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Sendra E, Fernández-Muñoz A, Zamorano L, Oliver A, Horcajada JP, Juan C, Gómez-Zorrilla S. Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective. Infection 2024; 52:1235-1268. [PMID: 38954392 PMCID: PMC11289218 DOI: 10.1007/s15010-024-02313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.
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Affiliation(s)
- Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
| | - Almudena Fernández-Muñoz
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Laura Zamorano
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Antonio Oliver
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Juan
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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Singh C, Abdullah R. Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital's Adult Intensive Care Unit. Cureus 2024; 16:e59877. [PMID: 38854202 PMCID: PMC11157479 DOI: 10.7759/cureus.59877] [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: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The mitigation of ventilator-associated pneumonia (VAP) is a vital undertaking in safeguarding patient well-being. The research aimed to evaluate the impact of a multidisciplinary, comprehensive monitoring approach on VAP incidence in a tertiary medical-surgical-trauma critical care unit. METHODOLOGY The research was conducted within an adult medical-surgical ICU from June 2021 to December 2022. VAP data were collected by prospective targeted surveillance in accordance with the guidelines provided by the National Healthcare Safety Network (NHSN) and the Centers for Disease Control and Prevention. In contrast, a cross-sectional design was used to gather bundle data, according to the defined methodology of the Institute for Healthcare Improvement (IHI), and the rate of variation in admission prior to the bundle's installation was evaluated. RESULT The features of ventilated patients in adult medical-surgical ICUs were studied between 2021 and 2022. Regarding demographics, men comprised 42.6% and 45.3% of VAP patients and 65.3% and 50.7% of bundle care patients, respectively. Notably, 33.1% of patients in VAP and 54.5% in bundle care were over 60 years old. Clinical indicators such as median age (12.6 vs. 8 months for non-VAP vs. VAP patients), antibiotic usage (65% vs. 99% for non-VAP vs. VAP patients), and risk factors like trauma diagnosis (HR: 2.59, 95% CI: 2.07-3.23), and accidental extubation (HR: 4.11, 95% CI: 1.93-8.73) differed significantly between the bundle and non-bundle care groups. A significant increase in bundle compliance was seen from 90% in 2021 to 97% in 2022 (P-value <0.001), which helped to lower VAP rates and highlight the need for ongoing quality improvement in ICU treatment. CONCLUSION The use of ventilator bundles at a tertiary care hospital resulted in improvements in ventilator utilization, with an approximate increase of 20% and VAP rates of over 70% for adult critical patients.
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Affiliation(s)
- Chandni Singh
- Department of Cardiac Anaesthesia, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Rashid Abdullah
- Department of Anaesthesiology and Critical Care, Chandni Hospital, Kanpur, IND
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Hammoudi Halat D, Ayoub Moubareck C. Hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative pathogens: Understanding epidemiology, resistance patterns, and implications with COVID-19. F1000Res 2024; 12:92. [PMID: 38915769 PMCID: PMC11195619 DOI: 10.12688/f1000research.129080.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 06/26/2024] Open
Abstract
The ongoing spread of antimicrobial resistance has complicated the treatment of bacterial hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Gram-negative pathogens, especially those with multidrug-resistant profiles, including Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, and Acinetobacter spp., are important culprits in this type of infections. Understanding the determinants of resistance in pathogens causing pneumonia is ultimately stressing, especially in the shadows of the COVID-19 pandemic, when bacterial lung infections are considered a top priority that has become urgent to revise. Globally, the increasing prevalence of these pathogens in respiratory samples represents a significant infection challenge, with major limitations of treatment options and poor clinical outcomes. This review will focus on the epidemiology of HAP and VAP and will present the roles and the antimicrobial resistance patterns of implicated multidrug-resistant (MDR) Gram-negative pathogens like carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Enterobacterales (CRE), as well as colistin-resistant Gram-negative pathogens and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. While emerging from the COVID-19 pandemic, perspectives and conclusions are drawn from findings of HAP and VAP caused by MDR Gram-negative bacteria in patients with COVID-19.
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Li Y, Roberts JA, Walker MM, Aslan AT, Harris PNA, Sime FB. The global epidemiology of ventilator-associated pneumonia caused by multi-drug resistant Pseudomonas aeruginosa: A systematic review and meta-analysis. Int J Infect Dis 2024; 139:78-85. [PMID: 38013153 DOI: 10.1016/j.ijid.2023.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES The objective of this systematic review and meta-analysis was to estimate the global prevalence of multi-drug resistant (MDR) Pseudomonas aeruginosa causing ventilator-associated pneumonia (VAP). METHODS The systematic search was conducted in four databases. Original studies describing MDR P. aeruginosa VAP prevalence in adults from 2012- 2022 were included. A meta-analysis, using the random effects model, was conducted for overall, subgroups (country, published year, study duration, and study design), and European data, respectively. Univariate meta-regression based on pooled estimates was also conducted. Systematic review registered in International Prospective Register of Systematic Review (CRD42022384035). RESULTS In total of 31 studies, containing a total of 7951 cases from 16 countries, were included. The overall pooled prevalence of MDR among P. aeruginosa causing VAP was 33% (95% confidence interval [CI] 27.7-38.3%). The highest prevalence was for Iran at 87.5% (95% CI 69-95.7%), and the lowest was for the USA at 19.7% (95% CI 18.6-20.7%). The European prevalence was 29.9% (95% CI 23.2-36.7%). CONCLUSIONS This review indicates that the prevalence of MDR P. aeruginosa in patients with VAP is generally high and varies significantly between countries; however, data are insufficient for many countries. The data in this study can provide a reference for VAP management and drug customisation strategies.
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Affiliation(s)
- Yixuan Li
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Departments of Phaemacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mikaela M Walker
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Abdullah Tarik Aslan
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Patrick N A Harris
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Pathology Queensland, Health Support Queensland, Herston, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia.
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Rosenthal VD, Jin Z, Rodrigues C, Myatra SN, Divatia JV, Biswas SK, Shrivastava AM, Kharbanda M, Nag B, Mehta Y, Sarma S, Todi SK, Bhattacharyya M, Bhakta A, Gan CS, Low MSY, Bt Madzlan Kushairi M, Chuah SL, Wang QY, Chawla R, Jain AC, Kansal S, Bali RK, Arjun R, Davaadagva N, Bat-Erdene B, Begzjav T, Mohd Basri MN, Tai CW, Lee PC, Tang SF, Sandhu K, Badyal B, Arora A, Sengupta D, Yin R. Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections. Infect Control Hosp Epidemiol 2023; 44:1261-1266. [PMID: 36278508 DOI: 10.1017/ice.2022.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify risk factors for mortality in intensive care units (ICUs) in Asia. DESIGN Prospective cohort study. SETTING The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. PARTICIPANTS Patients aged >18 years admitted to ICUs. RESULTS In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). CONCLUSIONS Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
- International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, United States
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
| | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Sanjay K Biswas
- Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
| | | | | | | | | | | | | | | | - Arpita Bhakta
- Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Soo Lin Chuah
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Qi Yuee Wang
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Pei-Chuen Lee
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Swee-Fong Tang
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Kavita Sandhu
- Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
| | - Binesh Badyal
- Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
| | - Ankush Arora
- Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
| | - Deep Sengupta
- Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
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Plasencia-Rebata S, Levy-Blitchtein S, Del Valle-Mendoza J, Silva-Caso W, Peña-Tuesta I, Vicente Taboada W, Barreda Bolaños F, Aguilar-Luis MA. Effect of Phenylalanine-Arginine Beta-Naphthylamide on the Values of Minimum Inhibitory Concentration of Quinolones and Aminoglycosides in Clinical Isolates of Acinetobacter baumannii. Antibiotics (Basel) 2023; 12:1071. [PMID: 37370390 DOI: 10.3390/antibiotics12061071] [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: 04/16/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Acinetobacter baumannii has become the most important pathogen responsible for nosocomial infections in health systems. It expresses several resistance mechanisms, including the production of β-lactamases, changes in the cell membrane, and the expression of efflux pumps. (2) Methods: A. baumannii was detected by PCR amplification of the blaOXA-51-like gene. Antimicrobial susceptibility to fluoroquinolones and aminoglycosides was assessed using the broth microdilution technique according to 2018 CLSI guidelines. Efflux pump system activity was assessed by the addition of a phenylalanine-arginine beta-naphthylamide (PAβN) inhibitor. (3) Results: A total of nineteen A. baumannii clinical isolates were included in the study. In an overall analysis, in the presence of PAβN, amikacin susceptibility rates changed from 84.2% to 100%; regarding tobramycin, they changed from 68.4% to 84.2%; for nalidixic acid, they changed from 73.7% to 79.0%; as per ciprofloxacin, they changed from 68.4% to 73.7%; and, for levofloxacin, they stayed as 79.0% in both groups. (4) Conclusions: The addition of PAβN demonstrated a decrease in the rates of resistance to antimicrobials from the family of quinolones and aminoglycosides. Efflux pumps play an important role in the emergence of multidrug-resistant A. baumannii strains, and their inhibition may be useful as adjunctive therapy against this pathogen.
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Affiliation(s)
- Stefany Plasencia-Rebata
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Saul Levy-Blitchtein
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Microbiology Department, Vall d'Hebron University Hospital, 08034 Barcelona, Spain
| | - Juana Del Valle-Mendoza
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Laboratorio de Biomedicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Instituto de Investigación Nutricional, Lima 15024, Peru
| | - Wilmer Silva-Caso
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Laboratorio de Biomedicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Instituto de Investigación Nutricional, Lima 15024, Peru
| | - Isaac Peña-Tuesta
- Laboratorio de Biomedicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Instituto de Investigación Nutricional, Lima 15024, Peru
| | | | | | - Miguel Angel Aguilar-Luis
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Laboratorio de Biomedicina, Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Instituto de Investigación Nutricional, Lima 15024, Peru
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Hassan ME, Al-Khawaja SA, Saeed NK, Al-Khawaja SA, Al-Awainati M, Radhi SSY, Alsaffar MH, Al-Beltagi M. Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain: Prevalence and antibiotics susceptibility pattern. World J Crit Care Med 2023; 12:165-175. [PMID: 37397586 PMCID: PMC10308340 DOI: 10.5492/wjccm.v12.i3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that. It is the most common infection encountered among intubated patients. VAP incidence showed wide variability between countries.
AIM To define the VAP incidence in the intensive care unit (ICU) in the central government hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.
METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020. It included adult and adolescent patients (> 14 years old) admitted to the ICU and required intubation and mechanical ventilation. VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score, which considers the clinical, laboratory, microbiological, and radiographic evidence.
RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155. Forty-six patients developed VAP during their ICU stay (29.7%). The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period, with a mean age of 52 years ± 20. Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96 ± 6.55. Gram-negative contributed to most VAP cases in our unit, with multidrug-resistant Acinetobacter being the most identified pathogen.
CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark, which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.
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Affiliation(s)
- Mohamed Eliwa Hassan
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Safaa Abdulaziz Al-Khawaja
- Infectious Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Medical Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busiateen 15503, Muharraq, Bahrain
| | - Sana Abdulaziz Al-Khawaja
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mahmood Al-Awainati
- Department of Family Medicine, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Sara Salah Yusuf Radhi
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohamed Hameed Alsaffar
- Intensive Care Unit, Department of Internal medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain, Manama 12, Manama, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
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Alnimr A. Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy. Infect Dis Ther 2023:10.1007/s40121-023-00820-2. [PMID: 37273072 DOI: 10.1007/s40121-023-00820-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that is frequent, as more than half of antibiotics prescriptions in ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred to in different settings. The estimated attributable mortality of VAP can go up to 50%, which is higher in cases of antimicrobial-resistant VAP. When the diagnosis of pneumonia in a mechanically ventilated patient is made, initiation of effective antimicrobial therapy must be prompt. Microbiological diagnosis of VAP is required to optimize timely therapy since effective early treatment is fundamental for better outcomes, with controversy continuing regarding optimal sampling and testing. Understanding the role of antimicrobial resistance in the context of VAP is crucial in the era of continuously evolving antimicrobial-resistant clones that represent an urgent threat to global health. This review is focused on the risk factors for antimicrobial resistance in adult VAP and its novel microbiological tools. It aims to summarize the current evidence-based knowledge about the mechanisms of resistance in VAP caused by multidrug-resistant bacteria in clinical settings with focus on Gram-negative pathogens. It highlights the evidence-based antimicrobial management and prevention of drug-resistant VAP. It also addresses emerging concepts related to predictive microbiology in VAP and sheds lights on VAP in the context of coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Amani Alnimr
- Department of Microbiology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
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The prevalence of antibiotic-resistant Acinetobacter baumannii infections among the Iranian ICU patients: A systematic review and meta-analysis. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Rosenthal VD, Yin R, Lu Y, Rodrigues C, Myatra SN, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Daboor MA, Todi SK, Aguirre-Avalos G, Guclu E, Gan CS, Alvarez LFJ, Chawla R, Hlinkova S, Arjun R, Agha HM, Chavarria MAZ, Davaadagva N, Basri MNM, Gomez K, De Moros DA, Tai CW, Gonzalez AS, Moreno LAA, Sandhu K, Janc J, Bocanegra MCA, Yildizdas D, Medina YAC, Mota MIV, Omar AA, Duszynska W, BelKebir S, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Memish ZA, Jin Z. The Impact of Healthcare-Associated Infections on Mortality in ICU: A Prospective Study in Asia, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2022; 51:675-682. [PMID: 36075294 DOI: 10.1016/j.ajic.2022.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients. METHODS Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries. RESULTS Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (CLABSI) (aOR:1.84; p<0.0001); ventilator-associated pneumonia (VAP) (aOR:1.48; p<0.0001); catheter-associated urinary tract infection (CAUTI) (aOR:1.18;p<0.0001); medical hospitalization (aOR:1.81; p<0.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; p<0.0001); female gender (aOR:1.09; p<0.0001); age (aOR:1.012; p<0.0001); central line-days, risk rises 2% per day (aOR:1.02; p<0.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; p<0.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;p<0.0001). CONCLUSION Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; CLABSI, VAP, CAUTI, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fl, U.S.; International Nosocomial Infection Control Consortium, Miami, Fl, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fl, U.S
| | - Yawen Lu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fl, U.S
| | - Camilla Rodrigues
- Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde. Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Sona Hlinkova
- Catholic University In Ruzomberok, Faculty Of Health, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | | | | | | | | | | | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | | | | | | | | | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Wieslawa Duszynska
- Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Souad BelKebir
- An Najah National University Hospital, Nablus, Palestine
| | - Amani Ali El-Kholy
- Dar Alfouad Hospital, 6th of October City., sixth of October City, Egypt
| | | | - George Horhat Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | - Lili Tao
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fl, U.S
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Capasso R, Pinto A, Serra N, Atripaldi U, Corcione A, Bocchini G, Guarino S, Lieto R, Rea G, Sica G, Valente T. Alert Germ Infections: Chest X-ray and CT Findings in Hospitalized Patients Affected by Multidrug-Resistant Acinetobacter baumannii Pneumonia. Tomography 2022; 8:1534-1543. [PMID: 35736874 PMCID: PMC9228714 DOI: 10.3390/tomography8030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
Acinetobacter baumannii (Ab) is an opportunistic Gram-negative pathogen intrinsically resistant to many antimicrobials. The aim of this retrospective study was to describe the imaging features on chest X-ray (CXR) and computed tomography (CT) scans in hospitalized patients with multidrug-resistant (MDR) Ab pneumonia. CXR and CT findings were graded on a three-point scale: 1 represents normal attenuation, 2 represents ground-glass attenuation, and 3 represents consolidation. For each lung zone, with a total of six lung zones in each patient, the extent of disease was graded using a five-point scale: 0, no involvement; 1, involving 25% of the zone; 2, 25−50%; 3, 50−75%; and 4, involving >75% of the zone. Points from all zones were added for a final total cumulative score ranging from 0 to 72. Among 94 patients who tested positive for MDR Ab and underwent CXR (males 52.9%, females 47.1%; mean age 64.2 years; range 1−90 years), 68 patients underwent both CXR and chest CT examinations. The percentage of patients with a positive CT score was significantly higher than that obtained on CXR (67.65% > 35.94%, p-value = 0.00258). CT score (21.88 ± 15.77) was significantly (p-value = 0.0014) higher than CXR score (15.06 ± 18.29). CXR and CT revealed prevalent bilateral abnormal findings mainly located in the inferior and middle zones of the lungs. They primarily consisted of peripheral ground-glass opacities and consolidations which predominated on CXR and CT, respectively.
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Affiliation(s)
- Raffaella Capasso
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-081-706-2629
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80138 Napoli, Italy;
| | - Umberto Atripaldi
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Adele Corcione
- Department of Translational Medical Sciences, Section of Pediatrics, University Federico II of Naples, 80138 Napoli, Italy;
| | - Giorgio Bocchini
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Salvatore Guarino
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy; (U.A.); (G.B.); (S.G.); (R.L.); (G.R.); (G.S.); (T.V.)
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Bharathi KS, Pruthi G, Lathashree S, Simha P. The Bacteriological and Clinical Outcomes of Ventilator-associated Pneumonia Post-cardiac Surgery in the Pediatric Surgical Intensive Care Unit: A Prospective, Observational Study. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_174_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Li ZJ, Wang KW, Liu B, Zang F, Zhang Y, Zhang WH, Zhou SM, Zhang YX. The Distribution and Source of MRDOs Infection: A Retrospective Study in 8 ICUs, 2013-2019. Infect Drug Resist 2021; 14:4983-4991. [PMID: 34866918 PMCID: PMC8636692 DOI: 10.2147/idr.s332196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background To analyze the distribution and source of MDROs infection in the ICUs and to provide a basis for formulating more effective prevention and control programs for MDROs. Methods A retrospective investigation was conducted on MDROs infection in 8 ICUs of a large tertiary hospital from July 2013 to June 2019. A total of 2629 strains of MDROs isolated from 1701 inpatients were selected for analysis. The MDROs of the 8 ICUs were divided into two types of four categories according to source: out-of-hospital (out-of-hospital transfer and community acquisition) and in-hospital (in-hospital transfer and department acquisition) infections. Results CRAB (41.84%) and CRE (35.07%) accounted for the majority of the infecting MDROs. The detection rates of MRSA, CRAB, CRPA and CRE were 61.24%, 83.75%, 43.01% and 30.15%, respectively. The top three infection sites of MDROs were the lower respiratory tract (81.10%), blood (6.70%) and abdominal cavity (5.80%). The out-of-hospital and in-hospital infection rates of MDROs were 50.51% and 49.49%, respectively; the out-of-hospital infection rates for MRSA, CRAB, CRPA and CRE were 43.56%, 55.91, 64.44% and 44.58%, respectively. The proportions of MRSA, CRAB, CRPA and CRE infections contracted in the department were 40.98%, 36.27%, 25.56% and 46.62%, respectively. There was a statistically significant difference between comprehensive ICU and specialized ICU wards as sources for CRAB infections (P < 0.001). Conclusion The main source of MDROs in the ICU is not the hospital itself entirely. It is particularly important to strengthen the identification of MDRO sources and implement more effective and accurate infection prevention and control measures.
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Affiliation(s)
- Zhan-Jie Li
- Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Ke-Wei Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Jiangnan University, Wuxi, 214062, Jiangsu, People's Republic of China
| | - Bo Liu
- Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Feng Zang
- Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yu Zhang
- Department of Infection Management, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Wei-Hong Zhang
- Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Su-Ming Zhou
- Department of Geriatric Critical Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yong-Xiang Zhang
- Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
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14
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Rahimibashar F, Miller AC, Yaghoobi MH, Vahedian-Azimi A. A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study. BMC Pulm Med 2021; 21:161. [PMID: 33985474 PMCID: PMC8118372 DOI: 10.1186/s12890-021-01527-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. Methods A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal aspirate cultures (TAC) and serum procalcitonin values were obtained for each patient. Results Eighty-five patients were enrolled (VAP 45, controls 40). Using HELICS as the reference standard, the sensitivity and specificity for each of the assessed diagnostic algorithms were: CDC/NHSN (Sensitivity 54.2%; Specificity 100%), CPIS (Sensitivity 68.75%; Specificity 95.23%), Johanson (Sensitivity 67.69%; Specificity 95%). The positive TAC rate was 81.2%. The sensitivity for positive TAC with the serum procalcitonin level > 0.5 ng/ml was 51.8%. Conclusion VAP remains a considerable source of morbidity and mortality in modern intensive care units. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS had the greatest comparative diagnostic accuracy, whereas the sensitivity of the CDC/NHSN was only marginally better than a positive TAC plus serum procalcitonin > 0.5 ng/ml. Algorithm accuracy was improved by adding serum procalcitonin > 0.5 ng/ml, but not positive quantitative TAC. Trial Registration: Not indicated for this study type.
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Affiliation(s)
- Farshid Rahimibashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Andrew C Miller
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
| | - Mojtaba H Yaghoobi
- Department of Infectious and Tropical Diseases, Alborz University of Medical Sciences, Alborz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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15
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Kharel S, Bist A, Mishra SK. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS One 2021; 16:e0247832. [PMID: 33690663 PMCID: PMC7942996 DOI: 10.1371/journal.pone.0247832] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/14/2021] [Indexed: 12/17/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). The South East Asian Region is a part of the world with limited health resources where infectious diseases are still underestimated. We aimed to review the literature in this part of the world to describe incidence, mortality and microbiological evidence of VAP and explore preventive and control strategies. We selected 24 peer-reviewed articles published from January 1, 2000 to September 1, 2020 from electronic databases and manual searching for observational studies among adult patients diagnosed with VAP expressed per thousand days admitted in ICU. The VAP rates ranged from 2.13 to 116 per thousand days, varying among different countries of this region. A significant rate of mortality was observed in 13 studies ranging from 16.2% to 74.1%. Gram negative organisms like Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae and Gram-positive organisms like Staphylococcus aureus and Enterococcus species were frequently found. Our findings suggest an alarming situation of VAP among patients of most of the countries of this region with increasing incidence, mortality and antibiotic resistance. Thus, there is an urgent need for cost effective control and preventive measures like interventional studies and educational programs on staff training, hand hygiene, awareness on antibiotic resistance, implementation of antibiotic stewardship programs and appropriate use of ventilator bundle approach.
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Affiliation(s)
- Sanjeev Kharel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
- * E-mail:
| | - Anil Bist
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Shyam Kumar Mishra
- Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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16
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Arayasukawat P, So-Ngern A, Reechaipichitkul W, Chumpangern W, Arunsurat I, Ratanawatkul P, Chuennok W. Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand. BMC Pulm Med 2021; 21:47. [PMID: 33516213 PMCID: PMC7847239 DOI: 10.1186/s12890-021-01415-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50% EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8%) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS [median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days], hospital LOS [median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days] shorter MV days [median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days] and lower hospital mortality (16.7% vs 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 [95% confidence interval (CI), 1.08–4.54, p = 0.02]. Conclusion LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.
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Affiliation(s)
- Pavarit Arayasukawat
- Department of Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Apichart So-Ngern
- Division of Sleep Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Wipa Reechaipichitkul
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Worawat Chumpangern
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Itthiphat Arunsurat
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pailin Ratanawatkul
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wanna Chuennok
- Infectious Control Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Medina-Rojas M, Stribling W, Snesrud E, Garry BI, Li Y, Gann PM, Demons ST, Tyner SD, Zurawski DV, Antonic V. Comparison of Pseudomonas aeruginosa strains reveals that Exolysin A toxin plays an additive role in virulence. Pathog Dis 2020; 78:5804881. [PMID: 32167551 DOI: 10.1093/femspd/ftaa010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa possesses an array of virulence genes ensuring successful infection development. A two-partner secretion system Exolysin BA (ExlBA) is expressed in the PA7-like genetic outliers consisting of ExlA, a pore-forming toxin and ExlB transporter protein. Presence of exlBA in multidrug-resistant (MDR) strains has not been investigated, particularly in the strains isolated from wounded soldiers. METHODS We screened whole genome sequences of 2439 MDR- P. aeruginosa strains for the presence of exlBA. We compiled all exlBA positive strains and compared them with a diversity set for demographics, antimicrobial profiles and phenotypic characteristics: surface motility, biofilm formation, pyocyanin production and hemolysis. We compared the virulence of strains with comparable phenotypic characteristics in Galleria mellonella. RESULTS We identified 33 exlBA-positive strains (1.5%). These strains have increased antibiotic resistance, they are more motile, produce more robust biofilms and have comparable pyocianin production with the diversity set despite the phenotypic differences within the group. In in vivo infection models, these strains were less virulent than Type III Secretion System (T3SS) positive counterparts. CONCLUSIONS exlBA-positive strains are wide spread among the PA7-like outliers. While not as virulent as strains possessing T3SS, these strains exhibit phenotypic features associated with virulence and are still lethal in vivo.
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Affiliation(s)
- Maria Medina-Rojas
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - William Stribling
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Erik Snesrud
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Brittany I Garry
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Yuanzhang Li
- Walter Reed Army Institute of Research, Preventive Medicine, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Patrick Mc Gann
- Walter Reed Army Institute of Research, Multidrug-Resistant Organism Repository and Surveillance Network, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Samandra T Demons
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Stuart D Tyner
- Walter Reed Army Institute of Research, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Daniel V Zurawski
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
| | - Vlado Antonic
- Walter Reed Army Institute of Research, Wound Infections Department, Bacterial Disease Branch, 503 Robert Grant Ave, Silver Spring MD, 20910, USA
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Gong Z, Li J, Luo H, Zhan D, Liu X, Gao C, Huang J, Qian Y, Song Y, Quan W, An S, Tian Y, Hu Z, Sun J, Yuan H, Jiang R. Low-temperature laminar flow ward for the treatment of multidrug resistance Acinetobacter baumannii pneumonia. Eur J Clin Microbiol Infect Dis 2020; 39:877-887. [PMID: 31898800 PMCID: PMC7223702 DOI: 10.1007/s10096-019-03790-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/04/2019] [Indexed: 01/17/2023]
Abstract
This study was designed to investigate the effect of low-temperature laminar flow ward (LTLFW) on the Acinetobacter baumannii pneumonia (MDR-ABP) in neurosurgical intensive care unit (NICU) patients. We evaluated whether patients in a LTLFW had significantly improved clinical outcomes as compared to those in nonconstant-temperature NICU (room temperature). The association of temperature with the prevalence of ABP and A. baumannii isolates (ABI) found in NICU patients was specifically investigated. In vitro microbiological experiments were conducted to measure the proliferation, antibiotic sensitivity, and genomic profiles of A. baumannii (AB) that grew in variable temperatures. MDR-ABP patients in LTLFW had significantly improved outcomes than those in the room temperature NICU. In addition, the numbers of ABI were positively associated with mean ambient outdoor temperatures (P = 0.002), with the incidence of ABP and average numbers of ABI among NICU patients being substantially lower in the winter as compared to other seasons. However, there were no significant seasonal variations in the other strains of the top five bacteria. Consistent with these clinical observations, AB growing at 20°C and 25°C had significantly reduced viability and antibiotic resistance compared to those growing at 35°C. The expression of genes related to AB survival ability, drug resistance, and virulence also differed between AB growing at 20°C and those at 35°C. LTLFW is effective in promoting the recovery of MDR-ABP patients because low temperatures reduced the density and virulence of AB and enhanced the efficacy of antibiotics, likely at the genetic level.
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Affiliation(s)
- Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | | | - Hongliang Luo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Daqiang Zhan
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Yu Qian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Yiming Song
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Zhidong Hu
- Department of clinical laboratories, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Hengjie Yuan
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.
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Bozkurt-Guzel C, Inci G, Oyardi O, Savage PB. Synergistic Activity of Ceragenins Against Carbapenem-Resistant Acinetobacter baumannii Strains in Both Checkerboard and Dynamic Time-Kill Assays. Curr Microbiol 2020; 77:1419-1428. [PMID: 32189050 PMCID: PMC7223130 DOI: 10.1007/s00284-020-01949-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Abstract
Acinetobacter baumannii is an emerging opportunistic pathogen that primarily infects critically ill patients in nosocomial settings and there is a need for identifying new alternative therapeutic agents against these organisms. Ceragenins are non-peptide, membrane-active agents that mimic the antimicrobial properties of antimicrobial peptides (AMPs) and affect the membrane permeability of microorganisms. The in vitro activities of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 either alone or in combination with colistin (sulphate) were determined against 25 carbapenem-resistant A. baumannii strains. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of selected ceragenins and colistin against these isolates were measured by in vitro microbroth dilution techniques. Checkerboard techniques and time-kill assays were performed to determine the activities of combinations. The MIC50 values (mg/L) of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 and colistin were 32, 4, 8, 2, 4 and 0.5, respectively. The MIC90 (mg/L) of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 and colistin were 128, 8, 16, 8, 16 and 16, respectively. At 6 h, 1×MIC and 2×MIC of CSA-13 were bactericidal. CSA-13 + colistin combination displayed synergistic interaction. Antagonism between antimicrobials was not observed. According to the results, CSA-13 and CSA-131 can be good alternatives for infections caused by carbapenem-resistant A. baumannii.
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Affiliation(s)
- Cagla Bozkurt-Guzel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Gozde Inci
- Department of Biochemistry, College of Medicine, Hallym University, Gangwon-do, Chuncheon, 200-702, South Korea
| | - Ozlem Oyardi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey.
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, 84602, USA
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Wang Y, Zhang R, Liu W. Distribution and drug resistance of pathogenic bacteria in ventilator-associated pneumonia at a local hospital of North-eastern China. Infect Drug Resist 2018; 11:2249-2255. [PMID: 30519063 PMCID: PMC6239098 DOI: 10.2147/idr.s172598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the distribution of pathogenic bacteria in ventilator-associated pneumonia (VAP), and epidemiological characteristics of extended-spectrum β lactamase (ESBL)-producing bacteria. Patients and methods Lower respiratory tract secretions from 156 patients with mechanical ventilation were collected using a protective specimen brush (PSB), with quantitative bacterial culture carried out and antibiotic sensitivity measured. ESBLs produced by Gram-negative bacilli were detected using the double disk diffusion method and monitored by plasmid profiles. Results Gram-negative bacilli accounted for 78.9% of VAP pathogens, with Acinetobacter baumannii (25%), Pseudomonas aeruginosa (19.7%), and Klebsiella pneumoniae (14.5%) as the most common strains. There were 12 Gram-positive strains detected (15.8%); mostly methicillin-resistant. Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus. There were also four strains of Candida albicans detected (5.26%). Most Gram-negative bacilli are sensitive to imipenem, but A. baumannii is serious resistant. ESBLs were detected in nine strains of Gram-negative bacilli; mainly produced by K. pneumoniae and Escherichia coli, to different degrees of multidrug resistance. Five strains of K. pneumoniae-producing ESBLs were from the same clonal origin, as confirmed by plasmid restriction endonuclease analysis. Conclusion VAP was mainly caused by Gram-negative bacteria, with high antibiotic resistance rates. Plasmids played an important role in the spread of antibiotic resistance among bacteria.
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Affiliation(s)
- Yu Wang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
| | - Rong Zhang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
| | - Wei Liu
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
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Lin S, Liang L, Zhang C, Ye S. Preliminary experience of tigecycline treatment in critically ill children with ventilator-associated pneumonia. J Int Med Res 2018; 48:300060518760435. [PMID: 29614915 PMCID: PMC7113491 DOI: 10.1177/0300060518760435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Ventilator-associated pneumonia (VAP) is a life-threatening complication for
children who are treated in a paediatric intensive care unit. Tigecycline
treatment of children with VAP has not been well studied. This study aimed
to describe tigecycline use in children with VAP in a tertiary care
hospital. Methods We conducted a retrospective chart review in a tertiary hospital from May 1,
2012 to May 1, 2017. Results Twenty-four children (20 girls) with median age of 8 months (range, 27 days
to 6 years and 9 months) were treated with tigecycline. In-hospital
mortality was 41.7% (10/24). The primary diagnosis was congenital heart
disease (15/24). A total of 70.8% (17/24) of patients received a loading
dose (1.5 mg/kg), followed by 1 mg/kg every 12 hours. The median duration of
tigecycline therapy was 10.75 days (range, 3–21.5 days). Sulperazone was the
most frequently used concomitant antibiotic. Eighteen pathogens were
isolated in 16 cases. Tigecycline therapy failed in 41.6% (10/24) of
patients and 20.8% (5/24) died. The pathogen was eradicated in 37.5% (6/16)
of patients. No serious adverse effects were detected. Conclusion Tigecycline combined with other agents as salvage therapy in children with
VAP is well tolerated. Our preliminary results show a positive clinical
response.
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Affiliation(s)
- Shupeng Lin
- 37066 Zhejiang University School of Medicine Children's Hospital , Division of Hematology- Oncology, No. 57 Zhugan Road, Hangzhou, CN 310052
| | - Lingfang Liang
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
| | - Chenmei Zhang
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
| | - Sheng Ye
- 37066 Zhejiang University School of Medicine Children's Hospital , Pediatric Intensive Care Unit, No. 3333 Binsheng Road, Hangzhou, CN 310003
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A Systematic Review of the Burden of Multidrug-Resistant Healthcare-Associated Infections Among Intensive Care Unit Patients in Southeast Asia: The Rise of Multidrug-Resistant Acinetobacter baumannii. Infect Control Hosp Epidemiol 2018; 39:525-533. [PMID: 29580299 DOI: 10.1017/ice.2018.58] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVETo summarize the clinical burden (cumulative incidence, prevalence, case fatality rate and length of stay) and economic burden (healthcare cost) of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDROs) among patients in intensive care units (ICUs) in Southeast Asia.DESIGNSystematic review.METHODSWe conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, EconLit, and the Cochrane Library databases from their inception through September 30, 2016. Clinical and economic burdens and study quality were assessed for each included study.RESULTSIn total, 41 studies met our inclusion criteria; together, 22,876 ICU patients from 7 Southeast Asian countries were included. The cumulative incidence of HAI caused by A. baumannii (AB) in Southeast Asia is substantially higher than has been reported in other regions, especially carbapenem-resistant AB (CRAB; 64.91%) and multidrug-resistant AB (MDR-AB) (58.51%). Evidence of a dose-response relationship between different degrees of drug resistance and excess mortality due to AB infections was observed. Adjusted odds ratios were 1.23 (95% confidence interval [CI], 0.51-3.00) for MDR-AB, 1.72 (95% CI, 0.77-3.80) for extensively drug-resistant AB (XDR-AB), and 1.82 (95% CI, 0.55-6.00) for pandrug-resistant AB (PDR-AB). There is, however, a paucity of published data on additional length of stay and costs attributable to MDROs.CONCLUSIONSThis review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society. With our findings, we hope to draw the attention of clinicians and policy makers to the problem of antibiotic resistance and to issue a call for action in the management of MDROs.Infect Control Hosp Epidemiol 2018;39:525-533.
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Palavutitotai N, Jitmuang A, Tongsai S, Kiratisin P, Angkasekwinai N. Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections. PLoS One 2018; 13:e0193431. [PMID: 29470531 PMCID: PMC5823452 DOI: 10.1371/journal.pone.0193431] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality. METHODS We retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014. RESULTS Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05-36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36-10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44-7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66-28.82), admission to a medical department (aOR 4.67; 95% CI 1.81-12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50-9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05-7.08). CONCLUSION The prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.
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Affiliation(s)
- Nattawan Palavutitotai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anupop Jitmuang
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarachai Kiratisin
- Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Risk factors for Pseudomonas aeruginosa infections in Asia-Pacific and consequences of inappropriate initial antimicrobial therapy: A systematic literature review and meta-analysis. J Glob Antimicrob Resist 2018; 14:33-44. [PMID: 29454906 DOI: 10.1016/j.jgar.2018.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Treating infections of Gram-negative pathogens, in particular Pseudomonas aeruginosa, is a challenge for clinicians in the Asia-Pacific region owing to inherent and acquired antimicrobial resistance. This systematic review and meta-analysis provides updated information on risk factors for P. aeruginosa infection in Asia-Pacific as well as the consequences (e.g. mortality, costs) of initial inappropriate antimicrobial therapy (IIAT). METHODS Embase and MEDLINE databases were searched for Asia-Pacific studies reporting the consequences of IIAT versus initial appropriate antimicrobial therapy (IAAT) in Gram-negative bacterial infections as well as risk factors for serious P. aeruginosa infection. A meta-analysis of unadjusted mortality was performed using a random-effects model. RESULTS A total of 22 studies reporting mortality and 13 reporting risk factors were identified. The meta-analysis demonstrated that mortality was significantly lower in patients receiving IAAT versus IIAT, with a 67% reduction observed for 28- or 30-day all-cause mortality (odds ratio=0.33, 95% confidence interval 0.20-0.55; P<0.001). Risk factors for serious P. aeruginosa infection include previous exposure to antimicrobials, mechanical ventilation and previous hospitalisation. CONCLUSION High rates of antimicrobial resistance in Asia-Pacific as well as the increased mortality associated with IIAT and the presence of risk factors for serious infection highlight the importance of access to newer and appropriate antimicrobials.
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25
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In situ detection of live-to-dead bacteria ratio after inactivation by means of synchronous fluorescence and PCA. Proc Natl Acad Sci U S A 2018; 115:668-673. [PMID: 29311322 DOI: 10.1073/pnas.1716514115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The determination of live and dead bacteria is of considerable significance for preventing health care-associated infection in hospitals, field clinics, and other areas. In this study, the viable (live) and nonviable (dead) bacteria in a sample were determined by means of their fluorescence spectra and principal component analysis (PCA). Data obtained in this study show that it is possible to identify bacteria strains and determine the live/dead ratio after UV light inactivation and antibiotic treatment, in situ, within minutes. In addition, synchronous fluorescence scans enable the identification of bacterial components such as tryptophan, tyrosine, and DNA. Compared with the time-consuming plating and culturing methods, this study renders a means for rapid detection and determination of live and dead bacteria.
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Shi H, Zhu J, Zou B, Shi L, Du L, Long Y, Wang H, Xu H, Zhen Y, Sun L. Effects of specific egg yolk immunoglobulin on pan-drug-resistant Acinetobacter baumannii. Biomed Pharmacother 2017; 95:1734-1742. [PMID: 28962078 PMCID: PMC7126593 DOI: 10.1016/j.biopha.2017.09.112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/02/2023] Open
Abstract
With the growing emergence of
pan-drug-resistant Acinetobacter baumannii
(PDR-Ab) strains in clinical, new strategies for the treatment of PDR-Ab
infections are urgently needed. Egg yolk immunoglobulin (IgY) as a
convenient and inexpensive antibody has been widely applied to the
therapy of infectious diseases. The aim of this study was to produce IgY
specific to PDR-Ab and investigate its antibacterial effects
in vitro and in vivo.
IgYs specific to two PDR-Ab strains were produced by immunizing hens with
formaldehyde inactivated PDR-Ab cells and isolated from yolks with a
purity of 90% by water dilution, salt precipitations and ultrafiltration.
IgYs showed high titers when subjected to an ELISA and inhibited the
growth of PDR-Ab in a dose-dependent manner in liquid medium. Scanning
electron microscopy assay showed structural modification and aggregation
of PDR-Ab treated with specific IgYs. Freshly cultured PDR-Ab cells were
nasally inhaled in BALB/c mice to induce acute pneumonia. The infected
mice were intraperitoneally injected with specific IgYs using
cefoperazone/sulbactam and dexamethasone as positive controls. The IgYs
specific to PDR-Ab lowered the mortality of mice with PDR-Ab-induced
acute pneumonia, decreased the level of TNF-α and IL-1β in serum and
reduced inflammation in lung tissue. Specific IgY has the potential to be
used as a new therapeutic approach for the treatment of A.
baumannii-induced infections.
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Affiliation(s)
- Huaying Shi
- Affiliated Dalian Friendship Hospital of Dalian Medical University, Dalian, 116001, China
| | - Jie Zhu
- The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116021, China
| | - Boyang Zou
- College of Pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Lei Shi
- College of Pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Linying Du
- College of Pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Yayi Long
- College of Pharmacy, Dalian Medical University, Dalian, 116044, China
| | - Huaxin Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
| | - Hong Xu
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
| | - Yuhong Zhen
- College of Pharmacy, Dalian Medical University, Dalian, 116044, China.
| | - Lidan Sun
- Affiliated Dalian Friendship Hospital of Dalian Medical University, Dalian, 116001, China.
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de Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, de Miguel-Yanes JM, del Rio-Lopez B, Jiménez-García R. Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014. Medicine (Baltimore) 2017; 96:e7625. [PMID: 28746223 PMCID: PMC5627849 DOI: 10.1097/md.0000000000007625] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to describe trends in the incidence and outcomes of ventilator-associated pneumonia (VAP) among hospitalized patients in Spain (2010-2014).This is a retrospective study using the Spanish national hospital discharge database from year 2010 to 2014. We selected all hospital admissions that had an ICD-9-CM code: 997.31 for VAP in any diagnosis position. We analyzed incidence, sociodemographic and clinical characteristics, procedures, pathogen isolations, and hospital outcomes.We identified 9336 admissions with patients suffering a VAP. Incidence rates of VAP decreased significantly over time (from 41.7 cases/100,000 inhabitants in 2010 to 40.55 in 2014). The mean Charlson comorbidity index (CCI) was 1.08 ± 0.98 and it did not change significantly during the study period. The most frequent causative agent was Pseudomonas and there were not significant differences in the isolation of this microorganism over time. Time trend analyses showed a significant decrease in in-hospital mortality (IHM), from 35.74% in 2010 to 32.81% in 2014. Factor associated with higher IHM included male sex, older age, higher CCI, vein or artery occlusion, pulmonary disease, cancer, undergone surgery, emergency room admission, and readmission.This study shows that the incidence of VAP among hospitalized patients has decreased in Spain from 2010 to 2014. The IHM has also decreased over the study period. Further investigations are needed to improve the prevention and control of VAP.
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Affiliation(s)
- Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University
| | | | | | | | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University
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Jiménez-Trujillo I, Jiménez-García R, de Miguel-Díez J, de Miguel-Yanes JM, Hernández-Barrera V, Méndez-Bailón M, Pérez-Farinós N, Salinero-Fort MÁ, López-de-Andrés A. Incidence, characteristic and outcomes of ventilator-associated pneumonia among type 2 diabetes patients: An observational population-based study in Spain. Eur J Intern Med 2017; 40:72-78. [PMID: 28139447 DOI: 10.1016/j.ejim.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND To describe incidence, characteristics and outcomes of ventilator-associated pneumonia (VAP) during hospitalization among patients with or without type 2 diabetes (T2DM). METHODS We used the Spanish national hospital discharge database to select all hospitalization with VAP in subjects aged 40years or more from 2010 to 2014. We analyzed incidence, patient comorbidities, procedures, pneumonia pathogens and in-hospital outcomes according to diabetes status (T2DM and no-diabetes). We used propensity score analysis to estimate the effect of T2DM on in-hospital mortality RESULTS: In 7952 admissions, the patient developed a VAP (13.6% with T2DM). Adjusted incidence rate of VAP was slightly, but significantly, higher in T2DM than in non-diabetic patients (36.46[95% CI 34.41-38.51] vs. 32.57[95% CI 31.40-33.74] cases per 100,000/inhabitants). T2DM people were older and had higher Charlson comorbidity index than non-diabetic people. T2DM patients had a lower mean number of failing organs than non-diabetic patients (1.20 SD 1.17 vs. 1.45 SD 1.44, p<0.001). Pseudomonas was the most frequently isolated agent in both groups. IHM was 41.92% for T2DM patients and 37.91% for non-diabetic patients (p<0.05). Factors associated with a higher mortality in both groups included: older age, more comorbidities and primary diagnoses of vein or artery occlusion, pulmonary disease and cancer. T2DM was not associated with a higher in-hospital mortality after adjustment using a propensity score (OR 0.88; 95% CI 0.76-1.35). CONCLUSIONS VAP incidence rates were higher among T2DM patients. In-hospital mortality was higher among the older patients and those with more co-morbid conditions. T2DM does not predict higher mortality in VAP during hospitalization.
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Affiliation(s)
- Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
| | - Javier de Miguel-Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Comunidad de Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Comunidad de Madrid, Spain
| | - Napoleón Pérez-Farinós
- Health Security Agency, Ministry of Health, Social Services and Equality, Madrid, Comunidad de Madrid, Spain
| | | | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain
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Patil HV, Patil VC. Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital. J Nat Sci Biol Med 2017; 8:46-55. [PMID: 28250674 PMCID: PMC5320823 DOI: 10.4103/0976-9668.198360] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection. Aims: The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens. Settings and Design: This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012. Materials and Methods: The patients fulfilling criteria of VAP were included in this study. Statistical Analysis: This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant. Results: Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates. Conclusions: There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, PseudomonasE. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.
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Affiliation(s)
- Harsha V Patil
- Department of Microbiology, Krishna Institute of Medical Sciences University, Satara, Maharashtra, India
| | - Virendra C Patil
- Department of Medicine, Krishna Institute of Medical Sciences University, Satara, Maharashtra, India
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Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals. Eur J Clin Microbiol Infect Dis 2016; 35:1531-9. [PMID: 27272120 DOI: 10.1007/s10096-016-2694-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.
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Vries RD, Andrade CAS, Bakuzis AF, Mandal SM, Franco OL. Next-generation nanoantibacterial tools developed from peptides. Nanomedicine (Lond) 2016; 10:1643-61. [PMID: 26008197 DOI: 10.2217/nnm.15.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacteria resistant against various antimicrobial compounds have emerged in many countries, and the age of resistance has just started. Among the more promising novel antimicrobial compounds on which current research is focusing are the antimicrobial peptides (AMPs). These are often less susceptible to bacterial resistance since multiple modifications in the cellular membranes, cell wall and metabolism are required to reduce their effectiveness. Most likely, the use of pure AMPs will be insufficient for controlling pathogenic bacteria, and innovative approaches are required to employ AMPs in new antibiotic treatments. Therefore, here we review novel bionanotechnological approaches, including nanofibers, nanoparticles and magnetic particles for effectively using AMPs in fighting infectious diseases.
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Affiliation(s)
- Renko de Vries
- 2Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Cesar A S Andrade
- 3Departamento de Bioquímica e Programa de Pós-Graduação em Inovação Terapêutica, Universidade Federal de Pernambuco, 50670-901 Recife, PE, Brazil
| | - Andris F Bakuzis
- 4Instituto de Física, Universidade Federal de Goiás, 74001-970, Goiânia, GO, Brazil
| | - Santi M Mandal
- 5Anti-Infective Research Lab, Department of Microbiology, Vidyasagar University, Midnapore 721102, West Bengal, Índia
| | - Octavio L Franco
- 6Centro de Análises, Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, 70790-160, Brazil.,7S-Inova, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, MS, Brazil
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Pourhajibagher M, Hashemi FB, Pourakbari B, Aziemzadeh M, Bahador A. Antimicrobial Resistance of Acinetobacter baumannii to Imipenem in Iran: A Systematic Review and Meta-Analysis. Open Microbiol J 2016; 10:32-42. [PMID: 27099638 PMCID: PMC4814728 DOI: 10.2174/1874285801610010032] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/10/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
Imipenem-resistant multi-drug resistant (IR-MDR) Acinetobacter baumannii
has been emerged as a morbidity successful nosocomial pathogen throughout the
world.To address imipenem being yet the most effective antimicrobial
agent against A. baumannii to control outbreaks and treat patients, a
systematic review and meta-analysis was performed to evaluate the prevalence of
IR-MDR A. baumannii. We systematically searched Web of Science, PubMed,
MEDLINE, Science Direct, EMBASE, Scopus, Cochrane Library, Google Scholar, and
Iranian databases to identify studies addressing the antibiotic resistance of
A. baumannii to imipenem and the frequency of MDR strains in Iran. Out of 58
articles and after a secondary screening using inclusion and exclusion criteria
and on the basis of title and abstract evaluation, 51 studies were selected for
analysis. The meta-analysis revealed that 55% [95% confidence interval (CI),
53.0–56.5] of A. baumannii were resistant to imipenem and 74% (95% CI,
61.3–83.9) were MDR. The MDR A. baumannii population in Iran is rapidly
changing toward a growing resistance to imipenem. Our findings highlight the
critical need for a comprehensive monitoring and infection control policy as
well as a national susceptibility review program that evaluates IR-MDR A.
baumannii isolates from various parts of Iran.
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Affiliation(s)
- Maryam Pourhajibagher
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad B Hashemi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatrics Infectious Disease Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Aziemzadeh
- Department of Microbiology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Tan X, Zhu S, Yan D, Chen W, Chen R, Zou J, Yan J, Zhang X, Farmakiotis D, Mylonakis E. Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia. Med Mycol 2016; 54:557-66. [PMID: 27001670 DOI: 10.1093/mmy/myw009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/13/2016] [Indexed: 12/28/2022] Open
Abstract
This retrospective study was conducted to identify potential risk factors for Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) and evaluate the association between Candida spp. airway colonization and A. baumannii VAP. Intensive care unit (ICU) patients who were on mechanical ventilation (MV) for ≥48 hours were divided into the following groups: patients with and without Candida spp. airway colonization; colonized patients receiving antifungal treatment or not; patients with A. baumannii VAP and those without VAP. Logistic regression analysis and propensity score matching were used to identify factors independently associated with A. baumannii VAP. Among 618 eligible patients, 264 (43%) had Candida spp. airway colonization and 114 (18%) developed A. baumannii VAP. Along with MV for ≥7 days (adjusted odds ratio [aOR] 8.9, 95% confidence intervals [95% CI] 4.9-15.8) and presence of a central venous catheter (aOR 3.2, 95% CI 1.1-9), Candida spp. airway colonization (aOR 2.6, 95% CI 1.6-4.3) was identified as an independent risk factor for A. baumannii VAP. Patients with Candida spp. airway colonization were more likely to develop A. baumannii VAP than non-colonized patients (23% vs 15%, P=.01 and 34% vs. 15%, P<.001 in propensity score-matched subgroups). Administration of antifungal agents was not associated with A. baumannii VAP (29% vs. 21%, P=.153) but with higher in-hospital mortality (53% vs. 39%, P=.037). Candida spp. airway colonization (43%) and A. baumannii VAP (18%) were common in ICU patients who were on mechanical ventilation for at least 48 hours. Candida spp. airway colonization was an independent risk factor for subsequent A. baumannii VAP.
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Affiliation(s)
- Xiaojiang Tan
- Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | - Song Zhu
- Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | - Dongxing Yan
- Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | - Weiping Chen
- Department of Respiratory Medicine, The People's Hospital of Qingyuan, Jinan University Hospital, Qingyuan 511518, P. R. China
| | - Ruilan Chen
- Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | - Jian Zou
- Informatics Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | - Jingdong Yan
- Informatics Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China
| | | | - Dimitrios Farmakiotis
- Department of Medicine, Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
| | - Eleftherios Mylonakis
- Department of Medicine, Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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Alaei N, Aziemzadeh M, Bahador A. Antimicrobial resistance profiles and genetic elements involved in carbapenem resistance in Acinetobacter baumannii isolates from a referral hospital in Southern Iran. J Glob Antimicrob Resist 2016; 5:75-9. [PMID: 27436472 DOI: 10.1016/j.jgar.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 11/18/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022] Open
Abstract
In this study, antimicrobial resistance patterns, carbapenemase production, carbapenem-hydrolysing class D OXA-type β-lactamase (CHDL)-encoding genes and ISAba insertion elements were characterised in Acinetobacter baumannii isolates from Southern Iran. A total of 85 A. baumannii isolates from patients in a tertiary care hospital were isolated. Antibiotic susceptibility profiles to 14 antimicrobials were determined by disc diffusion assay. Minimum inhibitory concentrations (MICs) to colistin and tigecycline were determined by the broth microdilution method. Isolates were analysed for OXA-type carbapenemase-encoding genes, ISAba elements upstream of blaOXA genes, and carbapenemase production by the CarbAcineto NP test. Of the 85 A. baumannii isolates, 73 (86%) were non-susceptible to imipenem. The MIC50 and MIC90 values for imipenem were 16mg/L and 64mg/L, respectively. Fourteen isolates (16%) were resistant to colistin. Among the 79 carbapenem-non-susceptible A. baumannii isolates, 77 (97%) were carbapenemase-producers as determined by the CarbAcineto NP test. The most frequently identified OXA-type carbapenemase gene was blaOXA-23-like, which was identified in 44 isolates (52%), followed by blaOXA-24-like with 13 isolates (15%). Statistical analysis showed that ISAba elements upstream of the blaOXA gene were significantly related to imipenem-non-susceptible isolates. The presence of blaOXA genes and ISAba1 and ISAba4 elements can explain the resistance of the isolates to carbapenems. The concerns raised following the emergence of colistin-resistant A. baumannii isolates highlight the need for a comprehensive national programme to collect and examine A. baumannii isolates from different parts of Iran.
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Affiliation(s)
- Najmeh Alaei
- Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Karaj Branch, Karaj, Iran
| | - Masoud Aziemzadeh
- Department of Microbiology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abbas Bahador
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Keshavarz Blvd., 100 Poursina Ave., Tehran 14167-53955, Iran.
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Zorgani A, Abofayed A, Glia A, Albarbar A, Hanish S. Prevalence of Device-associated Nosocomial Infections Caused By Gram-negative Bacteria in a Trauma Intensive Care Unit in Libya. Oman Med J 2015; 30:270-5. [PMID: 26366261 DOI: 10.5001/omj.2015.54] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Device-associated nosocomial infections (DANIs) have a major impact on patient morbidity and mortality. Our study aimed to determine the distribution rate of DANIs and causative agents and patterns of antibiotic resistance in the trauma-surgical intensive care unit (ICU). . METHODS Our study was conducted at Abusalim Trauma Hospital in Tripoli, Libya. All devices associated with nosocomial infections, including central venous catheters (CVC), endotracheal tubes (ETT), Foley's urinary catheters, chest tubes, nasogastric tubes (NGT), and tracheostomy tubes, were removed aseptically and examined for Gram-negative bacteria (GNB). . RESULTS During a one-year study period, 363 patients were hospitalized; the overall mortality rate was 29%. A total of 79 DANIs were identified, the most common site of infection was ETT (39.2%), followed by urinary catheters (19%), NGTs (18%), tracheostomy tubes (11%), CVCs (10%), and chest tubes (3%). The most frequently isolated organisms were Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa (30%, 20%, and 14%, respectively). Extremely high resistance rates were observed among GNB to ampicillin (99%), cefuroxime (95%), amoxicillin-clavulante (92%), and nitrofurantoin (91%). Lower levels of resistance were exhibited to amikacin (38%), imipenem (38%), and colistin (29%). About 39% of the isolates were defined as multi-drug resistant (MDR). Overall, extended spectrum β-lactmase producers were expressed in 39% of isolates mainly among K. pneumonia (88%). A. baumannii isolates exhibited extremely high levels of resistance to all antibiotics except colistin (100% sensitive). In addition, 56.3% of A. baumannii isolates were found to be MDR. P. aeruginosa isolates showed 46%-55% effectiveness to anti-pseudomonas antibiotics. . CONCLUSION High rates of DANI's and the emergence of MDR organisms poses a serious threat to patients. There is a need to strengthen infection control within the ICU environment, introduce surveillance systems, and implement evidence-based preventive strategies.
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Inchai J, Liwsrisakun C, Theerakittikul T, Chaiwarith R, Khositsakulchai W, Pothirat C. Risk factors of multidrug-resistant, extensively drug-resistant and pandrug-resistant Acinetobacter baumannii ventilator-associated pneumonia in a Medical Intensive Care Unit of University Hospital in Thailand. J Infect Chemother 2015; 21:570-4. [PMID: 26026660 DOI: 10.1016/j.jiac.2015.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 12/23/2022]
Abstract
Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii remains a significant cause of morbidity and mortality. Increasing antimicrobial resistance influences the selection of antibiotic treatment especially pandrug-resistant A. baumannii. A retrospective cohort study was conducted in the Medical Intensive Care Unit to identify the risk factors of VAP caused by multidrug-resistant A. baumannii (MDR-AB), extensively drug-resistant A. baumannii (XDR-AB) and pandrug-resistant A. baumannii (PDR-AB). All 337 adult patients with confirmed A. baumannii VAP were included. The incidence of MDR-AB, XDR-AB and PDR-AB were 72 (21.4%), 220 (65.3%) and 12 (3.6%), respectively. The risk factor for MDR-AB was prior use of carbapenems (OR 5.20; 95% CI 1.41-19.17). Risk factors for XDR-AB were the prior use of carbapenems (OR, 6.30; 95% CI, 1.80-21.97) and a high Sequential Organ Failure Assessment (SOFA) score (OR 1.35; 95% CI 1.07-1.71). In PDR-AB, the risk factors were the prior use of colistin (OR, 155.95; 95% CI, 8.00-3041.98), carbapenems (OR, 12.84; 95% CI, 1.60-103.20) and a high Simplified Acute Physiology Score (SAPS II) (OR 1.10; 95% CI 1.01-1.22). In conclusion, previous exposure to antibiotics and severity of VAP were risk factors of drug-resistant A. baumannii. Judicious use of carbapenems and colistin is recommended to prevent the antimicrobial-resistant strains of this organism.
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Affiliation(s)
- Juthamas Inchai
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Moradi J, Hashemi FB, Bahador A. Antibiotic Resistance of Acinetobacter baumannii in Iran: A Systemic Review of the Published Literature. Osong Public Health Res Perspect 2015; 6:79-86. [PMID: 25938016 PMCID: PMC4411348 DOI: 10.1016/j.phrp.2014.12.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/20/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Acinetobacter baumannii is a bacterium responsible for health care-associated infections, and it frequently develops multiple drug resistance (MDR). The prevalence of antibiotic-resistant A. baumannii in Iran has increased, and this may cause significant clinical problems. Therefore, in order to elucidate the development of antibiotic resistance, we performed a systematic review of the literature published on antibiotic-resistant A. baumannii reported in Iran. METHODS Thirty-six publications that met the criteria for inclusion were reviewed from an initial 87 papers. Selected papers published between 2008 and September 2014, were categorized on the basis of the sample collecting year been between 2001 and 2013. RESULTS Analysis of data revealed that, in general, there was an increase in antimicrobial resistance. During the initial time point of these studies (2001-2007) there was a high rate of resistance to all antibiotics, with the exception of carbapenems, lipopeptides, and aminoglycosides that had a low resistance rate in comparison with the others. Also, the resistance rate was increased in one group of these three antimicrobial groups from 2010 to 2013. In particular, there was an increase in resistance to carbapenems (imipenem and meropenem) from 2010-2011 and 2012-2013, whereas no significant change in the resistance rate of the other two antimicrobial groups (lipopeptides and aminoglycosides) during the study time was observed, although we did observe certain trends in amikacin (aminoglycoside group antibiotic) between 2011-2012 and 2012-2013. CONCLUSION These findings indicate that antimicrobial resistance of A. baumannii in Iran has increased, which may very well affect the antimicrobial resistance of this organism worldwide. Based on these results, novel prevention and treatment strategies against A. baumannii infections are warranted. Furthermore, these data may assist in revising treatment guidelines and regional policies in care units to slow the emergence of antimicrobial resistance.
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Poole K. Stress responses as determinants of antimicrobial resistance in Pseudomonas aeruginosa: multidrug efflux and more. Can J Microbiol 2015; 60:783-91. [PMID: 25388098 DOI: 10.1139/cjm-2014-0666] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pseudomonas aeruginosa is a notoriously antimicrobial-resistant organism that is increasingly refractory to antimicrobial chemotherapy. While the usual array of acquired resistance mechanisms contribute to resistance development in this organism a multitude of endogenous genes also play a role. These include a variety of multidrug efflux loci that contribute to both intrinsic and acquired antimicrobial resistance. Despite their roles in resistance, however, it is clear that these efflux systems function in more than just antimicrobial efflux. Indeed, recent data indicate that they are recruited in response to environmental stress and, therefore, function as components of the organism's stress responses. In fact, a number of endogenous resistance-promoting genes are linked to environmental stress, functioning as part of known stress responses or recruited in response to a variety of environmental stress stimuli. Stress responses are, thus, important determinants of antimicrobial resistance in P. aeruginosa. As such, they represent possible therapeutic targets in countering antimicrobial resistance in this organism.
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Affiliation(s)
- Keith Poole
- Department of Biomedical and Molecular Sciences, Botterell Hall, Queen's University, Kingston, ON K7L 3N6, Canada
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Cikman A, Gulhan B, Aydin M, Ceylan MR, Parlak M, Karakecili F, Karagoz A. In vitro Activity of Colistin in Combination with Tigecycline against Carbapenem-Resistant Acinetobacter baumannii Strains Isolated from Patients with Ventilator-Associated Pneumonia. Int J Med Sci 2015; 12:695-700. [PMID: 26392806 PMCID: PMC4571546 DOI: 10.7150/ijms.11988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/26/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study investigated the minimum inhibitory concentration (MIC) values and in vitro activity of colistin in combination with tigecycline against carbapenem-resistant Acinetobacter baumannii strains isolated from patients with ventilator-associated pneumonia (VAP) using the E-test method. METHODS A total of 40 A. baumannii strains, identified using the Phoenix Automated Microbiology System (Becton, Dickinson and Co., Franklin Lakes, NJ, USA) by conventional methods, were included in this study. Pulsed-field gel electrophoresis was performed to examine the clonal relationships between isolates. The carbapenem resistance of the strains to colistin and tigecycline was assessed using the E-test method (Liofilchem, Roseto Degli Abruzzi, Italy). The in vitro activity of colistin in combination with tigecycline was evaluated using the fractional inhibitor concentration (FIC) index. RESULTS While only 1 of 40 A. baumannii strains was determined to be colistin resistant, 6 were tigecycline resistant. The MIC50, MIC90, and MIC intervals of the A. baumannii strains were 0.19, 1.5, and 0.064‒4 μg/ml for colistin and 1, 8, and 0.094‒256 μg/ml for tigecycline, respectively. No synergistic effect was observed using the FIC index; 8 strains exhibited an indifferent effect and 32 exhibited an antagonist effect. Three of the six strains that were resistant to tigecycline were indifferent; the remaining three were antagonistic. The colistin-resistant strain also exhibited an antagonist effect. CONCLUSION In contrast to their synergistic effect against carbapenem-resistant A. baumannii isolates, colistin and tigecycline were highly antagonistic to carbapenem-resistant A. baumannii strains isolated from patients with VAP when the drugs were administered together. Therefore, alternative treatment options should be used during the treatment of VAP attributed to A. baumannii.
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Affiliation(s)
- Aytekin Cikman
- 1. Department of Medical Microbiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Baris Gulhan
- 1. Department of Medical Microbiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Merve Aydin
- 1. Department of Medical Microbiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Mehmet Resat Ceylan
- 2. Viransehir State Hospital, Department of Infectious Diseases and Clinical Microbiology, Sanliurfa, Turkey
| | - Mehmet Parlak
- 3. Department of Medical Microbiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Faruk Karakecili
- 4. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Alper Karagoz
- 5. Molecular Microbiology Research and Application Laboratory, Public Health Institution of Turkey, Ankara, Turkey
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