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Soman R, Veeraraghavan B, Hegde A, Varma S, Todi S, Singh RK, Nagavekar V, Rodrigues C, Swaminathan S, Ramsubramanian V, Ansari A, Chaudhry D, Pednekar A, Bhagat S, Patil S, Barkate H. Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II). Expert Rev Anti Infect Ther 2024; 22:453-468. [PMID: 38790080 DOI: 10.1080/14787210.2024.2360116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019. AREAS COVERED A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to - face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to - face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus. EXPERT OPINION The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence.
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Affiliation(s)
- Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | | | - Ashit Hegde
- Department of Critical care, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Subhash Varma
- Internal Medicine and Hematology Fortis Hospital Mohali, Mohali, India
| | - Subhash Todi
- Department of Critical Care and Emergency Medicine, AMRI Hospital, Kolkata, India
| | - R K Singh
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vasant Nagavekar
- Department of Infectious Disease, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Camilla Rodrigues
- Department of Microbiology and Serology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - V Ramsubramanian
- Department of Infectious Diseases, Apollo Hospital, Chennai, India
| | - Abdul Ansari
- Department of Critical Care Services, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical care medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Amullya Pednekar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Saiprasad Patil
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Atlas N, Uzair B, Movellan J, Gracia R, Dupin D, Loinaz I, van Nostrum CF, Hays JP. In vitro activity of novel apramycin-dextran nanoparticles and free apramycin against selected Dutch and Pakistani Klebsiella pneumonia isolates. Heliyon 2023; 9:e22821. [PMID: 38125473 PMCID: PMC10730580 DOI: 10.1016/j.heliyon.2023.e22821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Klebsiella pneumoniae are bacteria associated with respiratory tract infections and are increasingly becoming resistant to antibiotics, including carbapenems. Apramycin is a veterinary antibiotic that may have the potential to be re-purposed for use in human health, for example, for the treatment of respiratory tract infections after coupling to inhalable nanoparticles. In the present study, the antibiotic apramycin was formulated with single chain polymeric nanoparticles and tested in free and formulated forms against a set of 13 Klebsiella pneumoniae isolates (from the Netherlands and Pakistan) expressing different aminoglycoside resistance phenotypes. Minimum Inhibitory Concentration, Time Kill Kinetics and biofilm experiments were performed providing evidence for the potential efficacy of apramycin and apramycin-based nanomedicines for the treatment of human Klebsiella pneumonia infections.
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Affiliation(s)
- Nagina Atlas
- Dept. Biological Science, International Islamic University Islamabad, Pakistan
- Utrecht Institute for Pharmaceutical Sciences, Dept. of Pharmaceutics, Utrecht University, Utrecht, the Netherlands
| | - Bushra Uzair
- Dept. Biological Science, International Islamic University Islamabad, Pakistan
| | - Julie Movellan
- CIDETEC, Basque Research and Technology Alliance (BRTA), Parque Científico y Tecnológico de Gipuzkoa, Miramon Pasealekua, 196, Donostia-San Sebastián 20014, Spain
| | - Raquel Gracia
- CIDETEC, Basque Research and Technology Alliance (BRTA), Parque Científico y Tecnológico de Gipuzkoa, Miramon Pasealekua, 196, Donostia-San Sebastián 20014, Spain
| | - Damien Dupin
- CIDETEC, Basque Research and Technology Alliance (BRTA), Parque Científico y Tecnológico de Gipuzkoa, Miramon Pasealekua, 196, Donostia-San Sebastián 20014, Spain
| | - Iraida Loinaz
- CIDETEC, Basque Research and Technology Alliance (BRTA), Parque Científico y Tecnológico de Gipuzkoa, Miramon Pasealekua, 196, Donostia-San Sebastián 20014, Spain
| | - Cornelus F. van Nostrum
- Utrecht Institute for Pharmaceutical Sciences, Dept. of Pharmaceutics, Utrecht University, Utrecht, the Netherlands
| | - John P. Hays
- Dept. Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre (Erasmus MC), Rotterdam, the Netherlands
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Ota Y, Prah I, Mahazu S, Gu Y, Nukui Y, Koike R, Saito R. Novel insights into genetic characteristics of blaGES-encoding plasmids from hospital sewage. Front Microbiol 2023; 14:1209195. [PMID: 37664110 PMCID: PMC10469963 DOI: 10.3389/fmicb.2023.1209195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The prevalence of Guiana extended-spectrum (GES)-type carbapenemase producers is increasing worldwide, and hospital water environments are considered as potential reservoirs. However, the genetic features underlying this resistance are not yet fully understood. This study aimed to characterize blaGES-encoding plasmids from a single-hospital sewage sample in Japan. Methods Carbapenemase producers were screened using carbapenemase-selective agar and polymerase chain reaction. Whole-genome sequencing analyzes were performed on the carbapenemase-producing isolates. Results Eleven gram-negative bacteria (four Enterobacter spp., three Klebsiella spp., three Aeromonas spp., and one Serratia spp.) with blaGES-24 (n = 6), blaGES-6 (n = 4), and blaGES-5 (n = 1) were isolated from the sewage sample. Five blaGES-24 and a blaGES-5 were localized in IncP-6 plasmids, whereas three blaGES-6 plasmids were localized in IncC plasmids with IncF-like regions. The remaining blaGES-6 and blaGES-24 were, respectively, localized on IncFIB-containing plasmids with IncF-like regions and a plasmid with an IncW-like replication protein. The IncP-6 and IncW-like plasmids had a close genetic relationship with plasmids from Japan, whereas the IncC/IncF-like and IncFIB/IncF-like plasmids were closely related to those from the United States and Europe. All blaGES genes were located on the class 1 integron cassette of the Tn3 transposon-related region, and the IncC/IncF-like plasmid carried two copies of the integron cassette. Eight of the eleven blaGES-encoding plasmids contained toxin-antitoxin system genes. Discussion The findings on the plasmids and the novel genetic content from a single wastewater sample extend our understanding regarding the diversity of resistance and the associated spread of blaGES, suggesting their high adaptability to hospital effluents. These findings highlight the need for the continuous monitoring of environmental GES-type carbapenemase producers to control their dissemination.
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Affiliation(s)
- Yusuke Ota
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Isaac Prah
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Samiratu Mahazu
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Parasitology and Tropical Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiaki Gu
- Department of Infectious Diseases, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Nukui
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryuji Koike
- Clinical Research Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Ryoichi Saito
- Department of Molecular Microbiology and Immunology, Tokyo Medical and Dental University, Tokyo, Japan
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