1
|
Ehsanipur F, Ebrahimi P, Tahernia L, Vafaee‐Shahi M. A fulminant presentation of post-COVID-19 necrotizing pneumonia and ischemic stroke in an 8-year-old girl: A case report and literature review. Clin Case Rep 2024; 12:e9222. [PMID: 39077727 PMCID: PMC11284262 DOI: 10.1002/ccr3.9222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/31/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
Necrotizing pneumonia (NP) is the destruction of the interstitial part of the lung due to severe infection. One cause of this rare and fatal condition in pediatrics is Acinetobacter. Severe infections, especially pneumonia, can prone pediatric patients to ischemic stroke. This study reports an 8-year-old girl presented to the emergency department complaining of shortness of breath, fever, and fatigue. She was admitted to the intensive care unit due to respiratory distress and pericardial effusion. Swab and respiratory secretion tests for COVID-19 and Acinetobacter were positive. In her admission course, her condition deteriorated, and on the fifth day, she underwent a craniotomy due to the signs of increased intracranial pressure (ICP). The computed tomography (CT) scan showed an ischemic stroke. Despite all efforts and medical efforts, the patient's clinical condition got worse, and she died 10 days after the surgery. COVID-19 can lead to vulnerability to severe bacterial infections such as NP in pediatrics. Severe infections are a significant risk factor for ischemic stroke. The presentation might be different in intubated unconscious patients, such as detecting increased ICP signs. In severe and extensive cases of NP and ischemia, the destruction of the lungs and brain tissue might be irreversible and even lethal. Doctors and parents should consider neurologic complaints in children with infectious diseases as a serious issue since infections make children vulnerable to complications such as stroke.
Collapse
Affiliation(s)
- Fahimeh Ehsanipur
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Cardiovascular Disease Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | | | - Mohammad Vafaee‐Shahi
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
| |
Collapse
|
2
|
Margalit I, Kunwar D, Gadot C, Meroi M, Scardellato R, Zamir A, Koutsolioutsou A, Goldberg E, Righi E, Yahav D. Clinical impact of active screening cultures for carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis. Am J Infect Control 2024:S0196-6553(24)00578-9. [PMID: 38936479 DOI: 10.1016/j.ajic.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB. METHODS A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening ("CRAB carrier") predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). RESULTS Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infection rate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups for CRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1. CONCLUSIONS Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.
Collapse
Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | | | - Chen Gadot
- Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Marco Meroi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Rebecca Scardellato
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Amber Zamir
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Anastasia Koutsolioutsou
- Deptment of Environmental Health and Monitoring of Smoking Secession, National Public Health Organization, Athens, Greece
| | - Elad Goldberg
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elda Righi
- Infectious Diseases Division, Diagnostic and Public Health Department, University of Verona, Verona, Italy
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Haddad N, Zeenny RM, El Halabi C, Abdallah T, El Helou R, Zahreddine NK, Kanj SS, Rizk NA. The experience of an antimicrobial stewardship program and antibiotic consumption and resistance trends during the COVID-19 pandemic at a tertiary care center in Beirut. J Infect Public Health 2024; 17:254-262. [PMID: 38128409 DOI: 10.1016/j.jiph.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Antimicrobial Resistance, a global concern, worsened with the COVID-19 pandemic that caused a surge of critically ill patients, increased antimicrobial consumption, and the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) aim to optimize antimicrobial utilization to fight resistance. We aim to describe the ASP experience and to study antimicrobial consumption and MDRO rates among COVID-19 patients at a tertiary care center in Beirut. METHODS We compiled the ASP interventions, defined as ASP team recommendations, from January 2019 until December 2021. Data on antimicrobial consumption, expressed as a defined daily dose (DDD) per 100 patient days, was collected per quarter for all antimicrobials and restricted antimicrobials per ASP guidance. Our primary objective was to report on the ASP experience, and the secondary objective was to reflect on the rates of MDROs among hospitalized COVID-19 patients with respiratory or bloodstream bacterial co-infections between March 2020 and September 2021. RESULTS 9922 ASP interventions were documented during this study period, with a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. Acceptance rates for these recommendations improved over time, with a noticeable decrease in the proportion of interventions related to de-escalation and discontinuation of broad-spectrum antimicrobials. We noted an increase in all antimicrobial consumption after the onset of the pandemic, peaking in Q4 2020 (142.8 DDD of anti-infectives/100 patient days) and Q1 2021 (79.1 DDD of restricted anti-infectives/100 patient days). As expected, MDROs, particularly ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Carbapenem-resistant Enterobacteriaceae) accounted for 24% of isolates obtained from this cohort. CONCLUSION This study highlights the experience of the ASP as we adapted to the COVID-19 pandemic. The ASP team maintained its operations and continued to monitor antibiotic consumption and provide recommendations to limit antibiotic misuse in an effort to mitigate the impact of the pandemic on antimicrobial resistance.
Collapse
Affiliation(s)
- Nisrine Haddad
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rony M Zeenny
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Celia El Halabi
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Abdallah
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Remie El Helou
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Nesrine A Rizk
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
4
|
Wong C. Antibiotic resistance is a growing threat - is climate change making it worse? Nature 2024:10.1038/d41586-023-04077-0. [PMID: 38191706 DOI: 10.1038/d41586-023-04077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
|
5
|
Rodríguez A, Gómez F, Sarvisé C, Gutiérrez C, Giralt MG, Guerrero-Torres MD, Pardo-Granell S, Picó-Plana E, Benavent-Bofill C, Trefler S, Berrueta J, Canadell L, Claverias L, Esteve Pitarch E, Olona M, García Pardo G, Teixidó X, Bordonado L, Sans MT, Bodí M. Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study. Biomedicines 2023; 11:3330. [PMID: 38137551 PMCID: PMC10741655 DOI: 10.3390/biomedicines11123330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. METHODS A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored. RESULTS A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed. CONCLUSION The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.
Collapse
Affiliation(s)
- Alejandro Rodríguez
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain;
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
| | - Frederic Gómez
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
- Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
| | - Carolina Sarvisé
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Cristina Gutiérrez
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Montserrat Galofre Giralt
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - María Dolores Guerrero-Torres
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Sergio Pardo-Granell
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Ester Picó-Plana
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Clara Benavent-Bofill
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
| | - Julen Berrueta
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Tarragona Health Data Research Working Group (THeDaR), Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Laura Canadell
- Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain;
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Laura Claverias
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
| | - Erika Esteve Pitarch
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Montserrat Olona
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
- Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Graciano García Pardo
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - Xavier Teixidó
- ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
| | - Laura Bordonado
- ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
| | - María Teresa Sans
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
- Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
| | - María Bodí
- Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.)
- Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
- Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
- Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain
| |
Collapse
|
6
|
Itani R, Khojah HMJ, Karout S, Rahme D, Hammoud L, Awad R, Abu-Farha R, Mukattash TL, Raychouni H, El-Lakany A. Acinetobacter baumannii: assessing susceptibility patterns, management practices, and mortality predictors in a tertiary teaching hospital in Lebanon. Antimicrob Resist Infect Control 2023; 12:136. [PMID: 38031181 PMCID: PMC10685635 DOI: 10.1186/s13756-023-01343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is a major nosocomial pathogen capable of causing life-threatening infections. This bacterium is highly resistant to antibiotics and associated with high mortality rates. Therefore, this study aimed to evaluate A. baumannii's susceptibility patterns to antimicrobials, assess the appropriateness of the initiated antimicrobial therapy, determine the mortality rate, and identify predictors associated with mortality. METHODS A retrospective observational study was conducted among patients infected with A. baumannii at a university hospital in Lebanon through the revision of medical records. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. RESULTS The records of 188 patients were screened, and 111 patients with A. baumannii infection were enrolled. Almost all isolates were resistant to carbapenem, and 43% of the isolates were extensively-drug resistant. Almost half of the patients received initial inappropriate antimicrobial therapy (n = 50, 45.1%). The 30-day mortality rate associated with A. baumannii infection was 71.2% (79/111). The time to mortality in patients who received inappropriate antimicrobial therapy (5.70 ± 1.07 days) was significantly shorter than in those who received appropriate antimicrobial therapy (12.43 ± 1.01 days, P < 0.01). Binary logistic regression revealed that inappropriate antimicrobial therapy (adjusted odds ratio [AOR] = 16.22, 95% CI 2.68-9.97, P = 0.002), mechanical ventilation (AOR = 14.72, 95% CI 3.27-6.61, P < 0.001), and thrombocytopenia (AOR = 8.82, 95% CI 1.12-9.75, P = 0.003) were more likely associated with mortality. CONCLUSIONS A. baumannii exhibits an alarming mortality rate among infected patients. Thrombocytopenia, mechanical ventilation, and inappropriate antibiotic administration are associated with mortality in patients infected with A. baumannii. The prompt initiation of appropriate antimicrobial therapy, infection control measures, and effective stewardship program are crucial to reduce the incidence of A. baumannii and improve the treatment outcomes.
Collapse
Affiliation(s)
- Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Hani M J Khojah
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, P.O. Box: 30051, 41477, Madinah, Kingdom of Saudi Arabia
| | - Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon.
| | - Deema Rahme
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Lara Hammoud
- Pharmacy Department, Hammoud Hospital University Medical Center, Sidon, Lebanon
| | - Reem Awad
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box: 11931, Amman, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Hamza Raychouni
- Intensive Care Unit, Central Military Hospital, Military Healthcare, Lebanese Army, Beirut, Lebanon
- Intensive Care Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- Department of Pharmacognosy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| |
Collapse
|
7
|
Eldin AB, Ezzat M, Afifi M, Sabry O, Caprioli G. Herbal medicine: the magic way crouching microbial resistance. Nat Prod Res 2023; 37:4280-4289. [PMID: 36719419 DOI: 10.1080/14786419.2023.2172009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
Bacterial resistance to antibiotics poses a high level of danger worldwide. Bacterial resistance mechanisms are spreading globally, impeding our ability to treat common infectious diseases. Misuse and overuse of antibiotics accelerate microbial resistance to antibiotics. Despite the exerted efforts, none of the newly developed antibiotics are expected to be effective against the dangerous forms of antibiotic-resistant bacteria. Since many plants have been shown to contain powerful antimicrobial compounds that can act synergistically or alternatively to antibiotics, the demand for herbal medicines has recently increased to co-treat microbes that are resistant to antibiotics. Maximum benefit can be achieved when the pharmacokinetics and pharmacodynamics of natural products match the antibiotic. This review article refers to nine highly effective and key herbs to use alongside antibiotics to overcome crises of antibiotic resistance. Their unique molecular mechanisms of action have been highlighted.
Collapse
Affiliation(s)
- Alaa Badr Eldin
- Pharmacognosy Department, Faculty of Pharmacy, MIU, Cairo, Egypt
| | - Marwa Ezzat
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Manal Afifi
- Pharmacognosy Department, Faculty of Pharmacy, MIU, Cairo, Egypt
| | - Omar Sabry
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
- Pharmacognosy Department, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | | |
Collapse
|
8
|
Lin AD, Fischer JDSDG, Santos MDM, Camillo-Andrade AC, Kurt LU, Souza TACB, Lajas ABL, Rivera B, Portela M, Duran R, Mira MT, Pillonetto M, Carvalho PC. Beyond the identifiable proteome: Delving into the proteomics of polymyxin-resistant and non-resistant Acinetobacter baumannii from Brazilian hospitals. J Proteomics 2023; 289:105012. [PMID: 37748533 DOI: 10.1016/j.jprot.2023.105012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
This work discloses a unique, comprehensive proteomic dataset of Acinetobacter baumannii strains, both resistant and non-resistant to polymyxin B, isolated in Brazil generated using Orbitrap Fusion Lumos. From nearly 4 million tandem mass spectra, the software DiagnoMass produced 240,685 quality-filtered mass spectral clusters, of which PatternLab for proteomics identified 44,553 peptides mapping to 3479 proteins. Crucially, DiagnoMass shortlisted 3550 and 1408 unique mass spectral clusters for the resistant and non-resistant strains, respectively, with only about a third with sequences (and PTMs) identified by PatternLab. Further open-search attempts via FragPipe yielded an additional ∼20% identifications, suggesting the remaining unidentified spectra likely arise from complex combinations of post-translational modifications and amino-acid substitutions. This highlights the untapped potential of the dataset for future discoveries, particularly given the importance of PTMs, which remain elusive to nucleotide sequencing approaches but are crucial for understanding biological mechanisms. Our innovative approach extends beyond the identifications that are typically subjected to the bias of a search engine; we discern which spectral clusters are differential and subject them to increased scrutiny, akin to spectral library matching by comparing captured spectra to themselves. Our analysis reveals adaptations in the resistant strain, including enhanced detoxification, altered protein synthesis, and metabolic adjustments. SIGNIFICANCE: We present comprehensive proteomic profiles of non-resistant and resistant Acinetobacter baumannii from Brazilian Hospitals strains, and highlight the presence of discriminative and yet unidentified mass spectral clusters. Our work emphasizes the importance of exploring this overlooked data, as it could hold the key to understanding the complex dynamics of antibiotic resistance. This approach not only informs antimicrobial stewardship efforts but also paves the way for the development of innovative diagnostic tools. Thus, our findings have profound implications for the field, as far as methods for providing a new perspective on diagnosing antibiotic resistance as well as classifying proteomes in general.
Collapse
Affiliation(s)
- Amanda Dal Lin
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil; Laboratório Experimental Multiuso, Pontifícia Universidade Católica do Paraná, Brazil
| | - Juliana de S da G Fischer
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil
| | - Marlon D M Santos
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil; Analytical Biochemistry and Proteomics Unit, Institut Pasteur de Montevideo/IIBCE, Montevideo, Uruguay
| | - Amanda Caroline Camillo-Andrade
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil; Analytical Biochemistry and Proteomics Unit, Institut Pasteur de Montevideo/IIBCE, Montevideo, Uruguay
| | - Louise Ulrich Kurt
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil
| | - Tatiana A C B Souza
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil
| | - Ana Beatriz Lyrio Lajas
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil
| | - Bernardina Rivera
- Analytical Biochemistry and Proteomics Unit, Institut Pasteur de Montevideo/IIBCE, Montevideo, Uruguay
| | - Magdalena Portela
- Analytical Biochemistry and Proteomics Unit, Institut Pasteur de Montevideo/IIBCE, Montevideo, Uruguay
| | - Rosario Duran
- Analytical Biochemistry and Proteomics Unit, Institut Pasteur de Montevideo/IIBCE, Montevideo, Uruguay
| | - Marcelo Távora Mira
- Laboratório Experimental Multiuso, Pontifícia Universidade Católica do Paraná, Brazil
| | - Marcelo Pillonetto
- Laboratório Experimental Multiuso, Pontifícia Universidade Católica do Paraná, Brazil; Laboratório Central do Estado do Paraná, Brazil.
| | - Paulo Costa Carvalho
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz - Paraná, Brazil.
| |
Collapse
|
9
|
Ameer NAA, Dhahi MAR. Alterations in gene expression of recA and umuDC in antibiotic-resistant Acinetobacter baumannii. J Med Life 2023; 16:531-539. [PMID: 37305826 PMCID: PMC10251391 DOI: 10.25122/jml-2022-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/01/2023] [Indexed: 06/13/2023] Open
Abstract
Acinetobacter baumannii is a critical pathogen with an efficient SOS (Save Our Ship) system that plays a significant role in antibiotic resistance. This prospective descriptive study aimed to investigate the association between expression levels of recA and umuDC genes, which are critical in SOS pathways, and antibiotic resistance in A. baumannii. We analyzed 78 clinical isolates and 31 ecological isolates using the Vitek-2 system for bacterial identification and antibiotic susceptibility testing and confirmed molecular identification of A. baumannii by conventional PCR of blaOXA-51 and blaOXA-23. Quantitative real-time polymerase chain reaction was used to determine gene expression levels of recA and umuDC. The results showed that in 25 clinical strains, 14/25 strains showed upregulation of recA, 7/25 strains exhibited upregulation of both umuDC and recA, and 1/25 strains showed upregulation of umuDC. Of these, 16/25 clinical strains were extensively resistant to antibiotics, except for colistin, and showed upregulation of recA and/or umuDC gene expression levels. In 6 ecological strains, recA showed upregulation in 3/6 strains, while both recA and umuDC were upregulated in 1/6 strain. In conclusion, high expression levels of recA and/or umuDC genes in A. baumannii complex and A. baumannii strains may contribute to increasing resistance to a wide range of antibiotics and may result in the initiation of an extensively drug-resistant (XDR) phenotype.
Collapse
|
10
|
Paramythiotou E, Routsi C. Editorial for Special Issue "Antimicrobial Therapy in Intensive Care Unit". Antibiotics (Basel) 2023; 12:antibiotics12020278. [PMID: 36830190 PMCID: PMC9952740 DOI: 10.3390/antibiotics12020278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Life-threatening infections, either as the initial reason for an admission to the intensive care unit (ICU) or acquired in the ICU, are especially common among critically ill patients [...].
Collapse
Affiliation(s)
- Elizabeth Paramythiotou
- 2nd Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ Hospital, 12462 Athens, Greece
- Correspondence: (E.P.); (C.R.)
| | - Christina Routsi
- 1st Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, ICU “Evangelismos” Hospital, 10676 Athens, Greece
- Correspondence: (E.P.); (C.R.)
| |
Collapse
|
11
|
The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19. VACUNAS (ENGLISH EDITION) 2023; 24. [PMCID: PMC9969533 DOI: 10.1016/j.vacune.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background: Infections caused by Acinetobacter baumannii, especially carbapenem-resistant (CR) strains, pose important challenges in patients with COVID-19 infection. Therefore, in the present study, we investigated co-infection and antimicrobial resistance patterns, as well as the role of A. baumannii in the outcome of patients with COVID-19. Materials and methods: Between February 2019 and January 2021, 141 patients with A. baumannii infections were detected from seven different hospitals (A to G) in Arak, Iran, and the antibacterial susceptibility pattern of these isolates was evaluated using disk diffusion and E-test methods. Forty-seven of these patients were co-infected with COVID-19. During the study, the data about the clinical course, demographic data, and the role of A. baumannii infections in the mortality rate of COVID-19 patients were collected. Results: Hospitals A and B reported the most patients, with 53 (38%) and 47 (33%), respectively. Additionally, most cases (105 cases, 75%) were reported from surgical and general ICUs. Mechanical ventilators were detected as predisposing factors in 95 (67%) patients, and infection was detected in 20% of patients on the 10th day after intubation. All of the A. baumannii isolates were resistant to different classes of antibiotics, such as carbapenems. Notably, 33% (47 patients) were also positive for COVID-19, and 68% (32 patients) died due to the infection. Statistical analysis showed a significant role of A. baumannii co-infection in the mortality rate of COVID-19 patients (p-value 0.05). Conclusion: co-infection with A. baumannii is one of the most important challenges in COVID-19 patients. Our results showed that all isolated bacteria were CR and significantly increased mortality rates in COVID-19 patients.
Collapse
|
12
|
AliMohammadi A, Chezani-sharahi N, Hezaveh ZA, Abbasi E, Shariati A, Ghaznavi-Rad E. The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19. VACUNAS 2023; 24:13-18. [PMID: 36341004 PMCID: PMC9622378 DOI: 10.1016/j.vacun.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
Background: Infections caused by Acinetobacter baumannii, especially carbapenem-resistant (CR) strains, pose important challenges in patients with COVID-19 infection. Therefore, in the present study, we investigated co-infection and antimicrobial resistance patterns, as well as the role of A. baumannii in the outcome of patients with COVID-19. Materials and methods: Between February 2019 and January 2021, 141 patients with A. baumannii infections were detected from seven different hospitals (A to G) in Arak, Iran, and the antibacterial susceptibility pattern of these isolates was evaluated using disk diffusion and E-test methods. Forty-seven of these patients were co-infected with COVID-19. During the study, the data about the clinical course, demographic data, and the role of A. baumannii infections in the mortality rate of COVID-19 patients were collected. Results: Hospitals A and B reported the most patients, with 53 (38%) and 47 (33%), respectively. Additionally, most cases (105 cases, 75%) were reported from surgical and general ICUs. Mechanical ventilators were detected as predisposing factors in 95 (67%) patients, and infection was detected in 20% of patients on the 10th day after intubation. All of the A. baumannii isolates were resistant to different classes of antibiotics, such as carbapenems. Notably, 33% (47 patients) were also positive for COVID-19, and 68% (32 patients) died due to the infection. Statistical analysis showed a significant role of A. baumannii co-infection in the mortality rate of COVID-19 patients (p-value 0.05). Conclusion: co-infection with A. baumannii is one of the most important challenges in COVID-19 patients. Our results showed that all isolated bacteria were CR and significantly increased mortality rates in COVID-19 patients.
Collapse
Affiliation(s)
- Ali AliMohammadi
- Assistant Professor of Forensic Medicine and Toxicology, Arak University of Medical Sciences, Arak, Iran
| | - Nahid Chezani-sharahi
- PhD student in Health Services Management, Arak University of Medical Sciences, Arak, Iran
| | | | - Elnaz Abbasi
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Aref Shariati
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran,Corresponding authors
| | - Ehsanollah Ghaznavi-Rad
- Department of Microbiology, faculty of Medicine, Arak University of Medical Sciences Arak, Iran,Corresponding authors
| |
Collapse
|
13
|
Sugihara T, Kamei J, Yasunaga H, Sasabuchi Y, Fujimura T. Prescription of Choreito, a Japanese Kampo Medicine, with Antimicrobials for Treatment of Acute Cystitis: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11121840. [PMID: 36551497 PMCID: PMC9774728 DOI: 10.3390/antibiotics11121840] [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: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Choreito, a Japanese Kampo medicine, is used to treat Japanese female patients for the quick relief of inflammatory symptoms associated with acute cystitis. We evaluated whether Choreito is effective in reducing antibiotic use and the number of clinic visits for these patients. Females aged 18-49 years who had acute cystitis for the first time, with no history of medical insurance use within 90 days prior to their visit, and no hospitalizations within the 30 days after their first visit were identified from the JMDC Claims Database between April 2018 and March 2021. For the 30 days after their first visit, patients who were given their first antimicrobial prescriptions with or without Choreito were compared regarding (i) the number of clinic visits, (ii) total antimicrobial prescription days, and (iii) the number of antimicrobial prescriptions adjusted for their age, Charlson comorbidity index, and the COVID-19 pandemic period (after April 2020). For the 319 and 8515 patients with or without a Choreito prescription, respectively, multivariable Poisson regression analyses showed that Choreito was significantly associated with a 5% shortening of a patient's total antimicrobial prescription days (Beta, 0.950; p = 0.038), whereas no significant difference was observed in the number of clinic visits and antimicrobial prescriptions (p = 0.624 and p = 0.732, respectively). The prescription of Choreito in combination with antimicrobials was associated with a slight reduction in total antimicrobial use for acute cystitis among females.
Collapse
Affiliation(s)
- Toru Sugihara
- Department of Urology, Jichi Medical University, Tochigi 329-0498, Japan
- Correspondence: ; Tel.: +81-285-58-7379
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-8654, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Tochigi 329-0498, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Tochigi 329-0498, Japan
| |
Collapse
|
14
|
Jantarathaneewat K, Camins B, Apisarnthanarak A. What are the considerations for the treatment of multidrug resistant Acinetobacter baumannii infections? Expert Opin Pharmacother 2022; 23:1667-1672. [PMID: 36210527 DOI: 10.1080/14656566.2022.2134778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kittiya Jantarathaneewat
- Center of Excellence in Pharmacy Practice and Management Research, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand.,Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Bernard Camins
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anucha Apisarnthanarak
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
15
|
Brink AJ, Richards GA. Antimicrobial Stewardship: Leveraging the "Butterfly Effect" of Hand Hygiene. Antibiotics (Basel) 2022; 11:1348. [PMID: 36290006 PMCID: PMC9598193 DOI: 10.3390/antibiotics11101348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 10/18/2023] Open
Abstract
It is vital that there are coordinated, collaborative efforts to address the threat of antimicrobial resistance (AMR) and to prevent and control the spread of hospital-onset infections, particularly those due to multidrug-resistant (MDR) pathogens. The butterfly effect is a concept in which metaphorically speaking, small, seemingly trivial events ultimately cascade into something of far greater consequence, more specifically by having a non-linear impact on very complex systems. In this regard, antimicrobial stewardship programs (ASP), when implemented alongside infection prevention control (IPC) interventions in hospitals, particularly hand hygiene (HH), are significantly more effective in reducing the development and spread of AMR bacteria than implementation of ASP alone. In this perspective, we briefly review the evidence for the combined effect, and call for closer collaboration between institutional IPC and ASP leadership, and for well-functioning IPC programs to ensure the effectiveness of ASP.
Collapse
Affiliation(s)
- Adrian John Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Guy Antony Richards
- Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa
| |
Collapse
|
16
|
Is It Possible to Eradicate Carbapenem-Resistant Acinetobacter baumannii (CRAB) from Endemic Hospitals? Antibiotics (Basel) 2022; 11:antibiotics11081015. [PMID: 36009885 PMCID: PMC9405503 DOI: 10.3390/antibiotics11081015] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Despite the global efforts to antagonize carbapenem-resistant Acinetobacter baumannii (CRAB) spreading, it remains an emerging threat with a related mortality exceeding 40% among critically ill patients. The purpose of this review is to provide evidence concerning the best infection prevention and control (IPC) strategies to fight CRAB spreading in endemic hospitals. Methods: The study was a critical review of the literature aiming to evaluate all available studies reporting IPC measures to control CRAB in ICU and outside ICU in both epidemic and endemic settings in the past 10 years. Results: Among the 12 included studies, the majority consisted of research reports of outbreaks mostly occurred in ICUs. The reported mortality reached 50%. Wide variability was observed related to the frequency of application of recommended CRAB IPC measures among the studies: environmental disinfection (100%); contact precautions (83%); cohorting staff and patients (75%); genotyping (66%); daily chlorhexidine baths (58%); active rectal screening (50%); closing or stopping admissions to the ward (33%). Conclusions: Despite effective control of CRAB spreading during the outbreaks, the IPC measures reported were heterogeneous and highly dependent on the different setting as well as on the structural characteristics of the wards. Reinforced ‘search and destroy’ strategies both on the environment and on the patient, proved to be the most effective measures for permanently eliminating CRAB spreading.
Collapse
|