- A E Fiore
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Manfredi R, Calza L, Tadolini M, Chiodo F. Complicated pneumococcal meningitis as the presenting illness in a patient with HIV infection. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(00)87151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hudson BJ, Havryk A, Abel SJ, Fernandas CJ. Treatment of severe meningitis due to antibiotic‐resistant
Streptococcus pneumoniae. Med J Aust 1999. [DOI: 10.5694/j.1326-5377.1999.tb123738.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Simon J Abel
- Intensive Care UnitManly District HospitalSydney
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Gootz TD, Zaniewski RP, Haskell SL, Kaczmarek FS, Maurice AE. Activities of trovafloxacin compared with those of other fluoroquinolones against purified topoisomerases and gyrA and grlA mutants of Staphylococcus aureus. Antimicrob Agents Chemother 1999; 43:1845-55. [PMID: 10428901 PMCID: PMC89379 DOI: 10.1128/aac.43.8.1845] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Frequencies of mutation to resistance with trovafloxacin and four other quinolones were determined with quinolone-susceptible Staphylococcus aureus RN4220 by a direct plating method. First-step mutants were selected less frequently with trovafloxacin (1.1 x 10(-10) at 2 to 4x the MIC) than with levofloxacin or ciprofloxacin (3.0 x 10(-7) to 3.0 x 10(-8) at 2 to 4x the MIC). Mutants with a change in GrlA (Ser80-->Phe or Tyr) were most commonly selected with trovafloxacin, ciprofloxacin, levofloxacin, or pefloxacin. First-step mutants were difficult to select with sparfloxacin; however, second-step mutants with mutations in gyrA were easily selected when a preexisting mutation in grlA was present. Against 29 S. aureus clinical isolates with known mutations in gyrA and/or grlA, trovafloxacin was the most active quinolone tested (MIC at which 50% of isolates are inhibited [MIC(50)] and MIC(90), 1 and 4 microg/ml, respectively); in comparison, MIC(50)s and MIC(90)s were 32 and 128, 16 and 32, 8 and 32, and 128 and 256 microg/ml for ciprofloxacin, sparfloxacin, levofloxacin, and pefloxacin, respectively. Strains with a mutation in grlA only were generally susceptible to all of the quinolones tested. For mutants with changes in both grlA and gyrA MICs were higher and were generally above the susceptibility breakpoint for ciprofloxacin, sparfloxacin, levofloxacin, and pefloxacin. Addition of reserpine (20 microg/ml) lowered the MICs only of ciprofloxacin fourfold or more for 18 of 29 clinical strains. Topoisomerase IV and DNA gyrase genes were cloned from S. aureus RN4220 and from two mutants with changes in GrlA (Ser80-->Phe and Glu84-->Lys). The enzymes were overexpressed in Escherichia coli GI724, purified, and used in DNA catalytic and cleavage assays that measured the relative potency of each quinolone. Trovafloxacin was at least five times more potent than ciprofloxacin, sparfloxacin, levofloxacin, or pefloxacin in stimulating topoisomerase IV-mediated DNA cleavage. While all of the quinolones were less potent in cleavage assays with the altered topoisomerase IV, trovafloxacin retained its greater potency relative to those of the other quinolones tested. The greater intrinsic potency of trovafloxacin against the lethal topoisomerase IV target in S. aureus contributes to its improved potency against clinical strains of S. aureus that are resistant to other quinolones.
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Affiliation(s)
- T D Gootz
- Central Research Division, Pfizer, Inc., Groton, Connecticut 06340, USA.
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Abstract
Increasingly, Streptococcus pneumoniae with reduced susceptibility to penicillin is becoming a healthcare concern, not only because of the high prevalence of infections caused by this pathogen but also because of the rate at which resistance has progressed. The incidence of penicillin resistance in strains of S. pneumoniae approaches 40% in some areas of the United States, and the incidence of high-level resistance has increased by 60-fold during the past 10 years. With the exception of meningitis and otitis media, there is no conclusive evidence that the acquisition of resistance by S. pneumoniae to beta-lactam antibiotics incurs greater morbidity and mortality in infections caused by this pathogen. However, if the current trends of resistance patterns continue, one can expect the morbidity and mortality to increase. The mechanism of beta-lactam resistance of S. pneumoniae involves genetic mutations which alter penicillin-binding protein structure, resulting in a decreased affinity for all beta-lactam antibiotics. In the treatment of infections caused by S. pneumoniae, it should not be assumed that nonsusceptibility to beta-lactam antibiotics correlates with clinical ineffectiveness of these agents. On the contrary, the recommended therapy for nonmeningeal pneumococcal infections (e.g., pneumonia, sepsis, acute otitis media) includes a beta-lactam antibiotic: penicillin G, amoxicillin, amoxicillin/clavulanate, cefuroxime, cefotaxime, or ceftriaxone. Recommended therapy for meningitis is cefotaxime or ceftriaxone, with the addition of vancomycin until susceptibility is known. These agents are recommended because of their ability to achieve serum/tissue concentrations greater than the minimum inhibitory concentrations (MICs) of these agents against penicillin-susceptible, penicillin-intermediate, and most penicillin-resistant strains (e.g., penicillin G, cefotaxime, ceftriaxone, amoxicillin, amoxicillin/clavulanate, and cefuroxime), or their ability to provide adequate concentrations in cerebrospinal fluid (e.g., cefotaxime, ceftriaxone).
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Affiliation(s)
- M R Jacobs
- Department of Pathology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Ohio 44106, USA
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Abstract
Pneumococcal pneumonia accounts for about one-sixth to two-thirds of all cases of community-acquired pneumonia. Its high frequency of occurrence worldwide and the high number of deaths associated with it--especially with bacteremic (invasive) disease--mark its importance. Invasive disease is associated with case-fatality rates of 15% to 25% among elderly adults. Penicillin-resistant Streptococcus pneumoniae (PRSP) first appeared in the 1970s, and its increased incidence in the late 1980s signaled its emerging importance. In individual patients in whom PRSP infection is suspected, the clinician must follow guidelines for empiric antibiotic therapy for community-acquired pneumonia until microbiological test results are known. When a diagnosis of pneumococcal pneumonia is established, the clinician should change to a regimen that targets the pneumococcus. Adults at highest risk for death from pneumococcal pneumonia include immunocompetent persons with underlying chronic diseases, immunocompromised persons, elderly persons, and unvaccinated residents of nursing homes and other chronic care facilities. Safe and effective, polyvalent polysaccharide pneumococcal vaccine should be used in persons 2 years of age and older who are at increased risk for serious pneumococcal pneumonia and in all persons 65 years of age and older.
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Affiliation(s)
- MA Mufson
- Department of Medicine, Marshall University School of Medicine, 1600 Medical Center Drive, Suite G500, Huntington, WV 25701-3655, USA
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Lark RL, Chenoweth C. Antimicrobial resistance in community-acquired respiratory tract pathogens. COMPREHENSIVE THERAPY 1999; 25:20-9. [PMID: 9987589 DOI: 10.1007/bf02889831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Antimicrobial resistance among common respiratory pathogens has become a significant problem. However, there remain multiple treatment options, including the newer macrolides, third-generation cephalosporins, beta-lactam/beta-lactamase inhibitor antibiotics, and the newer fluoroquinolones.
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Affiliation(s)
- R L Lark
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA
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Resistências aos Antibióticos em Pneumologia. REVISTA PORTUGUESA DE PNEUMOLOGIA 1999. [DOI: 10.1016/s0873-2159(15)30949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Spach DH, Black D. Antibiotic resistance in community-acquired respiratory tract infections: current issues. Ann Allergy Asthma Immunol 1998; 81:293-302; quiz 302-3. [PMID: 9809491 DOI: 10.1016/s1081-1206(10)63121-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In recent years, antibiotic resistance has emerged as an important global problem. The major goal of this review is to update important issues pertaining to antibiotic resistance, with an emphasis on antibiotic resistance involving community-acquired respiratory pathogens. In addition, this review examines potential reasons why antibiotic resistance has increased in recent years, how clinicians can better understand commonly used laboratory antibiotic resistance tests, and possible solutions to the increasing problem of antibiotic resistance. The article emphasizes the diagnosis, therapy, and prevention of antibiotic-resistant infections. DATA SOURCES We identified relevant English-language articles through MEDLINE search (1966 to March 1998). All articles related to antibiotic resistance and the scope of the articles included original investigative articles, reviews, letters, and editorials. In addition, we selected additional references from the bibliographies of the identified articles. STUDY SELECTION We selected articles for detailed review if they provided direct insight into the cause of antibiotic resistance, testing for antibiotic resistance, or the treatment of antibiotic resistance. Most, but not all, of the articles selected pertained to antibiotic resistance and respiratory tract infections. We performed a detailed review on approximately 40% of the originally selected articles. RESULTS Multiple factors that play a significant role in the development of antibiotic resistance include the overuse of antibiotics in both humans and animals, situations such as day care that enhance transmission via frequent close personal contact, and widespread dissemination of resistant strains via global travel. Most respiratory pathogens have developed resistance to commonly used antibiotics either by producing beta-lactamase or by altering binding site proteins. CONCLUSIONS In many regions of the United States, the level of antibiotic resistance has impacted the clinical management of common respiratory pathogens. Future efforts to curtail antibiotic resistance will require a concerted effort in multiple areas, particularly enhanced epidemiologic surveillance to better detect resistance trends, judicious use of antibiotics, and new drug development.
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Affiliation(s)
- D H Spach
- Division of Infectious Diseases, University of Washington, Seattle, USA
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