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Perković Vukčević N, Mijatović Jovin V, Vuković Ercegović G, Antunović M, Kelečević I, Živanović D, Vučinić S. Carbapenems as Antidotes for the Management of Acute Valproic Acid Poisoning. Pharmaceuticals (Basel) 2024; 17:257. [PMID: 38399472 PMCID: PMC10893297 DOI: 10.3390/ph17020257] [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: 12/04/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Valproic acid (VPA) is a broad-spectrum drug primarily used in the treatment of epilepsy and bipolar disorder. It is not an uncommon occurrence for VPA to cause intoxication. The established treatment of VPA poisoning includes supportive care, multiple doses of activated charcoal, levocarnitine and hemodialysis/hemoperfusion. There is a clinically significant interaction between carbapenem antibiotics and VPA. By affecting enterohepatic recirculation, carbapenems can increase the overall VPA clearance from the blood of intoxicated patients. It is suggested that carbapenems could successfully be used as antidotes in the treatment of acute VPA poisonings. THE AIM To evaluate the effectiveness of carbapenems in the treatment of patients acutely poisoned by VPA. PATIENTS AND METHODS This retrospective study included patients acutely poisoned by VPA and treated with carbapenems at the Department of Clinical Toxicology at the Military Medicinal Academy in Serbia for a two-year period. RESULTS After the admission, blood concentrations of VPA kept increasing, reaching their peak at 114-724 mg/L, while the mental state of the patients continued to decline, prompting a decision to introduce carbapenems. After the introduction of carbapenems, the concentrations of the drug dropped by 46-93.59% (average 72%) followed by rapid recovery of consciousness. Ten out of eleven patients had positive outcomes, while one patient died. The most commonly observed complication in our group of patients was bronchopneumonia. CONCLUSIONS The application of carbapenems for the management of acute VPA poisoning might be a useful and effective treatment option.
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Affiliation(s)
- Nataša Perković Vukčević
- National Poison Control Centre, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, 11042 Belgrade, Serbia
| | - Vesna Mijatović Jovin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Gordana Vuković Ercegović
- National Poison Control Centre, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, 11042 Belgrade, Serbia
| | - Marko Antunović
- National Poison Control Centre, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, 11042 Belgrade, Serbia
| | - Igor Kelečević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dejan Živanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Psychology, College of Social Work, 11000 Belgrade, Serbia
| | - Slavica Vučinić
- National Poison Control Centre, Military Medical Academy, 11000 Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, 11042 Belgrade, Serbia
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Tesfa T, Mitiku H, Edae M, Assefa N. Prevalence and incidence of carbapenem-resistant K. pneumoniae colonization: systematic review and meta-analysis. Syst Rev 2022; 11:240. [PMID: 36380387 PMCID: PMC9667607 DOI: 10.1186/s13643-022-02110-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a gram-negative rod belonging to the order Enterobacterales and having a wide distribution in the environment, including the human colon. Recently, the bacterium is one of the known problems in the healthcare setting as it has become resistant to last-resort drugs like carbapenems. The colonized person can serve as a reservoir for his/herself and others, especially in the healthcare setting leading to nosocomial and opportunistic infections. Therefore, we aimed to quantitatively estimate the rate of prevalence and incidence of colonization with carbapenem-resistant K. pneumoniae. METHODS A literature search was conducted on PubMed/MEDLINE, Google Scholar, Science Direct, Cochrane Library, WHO Index Medicus, and university databases. The study includes all published and unpublished papers that addressed the prevalence or incidence of K. pneumoniae colonization. Data were extracted onto format in Microsoft Excel and pooled estimates with a 95% confidence interval calculated using Der-Simonian-Laird random-effects model. With the use of I2 statistics and prediction intervals, the level of heterogeneity was displayed. Egger's tests and funnel plots of standard error were used to demonstrate the publication bias. RESULTS A total of 35 studies were included in the review and 32 records with 37,661 patients for assessment of prevalence, while ten studies with 3643 patients for incidence of colonization. The prevalence of carbapenem-resistant K. pneumoniae colonization varies by location and ranges from 0.13 to 22%, with a pooled prevalence of 5.43%. (3.73-7.42). Whereas the incidence of colonization ranges from 2 to 73% with a pooled incidence of 22.3% (CI 12.74-31.87), both prevalence and incidence reports are majorly from developed countries. There was a variation in the distribution of carbapenem resistance genes among colonizing isolates with KPC as a prominent gene reported from many studies and NDM being reported mainly by studies from Asian countries. A univariate meta-regression analysis indicated continent, patient type, study design, and admission ward do not affect the heterogeneity (p value>0.05). CONCLUSION The review revealed that colonization with K. pneumoniae is higher in a healthcare setting with variable distribution in different localities, and resistance genes for carbapenem drugs also have unstable distribution in different geographic areas.
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Affiliation(s)
- Tewodros Tesfa
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia.
| | - Habtamu Mitiku
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia
| | - Mekuria Edae
- Hiwot Fana Specialized University Hospital, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing Midwifery, College of Health and Medical Sciences, Haramaya University, P.O.Box 235, Harar, Ethiopia
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Nwafia IN, Ike AC, Orabueze IN, Nwafia WC. Carbapenemase producing Enterobacteriaceae: Environmental reservoirs as primary targets for control and prevention strategies. Niger Postgrad Med J 2022; 29:183-191. [PMID: 35900453 DOI: 10.4103/npmj.npmj_95_22] [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] [Indexed: 06/15/2023]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) have become one of the greatest public health challenges globally. In the past decade, antimicrobial resistance (AMR) was viewed as a clinical problem in many parts of the world; hence, the role and magnitude of the contribution of the environment were not well appreciated. This review article was done with online published articles extracted from different databases using search terms related to the work. Evidence has shown that there exists the presence of carbapenemase genes in the environment, consequently fuelling the dissemination with alarming consequences. CPE when acquired causes life-threatening infections in humans. The health and economic impact of these infections are numerous, including treatment failure due to limited therapeutic options which hamper the containment of infectious diseases, further contaminating the environment and worsening the public health challenge. It is a well-known fact that the rate of emergence of resistant genes has outpaced the production of new antimicrobial agents, so it is pertinent to institute effective environmental measures to combat the spread of AMR organisms before it will completely gain a foothold and take us back to 'the pre-antibiotic era'. Environmental sources and reservoirs of resistant genes should therefore be amongst the primary targets for the control and prevention of the spread of resistant genes in the environment. This calls for the effective implementation of the 'one health' strategy with stakeholders committed to the design and enforcement of environmental mitigation policies and guidelines.
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Affiliation(s)
- Ifeyinwa Nkeiruka Nwafia
- Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka; Department of Medical Microbiology, University of Nigeria Teaching Hospital Enugu, Enugu State, Nigeria
| | - Anthony Chibuogwu Ike
- Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Ibuchukwu Nkeonyenasoya Orabueze
- Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka; Department of Medical Microbiology, University of Nigeria Teaching Hospital Enugu, Enugu State, Nigeria
| | - Walter Chukwuma Nwafia
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
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Gatya Al-Mayahie SM, Al-Guranie DRT, Hussein AA, Bachai ZA. Prevalence of common carbapenemase genes and multidrug resistance among uropathogenic Escherichia coli phylogroup B2 isolates from outpatients in Wasit Province/ Iraq. PLoS One 2022; 17:e0262984. [PMID: 35077517 PMCID: PMC8789106 DOI: 10.1371/journal.pone.0262984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
Carbapenems are the last resort antimicrobials for the treatment of extended spectrum β-lactamases (ESBLs) producing Enterobacteriaceae. Emergence of carbapenems resistant group B2 uropathogenic E. coli (UPEC) is a major concern because of their high virulence. Prevalence of these enzymes and multidrug resistance (MDR) among B2 UPEC isolates from Iraqi outpatients with acute urinary tract infection (UTI) was evaluated in this research. Urine cultures were performed and the isolates were identified biochemically. Escherichia coli isolates were tested for phylogroup reference by quadraplex PCR, then B2 isolates were detected for antimicrobial resistance by disc diffusion test and carbapenemase genes by PCR. Escherichia coli was the most prevalent among Gram-negative isolates (66.6%) and B2 was the most detected phylogroup among E. coli isolates (33.9%). Most of B2 isolates showed high resistance rates to tested antimicrobials, especially β-lactams with MDR revealed in 100% of them. Whereas, low resistance rates were noted against carbapenems, aminoglycosides and nitrofurantoin. Carbapenemase genes were detected in 76.3% of B2 isolates. Of which, blaOXA-48 was the most frequent (57.8%), followed by blaPER (47.3%), blaKPC (15.7%), blaVEB and blaVIM (10.5%, for each). Whereas, blaGES and blaIMP genes were not found. Coproduction of these genes occurred among 17 isolates. The combination of blaOXA-48 and blaPER was the most frequent (41.1%). All carbapenemase producing isolates were MDR. These results revealed high prevalence of carbapenemase genes and MDR among B2 UPEC recovered in this study. In the study area. it is strongly advised to use aminoglycosides and nitrofurantoin for empirical treatment of UPEC.
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Affiliation(s)
| | | | - Aya Aziz Hussein
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
| | - Zaineb Ali Bachai
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
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Sahra S, Jahangir A, Hamadi R, Jahangir A, Glaser A. Clinical and Microbiologic Efficacy and Safety of Imipenem/Cilastatin/Relebactam in Complicated Infections: A Meta-analysis. Infect Chemother 2021; 53:271-283. [PMID: 34216121 PMCID: PMC8258290 DOI: 10.3947/ic.2021.0051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for Gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (HABP), and ventilator-associated bacterial pneumonia (VABP). MATERIALS AND METHODS We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. We included randomized clinical trials-with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A P-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I² statistic. RESULTS The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. CONCLUSION Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, HABP, VABP).
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Affiliation(s)
- Syeda Sahra
- Staten Island University Hospital, Staten Island, NY, USA.
| | | | | | | | - Allison Glaser
- Staten Island University Hospital, Staten Island, NY, USA
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Gulumbe BH, Ajibola O. Carbapenem Resistant Enterobacteriaceae in Africa. BORNEO JOURNAL OF PHARMACY 2020. [DOI: 10.33084/bjop.v3i2.1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbapenems are regarded as unique among the �-lactam antibiotics due to their broad spectrum of activity and ability to resist �-lactamase hydrolysis. Carbapenems are the only �-lactam antibiotics with efficacy in severe infections caused by extended-spectrum beta-lactamase (ESBL) producing bacteria. However, recent reports of carbapenem resistance particularly among members of Enterobacteriaceae that are responsible for diseases such as gastrointestinal infections, septicemia, pneumonia, meningitis, peritonitis as well as urinary tract infections, call for concerns. In Africa, the problem of carbapenem-resistant Enterobacteriaceae (CRE) is aggravated by factors such as the high rate of infections, poor diagnostic tools, sub-optimal disease surveillance, and abuse of antibiotics. Besides, the problem of CRE in Africa is understudied. This review distills available literature on the spread of CRE in Africa, CRE genes in circulation, and the need to pay attention to this emerging threat to lives in developing countries.
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Choi J, Baek J, Kweon D, Ko KS, Yoon H. Rapid determination of carbapenem resistance by low-cost colorimetric methods: Propidium Iodide and alamar blue staining. J Microbiol 2020; 58:415-421. [PMID: 32221821 DOI: 10.1007/s12275-020-9549-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 01/03/2023]
Abstract
Carbapenems are a class of β-lactam antibiotics with a broad antimicrobial activity spectrum. Owing to their sturdy structures resistant to most β-lactamases, they have been regarded as one of the last-resort antibiotics for combating multidrugresistant bacterial infections. However, the emergence of carbapenem resistance increases predominantly in nosocomial pathogens. To prevent spread of carbapenem resistance in early stages, it is imperative to develop rapid diagnostic tests that will substantially reduce the time and cost in determining carbapenem resistance. Thus, we devised a staining-based diagnostic method applicable to three different Gram-negative pathogens of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, all with the high potential to develop carbapenem resistance. Regardless of the resistance mechanisms presented by bacterial species and strains, double staining with propidium iodide (PI) and alamar blue (AB) identified resistant bacteria with an average sensitivity of 95.35%, 7 h after imipenem treatments in 343 clinical isolates. Among the three species tested, A. baumannii showed the highest diagnostic sensitivity of 98.46%. The PI and ABmediated staining method could be a promising diagnostic method with high-throughput efficacy and low cost.
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Affiliation(s)
- Jiyoon Choi
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Jiwon Baek
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea
| | - Daehyuk Kweon
- Department of Genetic Engineering and Center for Human Interface Nano Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Kwan Soo Ko
- Department of Molecular Cell Biology, Sungkyunkwan University, School of Medicine, Suwon, 16419, Republic of Korea.,Asia-Pacific Research Foundation for Infectious Diseases, Seoul, 06367, Republic of Korea
| | - Hyunjin Yoon
- Department of Molecular Science and Technology, Ajou University, Suwon, 16499, Republic of Korea. .,Department of Applied Chemistry and Biological Engineering, Ajou University, Suwon, 16499, Republic of Korea.
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Codjoe FS, Donkor ES. Carbapenem Resistance: A Review. Med Sci (Basel) 2017; 6:medsci6010001. [PMID: 29267233 PMCID: PMC5872158 DOI: 10.3390/medsci6010001] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Carbapenem resistance is a major and an on-going public health problem globally. It occurs mainly among Gram-negative pathogens such as Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, and may be intrinsic or mediated by transferable carbapenemase-encoding genes. This type of resistance genes are already widespread in certain parts of the world, particularly Europe, Asia and South America, while the situation in other places such as sub-Saharan Africa is not well documented. In this paper, we provide an in-depth review of carbapenem resistance providing up-to-date information on the subject.
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Affiliation(s)
- Francis S Codjoe
- Department of Medical Laboratory Sciences (Microbiology Division), School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
- Biomolecular Science Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK.
| | - Eric S Donkor
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
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Christophy R, Osman M, Mallat H, Achkar M, Ziedeh A, Moukaddem W, Dabboussi F, Hamze M. Prevalence, antibiotic susceptibility and characterization of antibiotic resistant genes among carbapenem-resistant Gram-negative bacilli and yeast in intestinal flora of cancer patients in North Lebanon. J Infect Public Health 2017; 10:716-720. [DOI: 10.1016/j.jiph.2016.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 08/08/2016] [Accepted: 10/01/2016] [Indexed: 11/28/2022] Open
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