1
|
August B, Matlob A, Kale-Pradhan PB. Sulbactam-Durlobactam in the Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections. Ann Pharmacother 2024; 58:735-741. [PMID: 37817550 DOI: 10.1177/10600280231204566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To review the pharmacology, efficacy, and safety of intravenous sulbactam-durlobactam (SUL-DUR) in the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections. DATA SOURCES PubMed databases and ClinicalTrials.gov were searched using the following terms: Sulbactam Durlobactam, ETX2514, Xacduro, Sulbactam-ETX2514, ETX2514SUL. STUDY SELECTION AND DATA EXTRACTION Articles published in English between January 1985 and September 13, 2023, related to pharmacology, safety, efficacy, and clinical trials were reviewed. DATA SYNTHESIS A phase II trial compared SUL-DUR with placebo with imipenem and cilastatin in both groups. Overall treatment success in the microbiological intention-to-treat analysis was reported in 76.6% of patients in the SUL-DUR group compared with 81% patients in the placebo group. A phase III trial compared SUL-DUR with colistin in adults with confirmed CRAB infections. Patients received either SUL-DUR or colistin and background therapy with imipenem-cilastatin. SUL-DUR was noninferior to colistin for 28-day all-cause mortality (19% vs 32.3%, treatment difference -13.2%; 95% CI [-30.0 to 3.5]). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Clinicians have limited options to treat CRAB infections. SUL-DUR has demonstrated efficacy against CRAB in patients with pneumonia and may be considered a viable treatment option. Nonetheless, potential impact of concomitant imipenem-cilastatin as background therapy on clinical trial findings is unclear. Further studies are needed to elucidate the role of SUL-DUR alone or in combination with other active antimicrobials for the treatment of CRAB infections. CONCLUSIONS SUL-DUR has shown to be predominantly noninferior to alternative antibiotics in the treatment of pneumonias caused by CRAB, making it a viable treatment option. Further postmarketing data is needed to ascertain its role in other infections.
Collapse
Affiliation(s)
- Benjamin August
- Department of Pharmacy Practice, Henry Ford Hospital, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Andrew Matlob
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Pramodini B Kale-Pradhan
- Department of Pharmacy Practice, Ascension St. John Hospital, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| |
Collapse
|
2
|
Abdul-Mutakabbir JC, Opoku NS, Tan KK, Jorth P, Nizet V, Fletcher HM, Kaye KS, Rybak MJ. Determining Susceptibility and Potential Mediators of Resistance for the Novel Polymyxin Derivative, SPR206, in Acinetobacter baumannii. Antibiotics (Basel) 2024; 13:47. [PMID: 38247606 PMCID: PMC10812597 DOI: 10.3390/antibiotics13010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
With the increase in carbapenem-resistant A. baumannii (CRAB) infections, there has been a resurgence in the use of polymyxins, specifically colistin (COL). Since the reintroduction of COL-based regimens in treating CRAB infections, several COL-resistant A. baumannii isolates have been identified, with the mechanism of resistance heavily linked with the loss of the lipopolysaccharide (LPS) layer of the bacterial outer membrane through mutations in lpxACD genes or the pmrCAB operon. SPR206, a novel polymyxin derivative, has exhibited robust activity against multidrug-resistant (MDR) A. baumannii. However, there is a dearth of knowledge regarding its efficacy in comparison with other A. baumannii-active therapeutics and whether traditional polymyxin (COL) mediators of A. baumannii resistance also translate to reduced SPR206 activity. Here, we conducted susceptibility testing using broth microdilution on 30 A. baumannii isolates (17 COL-resistant and 27 CRAB), selected 14 COL-resistant isolates for genomic sequencing analysis, and performed time-kill analyses on four COL-resistant isolates. In susceptibility testing, SPR206 demonstrated a lower range of minimum inhibitory concentrations (MICs) compared with COL, with a four-fold difference observed in MIC50 values. Mutations in lpxACD and/or pmrA and pmrB genes were detected in each of the 14 COL-resistant isolates; however, SPR206 maintained MICs ≤ 2 mg/L for 9/14 (64%) of the isolates. Finally, SPR206-based combination regimens exhibited increased synergistic and bactericidal activity compared with COL-based combination regimens irrespective of the multiple resistance genes detected. The results of this study highlight the potential utility of SPR206 in the treatment of COL-resistant A. baumannii infections.
Collapse
Affiliation(s)
- Jacinda C. Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA;
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, CA 92093, USA
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92374, USA; (N.S.O.); (H.M.F.)
| | - Nana Sakyi Opoku
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92374, USA; (N.S.O.); (H.M.F.)
| | - Karen K. Tan
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, CA 92374, USA;
| | - Peter Jorth
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Victor Nizet
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA;
| | - Hansel M. Fletcher
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92374, USA; (N.S.O.); (H.M.F.)
| | - Keith S. Kaye
- Department of Medicine, Rutgers University School of Medicine, New Brunswick, NJ 08854, USA;
| | - Michael J. Rybak
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA;
- Department of Medicine, Division of Infectious Diseases, Wayne State University, Detroit, MI 48201, USA
| |
Collapse
|
3
|
Thomsen J, Abdulrazzaq NM, AlRand H. Epidemiology and antimicrobial resistance trends of Acinetobacter species in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data. Front Public Health 2024; 11:1245131. [PMID: 38239785 PMCID: PMC10794577 DOI: 10.3389/fpubh.2023.1245131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Acinetobacter spp., in particular A. baumannii, are opportunistic pathogens linked to nosocomial pneumonia (particularly ventilator-associated pneumonia), central-line catheter-associated blood stream infections, meningitis, urinary tract infections, surgical-site infections, and other types of wound infections. A. baumannii is able to acquire or upregulate various resistance determinants, making it frequently multidrug-resistant, and contributing to increased mortality and morbidity. Data on the epidemiology, levels, and trends of antimicrobial resistance of Acinetobacter spp. in clinical settings is scarce in the Gulf Cooperation Council (GCC) and Middle East and North Africa (MENA) regions. Methods A retrospective 12-year analysis of 17,564 non-duplicate diagnostic Acinetobacter spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated at 317 surveillance sites by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET. Results Species belonging to the A. calcoaceticus-baumannii complex were mostly reported (86.7%). They were most commonly isolated from urine (32.9%), sputum (29.0%), and soft tissue (25.1%). Resistance trends to antibiotics from different classes during the surveillance period showed a decreasing trend. Specifically, there was a significant decrease in resistance to imipenem, meropenem, and amikacin. Resistance was lowest among Acinetobacter species to both colistin and tigecycline. The percentages of multidrug-resistant (MDR) and possibly extensively drug-resistant (XDR) isolates was reduced by almost half between the beginning of the study in 2010 and its culmination in 2021. Carbapenem-resistant Acinetobacter spp. (CRAB) was associated with a higher mortality (RR: 5.7), a higher admission to ICU (RR 3.3), and an increased length of stay (LOS; 13 excess inpatient days per CRAB case), as compared to Carbapenem-susceptible Acinetobacter spp. Conclusion Carbapenem-resistant Acinetobacter spp. are associated with poorer clinical outcomes, and higher associated costs, as compared to carbapenem-susceptible Acinetobacter spp. A decreasing trend of MDR Acinetobacter spp., as well as resistance to all antibiotic classes under surveillance was observed during 2010 to 2021. Further studies are needed to explore the reasons and underlying factors leading to this remarkable decrease of resistance over time.
Collapse
Affiliation(s)
- Jens Thomsen
- Abu Dhabi Public Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hussain AlRand
- Public Health Sector, Ministry of Health and Prevention, Dubai, United Arab Emirates
| |
Collapse
|
4
|
Papp-Wallace KM, McLeod SM, Miller AA. Durlobactam, a Broad-Spectrum Serine β-lactamase Inhibitor, Restores Sulbactam Activity Against Acinetobacter Species. Clin Infect Dis 2023; 76:S194-S201. [PMID: 37125470 PMCID: PMC10150275 DOI: 10.1093/cid/ciad095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Sulbactam-durlobactam is a pathogen-targeted β-lactam/β-lactamase inhibitor combination in late-stage development for the treatment of Acinetobacter infections, including those caused by multidrug-resistant strains. Durlobactam is a member of the diazabicyclooctane class of β-lactamase inhibitors with broad-spectrum serine β-lactamase activity. Sulbactam is a first-generation, narrow-spectrum β-lactamase inhibitor that also has intrinsic antibacterial activity against Acinetobacter spp. due to its ability to inhibit penicillin-binding proteins 1 and 3. The clinical utility of sulbactam for the treatment of contemporary Acinetobacter infections has been eroded over the last decades due to its susceptibility to cleavage by numerous β-lactamases present in this species. However, when combined with durlobactam, the activity of sulbactam is restored against this problematic pathogen. The following summary describes what is known about the molecular drivers of activity and resistance as well as results from surveillance and in vivo efficacy studies for this novel combination.
Collapse
Affiliation(s)
- Krisztina M Papp-Wallace
- Research Service, Veterans Affairs Northeast Ohio Healthcare System, USA
- Departments of Biochemistry and Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | |
Collapse
|
5
|
Principe L, Di Bella S, Conti J, Perilli M, Piccirilli A, Mussini C, Decorti G. Acinetobacter baumannii Resistance to Sulbactam/Durlobactam: A Systematic Review. Antibiotics (Basel) 2022; 11:antibiotics11121793. [PMID: 36551450 PMCID: PMC9774100 DOI: 10.3390/antibiotics11121793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have limited therapeutic options. Sulbactam-durlobactam is a combination of two βlactamase inhibitors with activity against CRAB under phase 3 clinical investigation. We performed a systematic review on in vitro studies reporting A. baumannii resistances against sulbactam/durlobactam. We considered "resistant" species to be those with MIC ≥ 8 mg/L. Ten studies were included in the review (9754 tested isolates). Overall, 2.3% of A. baumannii were resistant to sulbactam/durlobactam, and this percentage rose to 3.4% among CRAB subgroups and to 3.7% among colistin-resistant strains. Resistance was 100% among metallo β-lactamase-producing strains. Overall, in 12.5% of cases, sulbactam/durlobactam resistance was associated with the production of NDM-1, in 31.7% of cases with the substitutions in the PBP3 determinants, and in the remaining cases the resistance mechanism was unknown. In conclusion, A. baumannii resistance towards sulbactam/durlobactam is limited, except for MBL-producing strains.
Collapse
Affiliation(s)
- Luigi Principe
- Clinical Pathology and Microbiology Unit, “San Giovanni di Dio” Hospital, 88900 Crotone, Italy
- Correspondence:
| | - Stefano Di Bella
- Clinical University Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Jacopo Conti
- AOU Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy
| | - Mariagrazia Perilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Piccirilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Cristina Mussini
- AOU Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy
| | - Giuliana Decorti
- Clinical University Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
- Institute for Maternal & Child Health (I.R.C.C.S) Burlo Garofolo, 34129 Trieste, Italy
| |
Collapse
|
6
|
Gu Y, Zhang W, Lei J, Zhang L, Hou X, Tao J, Wang H, Deng M, Zhou M, Weng R, Xu J. Molecular epidemiology and carbapenem resistance characteristics of Acinetobacter baumannii causing bloodstream infection from 2009 to 2018 in northwest China. Front Microbiol 2022; 13:983963. [PMID: 36071964 PMCID: PMC9441628 DOI: 10.3389/fmicb.2022.983963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 01/10/2023] Open
Abstract
Bloodstream infection (BSI) caused by Acinetobacter baumannii poses a serious threat to health and is correlated with high mortality in patients with hospital-acquired infections, so the molecular epidemiology and antimicrobial resistance characteristics of this pathogen urgently need to be explored. A. baumannii isolates from BSI patients were collected in three tertiary hospitals in northwest China from 2009 to 2018. Antimicrobial susceptibility testing was used to determine the MICs of the A. baumannii isolates. Whole-genome sequencing based on the Illumina platform was performed for molecular epidemiological analyses and acquired resistance gene screening. The efflux pump phenotype was detected by examining the influence of an efflux pump inhibitor. The expression of efflux pump genes was evaluated by RT-PCR. In total, 47 A. baumannii isolates causing BSI were collected and they presented multidrug resistance, including resistance to carbapenems. Clone complex (CC) 92 was the most prevalent with 30 isolates, among which a cluster was observed in the phylogenetic tree based on the core genome multi-locus sequence type, indicating the dissemination of a dominant clone. BSI-related A. baumannii isolates normally harbour multiple resistance determinants, of which oxacillinase genes are most common. Except for the intrinsic blaOXA-51 family, there are some carbapenem-resistant determinants in these A. baumannii isolates, including blaOXA-23, which is encoded within the Tn2006, Tn2008 or Tn2009 transposon structures and blaOXA-72. The transfer of blaOXA-72 was suggested by XerC/D site-specific recombination. The AdeABC efflux pump system contributed to carbapenem resistance in A. baumannii isolates, as evidenced by the high expression of some of its encoding genes. Both the clone dissemination and carbapenem resistance mediated by oxacillinase or efflux pumps suggest an effective strategy for hospital infection control.
Collapse
Affiliation(s)
- Yihai Gu
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Wei Zhang
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Jine Lei
- Department of Clinical Laboratory, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lixia Zhang
- Department of Clinical Laboratory, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Xuan Hou
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Junqi Tao
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Hui Wang
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Minghui Deng
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Mengrong Zhou
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Rui Weng
- Department of Microbiology, 3201 hospital, School of Medicine, Xi'an Jiaotong University, Hanzhong, Shaanxi, China
| | - Jiru Xu
- Department of Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
7
|
Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America Guidance on the Treatment of AmpC β-lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections. Clin Infect Dis 2021; 74:2089-2114. [PMID: 34864936 DOI: 10.1093/cid/ciab1013] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. A previous guidance document focused on infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Here, guidance is provided for treating AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia infections. METHODS A panel of six infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated questions about the treatment of AmpC-E, CRAB, and S. maltophilia infections. Answers are presented as suggestions and corresponding rationales. In contrast to guidance in the previous document, published data on optimal treatment of AmpC-E, CRAB, and S. maltophilia infections are limited. As such, guidance in this document is provided as "suggested approaches" based on clinical experience, expert opinion, and a review of the available literature. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States. RESULTS Preferred and alternative treatment suggestions are provided, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, duration of therapy, and other management considerations are also discussed briefly. Suggestions apply for both adult and pediatric populations. CONCLUSIONS The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial-resistant infections. This document is current as of September 17, 2021 and will be updated annually. The most current versions of IDSA documents, including dates of publication, are available at www.idsociety.org/practice-guideline/amr-guidance-2.0/.
Collapse
Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel L Aitken
- Department of Pharmacy, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Robert A Bonomo
- Medical Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, University Hospitals Cleveland Medical Center and Departments of Medicine, Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Amy J Mathers
- Departments of Medicine and Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - David van Duin
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Lima WG, Brito JCM, de Lima ME, Pizarro ACST, Vianna MAMDM, de Paiva MC, de Assis DCS, Cardoso VN, Fernandes SOA. A short synthetic peptide, based on LyeTx I from Lycosa erythrognatha venom, shows potential to treat pneumonia caused by carbapenem-resistant Acinetobacter baumannii without detectable resistance. J Antibiot (Tokyo) 2021; 74:425-434. [PMID: 33972716 DOI: 10.1038/s41429-021-00421-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/02/2021] [Accepted: 04/02/2021] [Indexed: 11/09/2022]
Abstract
The emergence of antibiotic-resistant bacteria, especially carbapenem-resistant Acinetobacter baumannii (CRAB), together with relative stagnation in the development of effective antibiotics, has led to enormous health and economic problems. In this study, we aimed to describe the antibacterial spectrum of LyeTx I mnΔK, a short synthetic peptide based on LyeTx I from Lycosa erythrognatha venom, against CRAB. LyeTx I mnΔK showed considerable antibacterial activity against extensively resistant A. baumannii, with minimum inhibitory and bactericidal concentrations ranging from 1 to 16 µM and 2 to 32 µM, respectively. This peptide significantly increased the release of 260 nm-absorbing intracellular material from CRAB, suggesting bacteriolysis. LyeTx I mnΔK was shown to act synergistically with meropenem and colistin against CRAB. The cytotoxic concentration of LyeTx I mnΔK against Vero cells (CC50 = 55.31 ± 5.00 µM) and its hemolytic activity (HC50 = 77.07 ± 4.00 µM) were considerably low; however, its antibacterial activity was significantly reduced in the presence of human and animal serum and trypsin. Nevertheless, the inhalation of this peptide was effective in reducing pulmonary bacterial load in a mouse model of CRAB infection. Altogether, these results demonstrate that the peptide LyeTx I mnΔK is a potential prototype for the development of new effective and safe antibacterial agents against CRAB.
Collapse
Affiliation(s)
- William Gustavo Lima
- Laboratório de Radioisótopos, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Maria Elena de Lima
- Faculdade Santa Casa de Belo Horizonte, Programa de Pós-Graduação Stricto Senso de Medicina e Biomedicina, Belo Horizonte, MG, Brazil
| | | | | | - Magna Cristina de Paiva
- Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brazil
| | | | - Valbert Nascimento Cardoso
- Laboratório de Radioisótopos, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Simone Odília Antunes Fernandes
- Laboratório de Radioisótopos, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| |
Collapse
|
9
|
Yu SN, Kim T, Park SY, Lee YM, Park KH, Lee EJ, Jeon MH, Choo EJ, Kim TH, Lee MS, Park SY. Predictors of Acute Kidney Injury and 28-Day Mortality in Carbapenem-Resistant Acinetobacter baumannii Complex Bacteremia. Microb Drug Resist 2021; 27:1029-1036. [PMID: 33656377 DOI: 10.1089/mdr.2020.0312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Colistin is an, antibiotic used to treat carbapenem-resistant Acinetobacter baumannii complex (CRABC) infection. However, colistin is well known for its nephrotoxicity. To accurately assess the effects of colistin on acute kidney injury (AKI) and 28-day mortality, we investigated the risk factors associated with AKI and mortality in patients with CRABC bacteremia who received or never received colistin. Patients with CRABC bacteremia aged ≥18 years were retrospectively identified for 3 years at five tertiary teaching hospitals. AKI was defined by using the Kidney Disease Improving Global Outcomes criteria. AKI developed in 103 (34.9%) of the 295 patients enrolled patients. AKI developed more frequently in patients who received colistin than in patients who did not (46.7% vs. 29.5%, p = 0.004). Multivariate analysis showed that intravenous colistin usage was an independent risk factor for AKI in these patients. Nonfatal disease, catheter-related bloodstream infection, and administration of colistin were protective factors for 28-day mortality. However, the sequential organ failure assessment score and AKI were associated with poor outcomes. In conclusion, colistin may be a double-edged sword; although it causes AKI, it also reduces 28-day mortality in patients with CRABC bacteremia. Therefore, colistin administration as an appropriate antibiotic may improve CRABC bacteremia prognosis, despite its nephrotoxicity.
Collapse
Affiliation(s)
- Shi Nae Yu
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Tark Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Se Yoon Park
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Ki-Ho Park
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Jung Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Min Hyok Jeon
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eun Ju Choo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Tae Hyong Kim
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Mi Suk Lee
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Seong Yeon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| |
Collapse
|
10
|
Konca C, Tekin M, Geyik M. Susceptibility Patterns of Multidrug-Resistant Acinetobacter baumannii. Indian J Pediatr 2021; 88:120-126. [PMID: 32500488 PMCID: PMC7271137 DOI: 10.1007/s12098-020-03346-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the antimicrobial resistance patterns of multidrug-resistant Acinetobacter baumannii (MDRAB) in patients in pediatric intensive care units (PICU) in order to determine a guide for the empirical antibiotic treatment of MDRAB. METHODS The authors retrospectively evaluated the medical records of patients with MDRAB infections in the PICU during a follow-up period, between January 2015 and January 2017. The identification of A. baumannii was performed using a BD Phoenix 100 Automated Microbiology System. A BD Phoenix NMIC/ID-400 commercial kit was used to test antibiotic susceptibility. All data was entered into Microsoft Excel, and the data was analyzed using SPSS version 23.0. RESULTS The mean age of the patients was 8.1 ± 6.2 y. In all, 46 isolates were obtained from 33 patients. The most effective antimicrobial agents were colistin, trimethoprim/sulfamethoxazole, and tigecycline. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate of >45% for the isolates. Low sensitivities in 2015 to tigecycline, aminoglycosides, levofloxacin, and carbapenems had been lost in 2016. CONCLUSIONS Many drugs that were previously effective against MDRAB, have lost their effectiveness. Currently, there is no effective drug to fight MDRAB, apart from colistin. Thus, it is clear that new drugs and treatment protocols should be developed urgently.
Collapse
Affiliation(s)
- Capan Konca
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey.
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Mehmet Tekin
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Geyik
- Department of Pediatrics, School of Medicine, Adiyaman University, Adiyaman, Turkey
| |
Collapse
|
11
|
Abstract
Azithromycin (AZM) has been used to treat chronic inflammatory airway diseases because it regulates cell–cell contact between airway epithelial cells. Airway mucus hypersecretion is an important component of chronic respiratory diseases. Mucin 5AC (MUC5AC) is the major mucin produced by airway epithelial cells, and hypersecretion of MUC5AC is a sign of various pulmonary inflammatory diseases. Recently, it was found that matrix metallopeptidase 9 is involved in mucus hypersecretion. Moreover, AZM can inhibit the ability of TNF-α-to induce interleukin (IL)-8 production. This review focuses on the effects on AZM that may be beneficial in inhibiting MUC5AC, matrix metalloprotease-9 and IL-8 production in airway epithelial cells. In addition, recent studies have begun to assess activation of mitogen-activated protein kinase (MAPK) signaling pathways in response to AZM. Understanding these new developments may be helpful for clinicians.
Collapse
Affiliation(s)
- Jie Yang
- Central Laboratory, Danyang People's Hospital of Jiangsu Province, Danyang, Jiangsu, China
| |
Collapse
|
12
|
Lima WG, Brito JCM, Cardoso BG, Cardoso VN, de Paiva MC, de Lima ME, Fernandes SOA. Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2020; 39:1427-1438. [PMID: 32533271 DOI: 10.1007/s10096-020-03876-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
We conducted a systematic review and meta-analysis to determine the rate of polymyxin resistance among Acinetobacter baumannii isolates causing infection in hospitalized patients around the world during the period of 2010-2019. The systematic review was performed on September 1, 2019, using PubMed/MEDLINE, Scopus, and Web of Science; studies published after January 1, 2010, were selected. The data were summarized in tables, critically analyzed, and treated statistically using the RStudio® Software with Meta package and Metaprop Command. After applying exclusion factors, 41 relevant studies were selected from 969 articles identified on literature search. The overall rate of polymyxin-resistant A. baumannii (PRAB) related to hospitalized patients was estimated to be 13% (95% CI, 0.06-0.27), where a higher rate was observed in America (29%; 95% CI, 0.12-0.55), followed by Europe (13%; 95% CI, 0.02-0.52), and Asia (10%; 95% CI, 0.02-0.32). The extensive use of polymyxins on veterinary to control bacterial infection and growth promotion, as well as the resurgence in prescription and use of polymyxins in the clinics against carbapenem-resistant gram-negative bacteria, may have contributed to the increased incidence of PRAB. The findings of this meta-analysis revealed that the rate of PRAB recovered from hospitalized patients is distinctively high. Thus, action needs to be taken to develop strategies to combat the clinical incidence of PRAB-induced hospital infections.
Collapse
Affiliation(s)
- William Gustavo Lima
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. .,Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Campus Centro-Oeste/Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Divinópolis, MG, 35501-293, Brazil.
| | - Júlio César Moreira Brito
- Fundação Ezequiel Dias (FUNED), Belo Horizonte, MG, Brazil.,Programa de Pós-Graduação em Inovação Tecnológica e Biofarmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bárbara Gatti Cardoso
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Valbert Nascimento Cardoso
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Magna Cristina de Paiva
- Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Campus Centro-Oeste/Dona Lindu, Universidade Federal de São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, Divinópolis, MG, 35501-293, Brazil
| | - Maria Elena de Lima
- Programa de Pós-Graduação em Inovação Tecnológica e Biofarmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Instituto de Ensino e Pesquisa, Santa Casa-Belo Horizonte, Belo Horizonte, Brazil
| | - Simone Odília Antunes Fernandes
- Laboratório de Radioisótopos, Departamento de Análises Clinicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
13
|
Lima WG, Silva Alves GC, Sanches C, Antunes Fernandes SO, de Paiva MC. Carbapenem-resistant Acinetobacter baumannii in patients with burn injury: A systematic review and meta-analysis. Burns 2019; 45:1495-1508. [DOI: 10.1016/j.burns.2019.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/09/2019] [Accepted: 07/03/2019] [Indexed: 12/25/2022]
|
14
|
Jiang M, Mu Y, Li N, Zhang Z, Han S. Carbapenem-resistant Acinetobacter baumannii from Air and Patients of Intensive Care Units. Pol J Microbiol 2019; 67:333-338. [PMID: 30451450 PMCID: PMC7256820 DOI: 10.21307/pjm-2018-040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 12/03/2022] Open
Abstract
To understand the molecular epidemiology and antibiotic resistance of air and clinical isolates of Acinetobacter baumannii, the intensive care unit settings of a hospital in Northern China were surveyed in 2014. Twenty non-duplicate A. baumannii isolates were obtained from patients and five isolates of airborne A. baumannii were obtained from the wards’ corridors. Pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to analyze the homology relationships of isolates. Resistance and resistance genes were detected by drug susceptibility test and PCR. The results demonstrated that all isolates can be classified into eight PFGE types and four sequence types (ST208, ST195, ST369 and ST530). A pair of isolates from patients (TAaba004) and from the air (TAaba012) that share 100% similarity in PFGE was identified, indicating that air might be a potential and important transmission route for A. baumannii. More than 80% of the isolates were resistant to carbapenems and aminoglycoside antibiotics. Twenty-four isolates, which were resistant to carbapenems, carried the blaOXA-23-like gene. The data indicated that air might be an alternative way for the transmission of A. baumannii. Hospitals should pay more attention to this route, and design new measures accordingly.
Collapse
Affiliation(s)
- Meijie Jiang
- Laboratory Medicine, Tai'an City Central Hospital, Tai'an, Shandong, China
| | - Yunqing Mu
- Laboratory Medicine, Dezhou City People's Hospital, Dezhou, Shandong, China
| | - Ning Li
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, Shandong, China
| | - Zhijun Zhang
- Laboratory Medicine, Tai'an City Central Hospital, Tai'an, Shandong, China
| | - Shulin Han
- Department of Public Health, Tai'an City Central Hospital, Tai'an, Shandong, China
| |
Collapse
|
15
|
Bulens SN, Yi SH, Walters MS, Jacob JT, Bower C, Reno J, Wilson L, Vaeth E, Bamberg W, Janelle SJ, Lynfield R, Vagnone PS, Shaw K, Kainer M, Muleta D, Mounsey J, Dumyati G, Concannon C, Beldavs Z, Cassidy PM, Phipps EC, Kenslow N, Hancock EB, Kallen AJ. Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012-2015. Emerg Infect Dis 2019; 24:727-734. [PMID: 29553339 PMCID: PMC5875254 DOI: 10.3201/eid2404.171461] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In healthcare settings, Acinetobacter spp. bacteria commonly demonstrate antimicrobial resistance, making them a major treatment challenge. Nearly half of Acinetobacter organisms from clinical cultures in the United States are nonsusceptible to carbapenem antimicrobial drugs. During 2012–2015, we conducted laboratory- and population-based surveillance in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee to determine the incidence of carbapenem-nonsusceptible A. baumannii cultured from urine or normally sterile sites and to describe the demographic and clinical characteristics of patients and cases. We identified 621 cases in 537 patients; crude annual incidence was 1.2 cases/100,000 persons. Among 598 cases for which complete data were available, 528 (88.3%) occurred among patients with exposure to a healthcare facility during the preceding year; 506 (84.6%) patients had an indwelling device. Although incidence was lower than for other healthcare-associated pathogens, cases were associated with substantial illness and death.
Collapse
|
16
|
How to: molecular investigation of a hospital outbreak. Clin Microbiol Infect 2018; 25:688-695. [PMID: 30287413 DOI: 10.1016/j.cmi.2018.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studying hospital outbreaks by using molecular tools, i.e. synthesizing the molecular epidemiology data to its appropriate clinical-epidemiologic context, is crucial in order to identify infection source, infer transmission dynamics, appropriately allocate prevention resources and implement control measures. Whole-genome sequencing (WGS) of pathogens has become the reference standard, as it is becoming more accessible and affordable. Consequently, sequencing of the full pathogen genome via WGS and major progress in fit-for-purpose genomic data analysis tools and interpretation is revolutionizing the field of outbreak investigations in hospitals. Metagenomics is an additional evolving field that might become commonly used in the future for outbreak investigations. Nevertheless, practitioners are frequently limited in terms of WGS or metagenomics, especially for local outbreak analyses, as a result of costs or logistical considerations, reduced or lack of locally available resources and/or expertise. As a result, traditional approaches, including pulsed-field gel electrophoresis, repetitive-element palindromic PCR and multilocus sequence typing, along with other typing methods, are still widely used. AIMS To provide practitioners with evidenced-based action plans for usage of the various typing techniques in order to investigate the molecular epidemiology of nosocomial outbreaks, of clinically significant pathogens in acute-care hospitals. SOURCES PubMed search with relevant keywords along with personal collection of relevant publications. CONTENT Representative case scenarios and critical review of the relevant scientific literature. IMPLICATIONS The review provides practical action plans to manage molecular epidemiologic investigations of outbreaks caused by clinically significant nosocomial pathogens, while prioritizing the use and timely integration of the various methodologies.
Collapse
|
17
|
Lashinsky JN, Henig O, Pogue JM, Kaye KS. Minocycline for the Treatment of Multidrug and Extensively Drug-Resistant A. baumannii: A Review. Infect Dis Ther 2017; 6:199-211. [PMID: 28357705 PMCID: PMC5446366 DOI: 10.1007/s40121-017-0153-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 11/28/2022] Open
Abstract
Acinetobacter baumannii can cause life-threatening nosocomial infections associated with high rates of morbidity and mortality. In recent years, the increasing number of infections due to extensively drug-resistant Acinetobacter with limited treatment options has resulted in a need for additional therapeutic agents, and a renaissance of older, neglected antimicrobials. This has led to an increased interest in the use of minocycline to treat these infections. Minocycline has been shown to overcome many resistance mechanisms affecting other tetracyclines in A. baumannii, including tigecycline. Additionally, it has favorable pharmacokinetic and pharmacodynamic properties, as well as excellent in vitro activity against drug-resistant A. baumannii. Available data support therapeutic success with minocycline, while ease of dosing with no need for renal or hepatic dose adjustments and improved safety have made it an appealing therapy. This review will focus on the mechanisms of action and resistance to tetracyclines in A. baumannii, the in vitro activity, pharmacokinetic and pharmacodynamic properties of minocycline against A. baumannii, and finally the clinical experience with minocycline for the treatment of invasive infections due to this pathogen.
Collapse
Affiliation(s)
| | - Oryan Henig
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jason M Pogue
- Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Keith S Kaye
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
18
|
Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus. Infect Control Hosp Epidemiol 2017; 38:848-856. [DOI: 10.1017/ice.2017.83] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVEThe purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location.METHODSWe conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score–matched subsample.RESULTSPatients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85–2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22–1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39–3.21) and colonizations (RR, 1.32; 95% CI, 1.22–1.50) had an increased risk of death at 30 days.CONCLUSIONSWe found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations.Infect Control Hosp Epidemiol 2017;38:848–856
Collapse
|
19
|
The Impact of Reducing Antibiotics on the Transmission of Multidrug-Resistant Organisms. Infect Control Hosp Epidemiol 2017; 38:663-669. [PMID: 28270258 DOI: 10.1017/ice.2017.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Antibiotic resistance is a major threat to public health. Resistance is largely driven by antibiotic usage, which in many cases is unnecessary and can be improved. The impact of decreasing overall antibiotic usage on resistance is unknown and difficult to assess using standard study designs. The objective of this study was to explore the potential impact of reducing antibiotic usage on the transmission of multidrug-resistant organisms (MDROs). DESIGN We used agent-based modeling to simulate interactions between patients and healthcare workers (HCWs) using model inputs informed by the literature. We modeled the effect of antibiotic usage as (1) a microbiome effect, for which antibiotic usage decreases competing bacteria and increases the MDRO transmission probability between patients and HCWs and (2) a mutation effect that designates a proportion of patients who receive antibiotics to subsequently develop a MDRO via genetic mutation. SETTING Intensive care unit INTERVENTIONS Absolute reduction in overall antibiotic usage by experimental values of 10% and 25% RESULTS Reducing antibiotic usage absolutely by 10% (from 75% to 65%) and 25% (from 75% to 50%) reduced acquisition rates of high-prevalence MDROs by 11.2% (P<.001) and 28.3% (P<.001), respectively. We observed similar effect sizes for low-prevalence MDROs. CONCLUSIONS In a critical care setting, where up to 50% of antibiotic courses may be inappropriate, even a moderate reduction in antibiotic usage can reduce MDRO transmission. Infect Control Hosp Epidemiol 2017;38:663-669.
Collapse
|
20
|
Marchaim D, Levit D, Zigron R, Gordon M, Lazarovitch T, Carrico JA, Chalifa-Caspi V, Moran-Gilad J. Clinical and molecular epidemiology of Acinetobacter baumannii bloodstream infections in an endemic setting. Future Microbiol 2017; 12:271-283. [PMID: 28287300 DOI: 10.2217/fmb-2016-0158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM The transmission dynamics of Acinetobacter baumannii in endemic settings, and the relation between microbial properties and patients' clinical outcomes, are yet obscure and hampered by insufficient metadata. METHODS & RESULTS Of 20 consecutive patients with A. baumannii bloodstream infection that were thoroughly analyzed at a single center, at least one transmission opportunity was evident for 85% of patients. This implies that patient-to-patient transmission is the major mode of A. baumannii acquisitions in health facilities. Moreover, all patients who died immediately (<24 h of admission) were infected with a single clone (ST457; relative risk = 1.6; p = 0.05). CONCLUSION This preliminary analysis should prompt further investigation by mapping genomic virulence determinants among A. baumannii ST457 lineage compared with other strains.
Collapse
Affiliation(s)
- Dror Marchaim
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Levit
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Zigron
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Gordon
- NIBN, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tsillia Lazarovitch
- Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Joao A Carrico
- Instituto de Microbiologia & Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Jacob Moran-Gilad
- Public Health Services, Ministry of Health, Jerusalem, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,ESCMID Study Group for Genomic & Molecular Diagnostics (ESGMD), Basel, Switzerland
| |
Collapse
|
21
|
Chen Y, Gao J, Zhang H, Ying C. Spread of the blaOXA-23-Containing Tn 2008 in Carbapenem-Resistant Acinetobacter baumannii Isolates Grouped in CC92 from China. Front Microbiol 2017; 8:163. [PMID: 28220115 PMCID: PMC5292404 DOI: 10.3389/fmicb.2017.00163] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/23/2017] [Indexed: 11/17/2022] Open
Abstract
The rapid expansion of carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates is a big issue. We investigated the antibiotic susceptibility, molecular epidemiology and resistance gene of A. baumannii collected at two hospitals in Shanghai, China. Besides, the A. baumannii PCR-based replicon typing method (AB-PBRT) was conducted to categorize the plasmids into homogeneous groups on the basis of replicase genes. Most CRAB isolates showed high-level resistance to almost all antibiotics but retain susceptibility to colistin and tigecycline. A total of 101 isolates carried blaOXA-51-like gene. Sequencing identified the presence of blaOXA-66 for CRAB isolates. blaOXA–23 gene were discovered in all CRAB isolates. Each CRAB isolate contained 1–3 of 19 different plasmid replicase (rep) gene homology groups (GRs) and the GR6 (repAci6) was ubiquitous. Genotyping by Multilocus Sequence Typing (MLST) showed seven defined MLST patterns and three novel STs were found. eBURST analysis indicated they were all grouped in CC92 (GCII) with the most frequent ST208 (50%). Two blaOXA–23-bearing transposons were found: Tn2006 and Tn2008. Tn2008 were detected in 54 (96.4%) isolates and Tn2006 in two remaining isolates. The blaOXA–23 carbapenem gene was vitally associated with repAci6 plasmid belong to CC92 clonal group. Our survey revealed severe drug resistance in A. baumannii isolates. Tn2008-containing CC92 A. baumannii were endemic, which may facilitate the blaoxa23 dissemination.
Collapse
Affiliation(s)
- Yisheng Chen
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China
| | - Jing Gao
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China
| | - Haomin Zhang
- Department of Clinical Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Chunmei Ying
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University Shanghai, China
| |
Collapse
|
22
|
Jasemi S, Douraghi M, Adibhesami H, Zeraati H, Rahbar M, Boroumand MA, Aliramezani A, Ghourchian S, Mohammadzadeh M. Trend of extensively drug-resistant Acinetobacter baumannii and the remaining therapeutic options: a multicenter study in Tehran, Iran over a 3-year period. Lett Appl Microbiol 2016; 63:466-472. [PMID: 27626896 DOI: 10.1111/lam.12669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/19/2016] [Accepted: 09/08/2016] [Indexed: 12/22/2022]
Abstract
Comprehensive data on drug-resistant patterns of Acinetobacter baumannii isolates in developing countries is limited. We conducted a multihospital study to assess the rate and trend of drug-resistant phenotypes in Ac. baumannii using standardized definitions and to determine the remaining therapeutic options against resistant phenotypes. The 401 nonduplicate isolates were collected from six hospitals which are geographically distributed across Tehran, Iran over a 3-year period. Following PCR of blaOXA-51-like gene, susceptibility testing was performed against nine antimicrobial agent categories. Three hundred and ninety (97%) isolates were resistant to least two carbapenems; carbapenem-resistant Ac. baumannii. The majority of isolates (366, 91·3%) were extensively drug resistant (XDR) and the rest of the isolates were classified as multidrug resistant (26, 6·8%) and susceptible (9, 2·2%). The rate of XDR-AB slightly decreased from 93·8% in 2011 to 89·8% in 2013. A considerable decrease in resistance to doxycycline, minocycline and tigecycline was demonstrated. The XDR-AB isolates showed susceptibility to gentamicin (10·4%), tobramycin (23%), ampicilin-sulbactam (30·1%), minocycline (32·8%), tigecycline (10·7%), doxycycline (21·6%), colistin (100%) and polymixin B (100%). We demonstrated the rising trend of resistance to all antibiotic categories except tetracyclines and folate pathway inhibitors. We found that the treatment options against XDR-AB are extremely limited and each treatment alternative including even old, but safe, antibiotics might be considered. SIGNIFICANCE AND IMPACT OF THE STUDY The high frequency of drug-resistant phenotypes including carbapenem-resistant Acinetobacter baumannii, multidrug-resistant, and extensively resistant has been demonstrated in Ac. baumannii isolates tested here. As the antibiotic resistance pattern of isolates varies in different geographical regions, this study can provide comprehensive information about the antibiotic resistance profile of Ac. baumannii isolates in Tehran. In addition, the resistance profiles could be effectively considered by clinicians to manage antibiotic therapy. This work also emphasizes on the prudent use of antibiotics and the monitoring of antibiotic susceptibility trend and rate.
Collapse
Affiliation(s)
- S Jasemi
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M Douraghi
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - H Adibhesami
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - H Zeraati
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - M Rahbar
- Department of Microbiology, Reference Health Laboratories, Ministry of Health, Tehran, Iran
| | - M A Boroumand
- Department of Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - A Aliramezani
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Ghourchian
- Division of Microbiology, Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - M Mohammadzadeh
- Department of Infectious Diseases, Pediatrics Infectious Diseases Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Al Atrouni A, Hamze M, Jisr T, Lemarié C, Eveillard M, Joly-Guillou ML, Kempf M. Wide spread of OXA-23-producing carbapenem-resistant Acinetobacter baumannii belonging to clonal complex II in different hospitals in Lebanon. Int J Infect Dis 2016; 52:29-36. [PMID: 27663910 DOI: 10.1016/j.ijid.2016.09.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the molecular epidemiology of Acinetobacter baumannii strains isolated from different hospitals in Lebanon. METHODS A total of 119 non-duplicate Acinetobacter strains were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and partial rpoB gene sequencing. Antibiotic susceptibility testing was performed by disc diffusion method and all identified carbapenem-resistant isolates were investigated by PCR assays for the presence of the carbapenemase-encoding genes. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used for molecular typing. RESULTS Of the 119 A. baumannii isolates, 76.5% were resistant to carbapenems. The most common carbapenemase was the OXA-23-type, found in 82 isolates. The study of population structure using MLST revealed the presence of 30 sequence types (STs) including 18 new ones, with ST2 being the most commonly detected, accounting for 61% of the isolates typed. PFGE performed on all strains of ST2 identified a major cluster of 53 isolates, in addition to three other minor clusters and ten unique profiles. CONCLUSIONS This study highlights the wide dissemination of highly related OXA-23-producing carbapenem-resistant A. baumannii belonging to the international clone II in Lebanon. Thus, appropriate infection control measures are recommended in order to control the geographical spread of this clone in this country.
Collapse
Affiliation(s)
- Ahmad Al Atrouni
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon; ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie et Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon
| | - Tamima Jisr
- Department of Clinical Laboratory, Makassed General Hospital, Beirut, Lebanon
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Matthieu Eveillard
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Marie-Laure Joly-Guillou
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France
| | - Marie Kempf
- ATOMycA, InsermAtip-Avenir Team, CRCNA, Inserm U892, 6299 CNRS, University of Angers, Angers, France; Laboratoire de Bactériologie, Institut de Biologie en Santé - Centre Hospitalier Universitaire Angers, 4 rue Larrey, 49933 Angers cedex, France.
| |
Collapse
|
24
|
Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections. Infect Control Hosp Epidemiol 2016; 37:1212-8. [DOI: 10.1017/ice.2016.145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUNDOur objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies.METHODSWe identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections.RESULTSOur estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10–32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%–29.4%). With an incidence rate of 0.141 (95% CI, 0.136–0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509–13,625) in the United States.CONCLUSIONThe estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs.Infect Control Hosp Epidemiol 2016;1–7
Collapse
|
25
|
Clinical and Epidemiological Significance of Carbapenem Resistance in Acinetobacter baumannii Infections. Antimicrob Agents Chemother 2016; 60:3127-31. [PMID: 26883694 DOI: 10.1128/aac.02656-15] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/07/2016] [Indexed: 02/07/2023] Open
Abstract
Carbapenems are considered the treatment of choice for Acinetobacter baumannii infections. Many facilities implement preventive measures toward only carbapenem-resistant A. baumannii (CRAB). However, the independent role of the carbapenem resistance determinant on patient outcomes remains controversial. In a 6-year analysis of adults with A. baumannii bloodstream infection (BSI), the outcomes of 149 CRAB isolates were compared to those of 91 patients with carbapenem-susceptible A. baumannii In bivariable analyses, CRAB BSIs were significantly associated with worse outcomes and with a delay in the initiation of appropriate antimicrobial therapy (DAAT). However, in multivariable analyses, carbapenem resistance status was no longer associated with poor outcomes, while DAAT remained an independent predictor. The epidemiological significance of A. baumannii should not be determined by its resistance to carbapenems.
Collapse
|
26
|
Ellis D, Cohen B, Liu J, Larson E. Risk factors for hospital-acquired antimicrobial-resistant infection caused by Acinetobacter baumannii. Antimicrob Resist Infect Control 2015; 4:40. [PMID: 26457183 PMCID: PMC4600331 DOI: 10.1186/s13756-015-0083-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/02/2015] [Indexed: 01/14/2023] Open
Abstract
Background Acinetobacter baumannii can cause serious healthcare-associated infections (HAIs) and the incidence is increasing, with many strains now resistant to multiple antibiotic classes. The aims of this study were to examine factors associated with HAIs caused by antimicrobial-resistant as compared with antimicrobial-susceptible strains of A. baumannii and to investigate trends in the incidence of resistance over time. Electronic data from two U.S. hospitals in a large urban healthcare system in over the years 2006–2012 were used for the analysis. Multiple logistic regression was used to explore risk factors for infection with A. baumannii resistant to ampicillin or ampicillin/sulbactam in the bloodstream, urinary tract, and respiratory tract. The Cochran-Armitage trend test was used to explore resistance trends over time. Findings A total of 671 adults with first-time A. baumannii infection were included in the analysis; 302 isolates (45 %) were resistant to ampicillin or ampicillin/sulbactam and 369 (55 %) were susceptible. In the multivariable analysis, significant risk factors included longer length of stay prior to infection (Odds Ratio [OR] = 1.03; 95 % Confidence Interval [CI]: 1.01, 1.04), hospital A versus B (OR = 0.35; 95 % CI: 0.13, 0.93), and antibiotic use prior to infection (OR = 2.88; 95 % CI: 1.02, 8.13). Resistance was more common in respiratory infections (OR = 2.96; 95 % CI: 1.04, 8.44). No trend was found between year of infection and resistance. Conclusions The risk factors we identified are consistent with previous findings, but we found no evidence in this population that resistance to ampicillin or ampicillin/sulbactam was increasing over time.
Collapse
Affiliation(s)
- Darcy Ellis
- Mailman School of Public Health, Columbia, University Medical Center, 722 West 168th Street, New York, NY 10032 USA
| | - Bevin Cohen
- Mailman School of Public Health, Columbia, University Medical Center, 722 West 168th Street, New York, NY 10032 USA ; School of Nursing, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032 USA
| | - Jianfang Liu
- School of Nursing, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032 USA
| | - Elaine Larson
- Mailman School of Public Health, Columbia, University Medical Center, 722 West 168th Street, New York, NY 10032 USA ; School of Nursing, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032 USA
| |
Collapse
|
27
|
Pogue JM, Neelakanta A, Mynatt RP, Sharma S, Lephart P, Kaye KS. Carbapenem-resistance in gram-negative bacilli and intravenous minocycline: an antimicrobial stewardship approach at the Detroit Medical Center. Clin Infect Dis 2015; 59 Suppl 6:S388-93. [PMID: 25371515 DOI: 10.1093/cid/ciu594] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the era of carbapenem-resistance in Acinobacter baumannii and Enterobacteriaceae, there are limited treatment options for these pathogens. It is essential that clinicians fully assess all available therapeutic alternatives for these multidrug-resistant organisms. We herein describe the approach of the antimicrobial stewardship team at the Detroit Medical Center (DMC) for the evaluation and use of intravenous (IV) minocycline for the treatment of these resistant organisms, given potential advantages of IV minocycline over tigecycline and doxycycline. In vitro analyses at the DMC demonstrated good activity against A. baumannii (78% susceptibility), including 74% of carbapenem-resistant strains, but limited activity against our carbapenem-resistant K.pneumoniae (12% susceptibility.) Based in part on these results, IV minocycline was added to the formulary, primarily for the treatment of carbapenem-resistant A. baumannii. Early experience has been positive: 6/9 (67%) of patients who received IV minocycline had infections due to these organisms cured, including 6/7 (86%) who received doses of 200 mg twice daily.
Collapse
Affiliation(s)
- Jason M Pogue
- Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center Wayne State University School of Medicine, Detroit
| | | | - Ryan P Mynatt
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center
| | - Sarit Sharma
- Wayne State University School of Medicine, Detroit
| | - Paul Lephart
- Wayne State University School of Medicine, Detroit Detroit Medical Center University Laboratories
| | - Keith S Kaye
- Wayne State University School of Medicine, Detroit Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Michigan
| |
Collapse
|
28
|
Impact of Contact Isolation Precautions on Multi-Drug Resistant Acinetobacter baumannii in the Pediatric Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 36:1108-10. [PMID: 26047364 DOI: 10.1017/ice.2015.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
29
|
Viehman JA, Nguyen MH, Doi Y. Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections. Drugs 2015; 74:1315-33. [PMID: 25091170 DOI: 10.1007/s40265-014-0267-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acinetobacter baumannii is a leading cause of healthcare-associated infections worldwide. Because of various intrinsic and acquired mechanisms of resistance, most β-lactam agents are not effective against many strains, and carbapenems have played an important role in therapy. Recent trends show many infections are caused by carbapenem-resistant or even extensively drug-resistant (XDR) strains, for which effective therapy is not well established. Evidence to date suggests that colistin constitutes the backbone of therapy, but the unique pharmacokinetic properties of colistin have led many to suggest the use of combination antimicrobial therapy. However, the combination of agents and dosing regimens that delivers the best clinical efficacy while minimizing toxicity is yet to be defined. Carbapenems, sulbactam, rifampin and tigecycline have been the most studied in the context of combination therapy. Most data regarding therapy for invasive, resistant A. baumannii infections come from uncontrolled case series and retrospective analyses, though some clinical trials have been completed and others are underway. Early institution of appropriate antimicrobial therapy is shown to consistently improve survival of patients with carbapenem-resistant and XDR A. baumannii infection, but the choice of empiric therapy in these infections remains an open question. This review summarizes the most current knowledge regarding the epidemiology, mechanisms of resistance, and treatment considerations of carbapenem-resistant and XDR A. baumannii.
Collapse
Affiliation(s)
- J Alexander Viehman
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, S319 Falk Medical Building, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | | | | |
Collapse
|
30
|
Falagas ME, Vardakas KZ, Roussos NS. Trimethoprim/sulfamethoxazole for Acinetobacter spp.: A review of current microbiological and clinical evidence. Int J Antimicrob Agents 2015; 46:231-41. [PMID: 26070662 DOI: 10.1016/j.ijantimicag.2015.04.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Abstract
Clinicians nowadays are confronted with an epidemic of multidrug-resistant (MDR) Acinetobacter infections and are forced to consider every treatment alternative, including older antibiotic agents, not conventionally used. This review aimed to evaluate the published evidence on the antimicrobial activity and clinical effectiveness of trimethoprim/sulfamethoxazole (TMP-SMX) against Acinetobacter spp. Selected in vitro studies included antimicrobial surveillance reports, microbiological studies regarding the activity of TMP-SMX against MDR Acinetobacter isolates, and clinical studies published after the year 2000. Non-susceptibility rates for Acinetobacter spp. in surveillance studies ranged from 4% to 98.2%; in 23 of 28 studies, non-susceptibility to TMP-SMX was >50% and in a subset of 15 studies non-susceptibility was >70%. In studies regarding MDR Acinetobacter spp., non-susceptibility rates ranged from 5.9% to 100%; however, 19 of 21 studies reported >70% non-susceptibility. Extensively drug-resistant Acinetobacter baumannii complex had total (100%) resistance in five of six studies. Carbapenem-resistant Acinetobacter spp. had non-susceptibility rates to TMP-SMX of >80% in 22 of 26 studies. One study on polymyxin-resistant A. baumannii showed a susceptibility rate of 54.2% (13/24). Only seven case reports evaluated TMP-SMX for Acinetobacter spp. infections, mainly in combination with other agents; all cases were deemed therapeutic successes. Although TMP-SMX is not usually active against Acinetobacter spp., it might be considered in cases where there are no other options.
Collapse
Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Medicine-Infectious Diseases, IASO General Hospital, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Medicine-Infectious Diseases, IASO General Hospital, Athens, Greece
| | | |
Collapse
|
31
|
Molenaar RJ, van Engelen E. Pneumonia associated withAcinetobacter baumanniiin a group of minks (Neovison vison). Vet Q 2015; 35:174-6. [DOI: 10.1080/01652176.2015.1030714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
32
|
Pogue J, Kaye K, Cohen D, Marchaim D. Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clin Microbiol Infect 2015; 21:302-12. [DOI: 10.1016/j.cmi.2014.12.025] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/22/2014] [Accepted: 12/27/2014] [Indexed: 01/02/2023]
|
33
|
Luo TL, Rickard AH, Srinivasan U, Kaye KS, Foxman B. Association of blaOXA-23 and bap with the persistence of Acinetobacter baumannii within a major healthcare system. Front Microbiol 2015; 6:182. [PMID: 25814985 PMCID: PMC4357298 DOI: 10.3389/fmicb.2015.00182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Acinetobacter baumannii is an emerging opportunistic nosocomial pathogen. Two factors that may enhance persistence in healthcare settings are antimicrobial resistance and biofilm-forming ability. The aim of this work was to determine whether A. baumannii isolates that persist in healthcare settings (endemic), can be differentiated from sporadic isolates based upon their ability to resist antibiotics and their biofilm-forming capability. METHODS Two hundred and ninety A. baumannii isolates were isolated over 17 months in the Detroit Medical Center (DMC). The isolates were genotyped using repetitive extragenic palindromic-PCR (REP-PCR). REP-types appearing greater than 10 times during active surveillance were considered endemic. The in vitro biofilm-forming ability and antibiotic resistance profile of each isolate were evaluated. Isolates were tested for the presence of two genetic markers-one implicated in biofilm formation (bap) and the other in antibiotic resistance (blaOXA-23). RESULTS Of the 290 isolates evaluated, 84% carried bap and 36% carried blaOXA-23 . Five unique REP-PCR banding-types were detected >10 times (endemic) and constituted 58% of the 290 isolates. These five endemic REP-PCR types were 5.1 times more likely than sporadic isolates to carry both bap and blaOXA-23 . Furthermore, endemic isolates were resistant to 3 more antibiotic classes, on average, than sporadic isolates and four of the five endemic REP-PCR types formed denser biofilms in vitro than sporadic isolates. CONCLUSIONS Endemic A. baumannii isolates are more likely than sporadic isolates to possess factors that increase virulence and enhance survival within a large healthcare system.
Collapse
Affiliation(s)
- Ting L Luo
- Department of Epidemiology, School of Public Health, University of Michigan Ann Arbor, MI, USA
| | - Alexander H Rickard
- Department of Epidemiology, School of Public Health, University of Michigan Ann Arbor, MI, USA
| | - Usha Srinivasan
- Department of Epidemiology, School of Public Health, University of Michigan Ann Arbor, MI, USA
| | - Keith S Kaye
- Division of Infectious Diseases, Wayne State University Detroit, MI, USA
| | - Betsy Foxman
- Department of Epidemiology, School of Public Health, University of Michigan Ann Arbor, MI, USA
| |
Collapse
|
34
|
Doi Y, Murray GL, Peleg AY. Acinetobacter baumannii: evolution of antimicrobial resistance-treatment options. Semin Respir Crit Care Med 2015; 36:85-98. [PMID: 25643273 DOI: 10.1055/s-0034-1398388] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The first decade of the 20th century witnessed a surge in the incidence of infections due to several highly antimicrobial-resistant bacteria in hospitals worldwide. Acinetobacter baumannii is one such organism that turned from an occasional respiratory pathogen into a major nosocomial pathogen. An increasing number of A. baumannii genome sequences have broadened our understanding of the genetic makeup of these bacteria and highlighted the extent of horizontal transfer of DNA. Animal models of disease combined with bacterial mutagenesis have provided some valuable insights into mechanisms of A. baumannii pathogenesis. Bacterial factors known to be important for disease include outer membrane porins, surface structures including capsule and lipopolysaccharide, enzymes such as phospholipase D, iron acquisition systems, and regulatory proteins. A. baumannii has a propensity to accumulate resistance to various groups of antimicrobial agents. In particular, carbapenem resistance has become commonplace, accounting for the majority of A. baumannii strains in many hospitals today. Carbapenem-resistant strains are often resistant to all other routinely tested agents. Treatment of carbapenem-resistant A. baumannii infection therefore involves the use of combinations of last resort agents such as colistin and tigecycline, but the efficacy and safety of these approaches are yet to be defined. Antimicrobial-resistant A. baumannii has high potential to spread among ill patients in intensive care units. Early recognition and timely implementation of appropriate infection control measures is crucial in preventing outbreaks.
Collapse
Affiliation(s)
- Yohei Doi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gerald L Murray
- Department of Microbiology, Monash University, Melbourne, Australia
| | - Anton Y Peleg
- Department of Microbiology, Monash University, Melbourne, Australia
| |
Collapse
|
35
|
Qureshi ZA, Hittle LE, O'Hara JA, Rivera JI, Syed A, Shields RK, Pasculle AW, Ernst RK, Doi Y. Colistin-resistant Acinetobacter baumannii: beyond carbapenem resistance. Clin Infect Dis 2015; 60:1295-303. [PMID: 25632010 DOI: 10.1093/cid/civ048] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/07/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND With an increase in the use of colistin methansulfonate (CMS) to treat carbapenem-resistant Acinetobacter baumannii infections, colistin resistance is emerging. METHODS Patients with infection or colonization due to colistin-resistant A. baumannii were identified at a hospital system in Pennsylvania. Clinical data were collected from electronic medical records. Susceptibility testing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. To investigate the mechanism of colistin resistance, lipid A was subjected to matrix-assisted laser desorption/ionization mass spectrometry. RESULTS Twenty patients with colistin-resistant A. baumannii were identified. Ventilator-associated pneumonia was the most common type of infection. Nineteen patients had received intravenous and/or inhaled CMS for treatment of carbapenem-resistant, colistin-susceptible A. baumannii infection prior to identification of colistin-resistant isolates. The 30-day all-cause mortality rate was 30%. The treatment regimen for colistin-resistant A. baumannii infection associated with the lowest mortality rate was a combination of CMS, a carbapenem, and ampicillin-sulbactam. The colistin-susceptible and -resistant isolates from the same patients were highly related by PFGE, but isolates from different patients were not, suggesting evolution of resistance during CMS therapy. By MLST, all isolates belonged to the international clone II, the lineage that is epidemic worldwide. Phosphoethanolamine modification of lipid A was present in all colistin-resistant A. baumannii isolates. CONCLUSIONS Colistin-resistant A. baumannii occurred almost exclusively among patients who had received CMS for treatment of carbapenem-resistant, colistin-susceptible A. baumannii infection. Lipid A modification by the addition of phosphoethanolamine accounted for colistin resistance. Susceptibility testing for colistin should be considered for A. baumannii identified from CMS-experienced patients.
Collapse
Affiliation(s)
- Zubair A Qureshi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Lauren E Hittle
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore
| | - Jessica A O'Hara
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Jesabel I Rivera
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Alveena Syed
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Ryan K Shields
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Anthony W Pasculle
- Clinical Microbiology Laboratory, University of Pittsburgh Medical Center, Pennsylvania
| | - Robert K Ernst
- Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| |
Collapse
|
36
|
Pogue JM, Cohen DA, Marchaim D. Editorial commentary: Polymyxin-resistant Acinetobacter baumannii: urgent action needed. Clin Infect Dis 2015; 60:1304-7. [PMID: 25632011 PMCID: PMC4392843 DOI: 10.1093/cid/civ044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 01/02/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jason M Pogue
- Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Wayne State University School of Medicine, Michigan
| | - David A Cohen
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin
| | - Dror Marchaim
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin Sackler School of Medicine, Tel-Aviv University, Israel
| |
Collapse
|
37
|
McGrath EJ, Chopra T, Abdel-Haq N, Preney K, Koo W, Asmar BI, Kaye KS. An Outbreak of Carbapenem-Resistant Acinetobacter baumannii Infection in a Neonatal Intensive Care Unit: Investigation and Control. Infect Control Hosp Epidemiol 2015; 32:34-41. [DOI: 10.1086/657669] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective.To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrug-resistant) Acinetobacter baumannii infection involving 6 premature infants.Design.An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation.Setting.A 36-bed, level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan.Interventions.Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak.Results.Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results.Conclusions.The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism.
Collapse
|
38
|
Fujikura Y, Yuki A, Takamizawa K, Kawana A. [A case-control study of patient characteristics and risk factors for hospital-acquired Acinetobacter bacteremia in our hospital]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2014; 88:871-874. [PMID: 25764811 DOI: 10.11150/kansenshogakuzasshi.88.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
39
|
Latibeaudiere R, Rosa R, Laowansiri P, Arheart K, Namias N, Munoz-Price LS. Surveillance cultures growing carbapenem-Resistant Acinetobacter baumannii predict the development of clinical infections: a retrospective cohort study. Clin Infect Dis 2014; 60:415-22. [PMID: 25352586 DOI: 10.1093/cid/ciu847] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We aimed to determine the effect of the presence of carbapenem-resistant Acinetobacter baumannii in accordance with surveillance cultures on the subsequent development of clinical infections by this organism. METHODS This retrospective cohort study was conducted at a tertiary hospital from January 2010 to November 2011. We included all consecutive patients admitted to the trauma intensive care unit, who had weekly surveillance cultures performed (from rectum, and if intubated, respiratory secretions), and without evidence of A. baumannii infections prior to the collection of the first surveillance culture. Univariable and multivariable analyses were performed using log-binomial regression. Survival analyses were performed using Cox proportional hazards. RESULTS Three hundred sixty-four patients were included, of whom 49 (13.5%) had carbapenem-resistant A. baumannii on surveillance cultures. Patients with positive surveillance cultures had 8.4 (95% confidence interval [CI], 5.6-12.7; P < .0001) times the risk of developing a subsequent A. baumannii infection compared with patients who remained negative on surveillance cultures. Multivariable analysis showed significant associations between clinical infection and both positive surveillance cultures (relative risk [RR], 5.9 [95% CI, 3.8-9.3]; P < .0001) and mechanical ventilation (RR, 4.3 [95% CI, 1.03-18.2]; P = .05). On survival analyses, the only variable associated with the development of clinical infections was the presence of positive surveillance cultures (hazard ratio, 16.3 [95% CI, 9.1-29.1]; P < .001). CONCLUSIONS Presence of carbapenem-resistant A. baumannii on surveillance cultures is strongly associated with subsequent development of carbapenem-resistant A. baumannii infections. Prevention efforts should be focused at limiting the acquisition of this organism during hospitalization.
Collapse
Affiliation(s)
| | | | | | | | - Nicholas Namias
- Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - L Silvia Munoz-Price
- Institute for Health and Society Department of Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
40
|
Lee CS, Doi Y. Therapy of Infections due to Carbapenem-Resistant Gram-Negative Pathogens. Infect Chemother 2014; 46:149-64. [PMID: 25298904 PMCID: PMC4189141 DOI: 10.3947/ic.2014.46.3.149] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 12/31/2022] Open
Abstract
The prevalence of carbapenem-resistant gram-negative bacterial pathogens (CRGNs) has increased dramatically during the last 10 years, but the optimal treatment for CRGN infections is not well established due to the relative scarcity of robust clinical data. The polymyxins remain the most consistently active agents against CRGNs in vitro. Tigecycline, based on its in vitro antibacterial spectrum, could also be considered as a therapeutic option in the treatment of infections caused by certain CRGNs. Other agents, including aminoglycosides, rifampin, trimethoprim-sulfamethoxazole, fosfomycin and fluoroquinolones, could be considered as monotherapy or combination therapy against CRGNs in appropriate contexts, as combination therapy with two or more in vitro active drugs appears to be more effective than monotherapy based on some clinical data. Several promising new agents are in late-stage clinical development, including ceftolozane-tazobactam, ceftazidime-avibactam and plazomicin. Given the shortage of adequate treatment options, containment of CRGNs should be pursued through implementation of adequate infection prevention procedures and antimicrobial stewardship to reduce the disease burden and prevent future outbreaks of CRGNs.
Collapse
Affiliation(s)
- Chang-Seop Lee
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ; Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
41
|
Yamada K, Morinaga Y, Yanagihara K, Kaku N, Harada Y, Uno N, Nakamura S, Imamura Y, Hasegawa H, Miyazaki T, Izumikawa K, Kakeya H, Mikamo H, Kohno S. Azithromycin inhibits MUC5AC induction via multidrug-resistant Acinetobacter baumannii in human airway epithelial cells. Pulm Pharmacol Ther 2014; 28:165-70. [DOI: 10.1016/j.pupt.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/21/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
|
42
|
Carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii: assessing their impact on organ transplantation. Curr Opin Organ Transplant 2014; 15:676-82. [PMID: 20930636 DOI: 10.1097/mot.0b013e3283404373] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review highlights the impact of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii on patients who have undergone organ transplantation and explores both available and potential agents to treat infections caused by these multidrug-resistant (MDR) pathogens. RECENT FINDINGS Few antimicrobials exist to treat carbapenem-resistant Gram-negative infections, and resistance to salvage therapies is escalating. Organ transplantation appears to be a risk factor for infections with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Isolation of these MDR bacteria is increasing and may be associated with allograft failure and mortality. In the majority of cases, aminoglycosides, polymyxins, and tigecycline have been employed to treat these infections. Anecdotal successes exist but these antibiotics may be unreliable. Few novel agents are in development. SUMMARY Bacterial infections remain a leading cause of posttransplantation morbidity and mortality. Carbapenem resistance is a significant threat to allograft and patient survival. With few antimicrobials being developed, transplant centers may be forced to make decisions regarding surveillance, empiric antimicrobial regimens, and transplant candidacy in the setting of carriage of MDR pathogens. There is an urgent need for collaborative studies to address the clinical impact of these infections on transplantation.
Collapse
|
43
|
Talreja D, Kaye KS, Yu FS, Walia SK, Kumar A. Pathogenicity of ocular isolates of Acinetobacter baumannii in a mouse model of bacterial endophthalmitis. Invest Ophthalmol Vis Sci 2014; 55:2392-402. [PMID: 24644055 DOI: 10.1167/iovs.13-13401] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine the virulence properties of ocular isolates of Acinetobacter baumannii in causing endophthalmitis in a mouse model. METHODS Endophthalmitis was induced by intravitreal injections of the bacteria into C57BL/6 (B6) mouse eyes. The disease progression was monitored by ophthalmoscopic, electroretinography (ERG), histologic, cell death (TUNEL labeling), and microbiological parameters. The expression of cytokines/chemokines was checked by quantitative RT-PCR (qRT-PCR) and ELISA. Flow cytometry was used to determine cellular infiltration. The role of neutrophils was determined using neutropenic mice. The virulence traits (biofilm formation, adherence, and cytotoxicity) of the ocular isolates were tested using corneal epithelial cells. RESULTS Among the three clinical isolates and a standard ATCC 19606 strain tested, a biofilm producing multidrug resistant (MDR) strain of A. baumannii AB12 caused severe endophthalmitis (100% destruction of the eyes) leading to the loss of retinal function as assessed by ERG analysis. Elevated levels of inflammatory mediators (TNF-α, IL-1β, CXCL2, and IL-6) were detected in AB12-infected eyes. Histologic and TUNEL staining revealed increased retinal cell death and the flow cytometry data showed the presence of inflammatory cells, primarily neutrophils (CD45(+)/Ly6G(+)). Neutropenic mice showed an increased bacterial burden, reduced inflammatory response, and severe tissue destruction. CONCLUSIONS These results indicate that A. baumannii causes severe intraocular inflammation and retinal damage. Furthermore, neutrophils play an important role in the pathogenesis of A. baumannii endophthalmitis.
Collapse
Affiliation(s)
- Deepa Talreja
- Kresge Eye Institute, Wayne State University, Detroit, Michigan, United States
| | | | | | | | | |
Collapse
|
44
|
Coyle JR, Kaye KS, Taylor T, Tansek R, Campbell M, Hayakawa K, Marchaim D. Effectiveness and cost of implementing an active surveillance screening policy for Acinetobacter baumannii: a Monte Carlo simulation model. Am J Infect Control 2014; 42:283-7. [PMID: 24581017 DOI: 10.1016/j.ajic.2013.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acinetobacter baumannii infections are common and associated with high mortality and costs. Early identification of asymptomatic carriers can reduce patient-to-patient transmission, but the sensitivity of A baumannii surveillance tools is poor, and thus active surveillance is not routine practice. This study examined whether an active surveillance screening policy can reduce the transmission, mortality, and costs associated with A baumannii. METHODS A simulation model was developed to determine the impact of active screening on patient outcomes. Model parameters included A baumannii prevalence, screening sensitivity and specificity, probability of transmission, progression from colonization to infection, mortality, and cost of screening, contact precautions, and infection. A scenario analysis was performed to evaluate the robustness of the results when varying the sensitivity of the screening test and the prevalence rate of A baumannii. RESULTS Assuming a screening sensitivity of 55%, active screening reduced A baumannii transmissions, infections, and deaths by 48%. As the screening sensitivity approached 90%, the reduction in transmissions, infections, and deaths reached 78%. For all scenarios tested, active surveillance was cost saving (19%-53% reduction in mean hospital cost per patient) except at a carrier prevalence of ≤2% and screening test sensitivity of ≤55%. CONCLUSIONS In institutions where A baumannii is endemic or during epidemics, implementing a surveillance program is cost-saving and can greatly reduce transmissions and deaths. Methodologies to improve the sensitivity of surveillance testing will help optimize the clinical impact of active screening programs on preventing the spread of A baumannii in health care facilities.
Collapse
|
45
|
Abstract
OBJECTIVE To characterize the descriptive and molecular epidemiology of Acinetobacter baumannii in our hospital. DESIGN Longitudinal analysis of electronic microbiology laboratory records and isolates. SETTING A 1,500 bed public teaching hospital in the Miami area. PATIENTS Consecutive patients with A. baumannii from January 1994 to December 2011. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS : Data on all A. baumannii isolates were clustered at the patient level, and the first isolate per single patient was determined. Yearly trends were analyzed based on carbapenem susceptibilities and originating units for all first isolates and first blood isolates per unique patient. Additionally, carbapenem nonsusceptible isolates frozen in the microbiology laboratory since 1998 were retrieved and evaluated using polymerase chain reaction and randomly amplified polymorphic DNA techniques. A total of 9,334 A. baumannii isolates were detected, of which 4,484 isolates (48%) were identified as first positive isolates per unique patient. Most of the burden of disease was located in the ICUs (odds ratio, 2.64 [95% CI, 2.17-3.22]; p < 0.0001) and in the adult wards (odds ratio, 3.867 [95% CI, 2.71-5.52]; p < 0.0001). Respiratory specimens constituted the most frequent source (49%; odds ratio, 1.619 [95% CI, 1.391-1.884]; p < 0.0001). Of the 4,484 first isolates, 846 isolates (18.9%) were carbapenem nonsusceptible and 3,638 isolates (81.1%) were carbapenem susceptible. Over the years, the number of carbapenem nonsusceptible isolates increased, whereas the number of carbapenem susceptible decreased (p < 0.0001). The trauma ICU had the highest burden of carbapenem nonsusceptible first isolates (205 of 846; 24.2%). Seven clones were discovered among 144 carbapenem nonsusceptible isolates; one of these clones was found from 1999 to 2005. OXA-23 and OXA-40 were identified in 96 and 13 isolates, respectively. One isolate harbored a novel CTX-M-115 enzyme. CONCLUSIONS This constitutes the largest experience with A. baumannii reported to date from a single center. Half of all isolates were respiratory specimens and were from adult ICUs, especially trauma. Even though this was a polyclonal process, a single clone was identified in the hospital through a 6-year span.
Collapse
|
46
|
Talreja D, Muraleedharan C, Gunathilaka G, Zhang Y, Kaye KS, Walia SK, Kumar A. Virulence properties of multidrug resistant ocular isolates of Acinetobacter baumannii. Curr Eye Res 2014; 39:695-704. [PMID: 24502411 DOI: 10.3109/02713683.2013.873055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Acinetobacter (A.) baumannii is an opportunistic pathogen and has been reported as a causative agent of ocular infections. The aim of this study is to identify virulence properties (biofilm formation, adhesion, invasion and cytotoxicity) and antibiotic resistance among A. baumannii isolates recovered from the eye. MATERIALS AND METHODS The Microscan Walk-Away®, an automated bacterial identification and susceptibility testing system was used to determine antibiotic resistance. Clonal relatedness was assessed by Pulsed-field gel electrophoresis (PFGE) and plasmid profile analysis. Conjugation experiments were carried out to determine the transfer of antibiotic resistance genes and PCR was used to confirm gene transfer. Virulence properties of the isolates were determined by biofilm formation using crystal violet and immunofluorescence staining, adherence and internalization using cultured corneal epithelial cells, and cytotoxicity by TUNEL-staining and LDH release assays. RESULTS All ocular isolates (n = 12) exhibited multidrug resistant (MDR) phenotype and one of the isolate (AB12) was resistant to 18 antibiotics (β-lactam, aminoglycosides, tetracycline, chloramphenicol and quinolones). The plasmid profile analysis showed the presence of multiple plasmids in each isolate and a total of 10 different profiles were observed. However, PFGE analysis was more discriminatory which revealed 12 distinct genotypes. Antibiotic resistance (tetracycline and quinolone) was transferable from the isolate AB12 to a recipient Escherichia coli J53. Ten isolates were strong biofilm producers and the remaining two (AB5 and AB7) were moderate producers. All isolates demonstrated adherence and invasive properties towards HCECs. A similar trend was observed in their ability to cause cell death and toxicity. CONCLUSIONS Our results indicate that ocular isolates of A. baumannii are biofilm producers and adherent and invasive to corneal epithelium, a first step in the pathogenesis of ocular infection. In addition, they demonstrated plasmid-mediated transfer of MDR traits making them a reservoir of resistance genes at ocular surface.
Collapse
Affiliation(s)
- Deepa Talreja
- Kresge Eye Institute, Wayne State University , Detroit, MI , USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Pogue JM, Mann T, Barber KE, Kaye KS. Carbapenem-resistantAcinetobacter baumannii: epidemiology, surveillance and management. Expert Rev Anti Infect Ther 2014; 11:383-93. [DOI: 10.1586/eri.13.14] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
48
|
Evaluation of the potential impact of a carbapenem de-escalation program in an academic healthcare system. J Infect Public Health 2013; 7:50-3. [PMID: 24210246 DOI: 10.1016/j.jiph.2013.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/26/2013] [Accepted: 09/18/2013] [Indexed: 11/20/2022] Open
Abstract
The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum β-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patient-days (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution.
Collapse
|
49
|
Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes. Antimicrob Agents Chemother 2013; 57:6270-5. [PMID: 24100492 DOI: 10.1128/aac.01520-13] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acinetobacter baumannii has become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR) A. baumannii has increased, there is a scarcity of studies which investigate BSI caused by CASR A. baumannii. A retrospective cohort study was conducted on adult patients with BSI caused by A. baumannii and who were admitted to the Detroit Medical Center between January 2006 and April 2009. Medical records were queried for patients' demographics, antimicrobial exposures, comorbidities, hospital stay, and clinical outcomes. Bivariate analyses and logistic regression were employed in the study. Two hundred seventy-four patients with BSI caused by A. baumannii were included in the study: 68 (25%) caused by CASR A. baumannii and 206 (75%) caused by non-CASR A. baumannii. In multivariate analysis, factors associated with BSI caused by CASR A. baumannii included admission with a rapidly fatal condition (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.27 to 6.32, P value = 0.01) and prior use of antimicrobials (OR = 2.83, 95% CI = 1.18 to 6.78, P value = 0.02). In-hospital mortality rates for BSI caused by CASR A. baumannii were significantly higher than those for non-CASR A. baumannii-induced BSI (43% versus 20%; OR = 3.0, 95% CI = 1.60 to 5.23, P value < 0.001). However, after adjusting for potential confounders, the association between BSI caused by CASR A. baumannii and increased risk of in-hospital mortality was not significant (OR = 1.15, 95% CI = 0.51 to 2.63, P value = 0.74). This study demonstrated that CASR A. baumannii had a distinct epidemiology compared to more susceptible A. baumannii strains; however, clinical outcomes were similar for the two groups. Admission with a rapidly fatal condition was an independent predictor for both CASR A. baumannii and in-hospital mortality.
Collapse
|
50
|
β -Lactamase-Producing Multidrug-Resistant Bacterial Pathogens from Tracheal Aspirates of Intensive Care Unit Patients at National Institute of Neurological and Allied Sciences, Nepal. ISRN MICROBIOLOGY 2013; 2013:847569. [PMID: 24078895 PMCID: PMC3775398 DOI: 10.1155/2013/847569] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022]
Abstract
The widespread use of tracheal intubation and mechanical ventilation to support the critically ill patients increases the risk of development of tracheobronchitis and bronchopneumonia. This cross-sectional study was conducted with an aim to isolate and identify bacterial pathogens from tracheal aspirates producing extended-spectrum β -lactamase (ESBL), AmpC β -lactamase, and metallo- β -lactamase (MBL) from August 2011 to April 2012 at National Institute of Neurological and Allied Sciences (NINAS), Kathmandu, Nepal. ESBL was detected by combined disk assay using cefotaxime and cefotaxime with clavulanate, AmpC β -lactamase by inhibitor-based method using cefoxitin and phenylboronic acid, and MBL by Imipenem-EDTA combined disk method. 167 bacterial strains were isolated from 187 samples and majority of them were Acinetobacter spp. followed by Klebsiella pneumoniae with 32.9% and 25.1%, respectively. 68.8% of isolates were multidrug resistant (MDR) and Acinetobacter spp. constituted 85.4%. ESBL, AmpC β -lactamase, and MBL were detected in 35 (25%), 51 (37.2%), and 11 (36.7%) isolates, respectively. Pseudomonas spp. (42.8%) were the predominant ESBL producer while Acinetobacter spp. were the major AmpC β -lactamase producer (43.1%) and MBL producer (54.5%).
Collapse
|