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Luo H, Han W, Zhang J, Cheng W, Li D, Zhao M, Cui N, Zhu H. Effect of Improved Nursing Strategy on Prognosis of Immunosuppressed Patients With Pneumonia and Sepsis: A Prospective Cohort Study. J Intensive Care Med 2024; 39:257-267. [PMID: 37723966 DOI: 10.1177/08850666231200184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Objectives: To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Methods: Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm3) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. Results: In accordance with the study criteria, 1019 patients were finally enrolled. Compared with patients in the control group, those in the treatment group had significantly fewer days on mechanical ventilation [5 (4, 7) versus 5 (4, 7) days, P = .03] and lower intensive care unit (ICU) mortality [21.1% (132 of 627) vs 28.8% (113 of 392); P = .005] and 28-day mortality [22.2% (139 of 627) vs 29.8% (117 of 392); P = .006]. The treatment group also had a shorter duration of ICU stay [9 (5, 15) vs 11 (6, 22) days, P = .0001] than the control group. The improved nursing strategy acted as an independent protective factor in 28-day mortality: odds ratio 0.645, 95% confidence interval: 0.449-0.927, P = .018. Conclusion: Our improved nursing strategy shortened the duration of mechanical ventilation and the ICU stay and decreased ICU mortality and 28-day mortality in immunosuppressed patients with pneumonia and sepsis. Trial registration: ChiCTR.org.cn, ChiCTR-ROC-17010750. Registered 28 February 2017.
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Affiliation(s)
- Hongbo Luo
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Wen Han
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiahui Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Wei Cheng
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Dongkai Li
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Mingxi Zhao
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Ashraf D, Ombarak RA, Samir A, Abdel-Salam AB. Characterization of multidrug-resistant potential pathogens isolated from milk and some dairy products in Egypt. J Adv Vet Anim Res 2023; 10:275-283. [PMID: 37534087 PMCID: PMC10390681 DOI: 10.5455/javar.2023.j679] [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: 04/30/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 08/04/2023] Open
Abstract
Objective This study aimed to explore the incidence and antimicrobial resistance (AMR) of Escherichia coli, Staphylococcus aureus, and Bacillus cereus in raw milk and some Egyptian dairy products, namely Kariesh cheese and rice with milk. Material and Methods 112 samples (70 raw milk, 30 Kariesh cheese, and 12 rice with milk) were randomly collected from different districts in Cairo and Giza, Egypt. The samples were examined for E. coli, S. aureus, and B. cereus presence. The susceptibility of the obtained isolates was tested against 11 antimicrobials using the disk diffusion method, and further, the presence of AMR genes was examined. Results The incidences of E. coli, S. aureus, and B. cereus were 69.64%, 12.5%, and 16.7% in the examined samples, respectively. The antibiogram indicated that E. coli isolates (n = 60) were resistant to gentamycin (73.33%), ampicillin (AM, 53.3%), and cefotaxime (CTX, 16.66%). Multidrug-resistant (MDR) E. coli strains (n = 5) were tested for β-lactams resistance genes. blaTEM was detected in all isolates, and two of them additionally carried blaCTX-M. Staphylococcus aureus isolates (n = 10) were resistant to AM (100%), followed by tetracycline (TE), CTX, and gentamycin (60% each). All MDR S. aureus strains (n = 4) carried blaZ and tetK, and three of them additionally carried aac(6')-aph (2''). Bacillus cereus isolates (n = 30) showed resistance to AM (100%), amoxicillin (20%), and TE (6.66%). bla and tetA genes were detected in all MDR B. cereus isolates (n = 6). Conclusion Our findings denote the high incidence of potential health hazards in raw milk and some of its products and the existence of AMR bacteria, including MDR strains, which can cause human illnesses that are difficult to treat.
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Affiliation(s)
- Dina Ashraf
- Department of Microbiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Rabee A. Ombarak
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, University of Sadat City, Sadat, Egypt
| | - Ahmed Samir
- Department of Microbiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Ayah B. Abdel-Salam
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
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3
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Mascolo A, Carannante N, Mauro GD, Sarno M, Costanzo M, Licciardi F, Bernardo M, Capoluongo N, Perrella A, Capuano A. Decolonization of drug-resistant Enterobacteriaceae carriers: A scoping review of the literature. J Infect Public Health 2023; 16:376-383. [PMID: 36702012 DOI: 10.1016/j.jiph.2023.01.009] [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: 07/26/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023] Open
Abstract
The ESCMID-EUCIC guideline on decolonization of multidrug-resistant Gram-negative bacteria carriers does not recommend routine decolonization and highlights the necessity of well-powered and designed randomized clinical trials. Based on this limited evidence, we decided to conduct a scoping review with the aim of describing and discussing the last published studies investigating the efficacy and safety of decolonization therapies in drug-resistant Enterobacteriaceae carriers. Studies published in PubMed from January 1, 2017 to December 28, 2021 were retrieved. A PICO (population, intervention, comparator, outcome) framework was used for article selection as follows: Population defined as any patient of any age in any setting with screening sample yielding for drug-resistant Enterobacteriaceae; Intervention defined as any decolonization; Controls defined as patients receiving no intervention (spontaneous decolonization) or a different decolonization therapy; Outcomes defined as a microbiological, clinical, epidemiological and adverse event. A total of 679 records were initially identified, of which 647 were excluded because they were not related to decolonization therapies. Other 18 records were excluded because not related to our aims, target bacteria, or study design. A total of 12 clinical studies were included, of which 4 were randomized clinical trials and 8 were non-randomized studies. The majority of studies evaluated selective decontamination of the digestive tract or selective oropharyngeal decontamination regimens. Selected studies were characterized by high heterogeneity. Further high-quality studies with proper design and sample size calculation are warranted.
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Affiliation(s)
- Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy.
| | - Novella Carannante
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy
| | - Gabriella di Mauro
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Marina Sarno
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy
| | - Mariantonia Costanzo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy
| | - Federica Licciardi
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy
| | - Mariano Bernardo
- Microbiology and Virology Unit, Ospedali dei Colli, Naples, Italy
| | - Nicolina Capoluongo
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy
| | - Alessandro Perrella
- Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
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Paprocka P, Durnaś B, Mańkowska A, Król G, Wollny T, Bucki R. Pseudomonas aeruginosa Infections in Cancer Patients. Pathogens 2022; 11:pathogens11060679. [PMID: 35745533 PMCID: PMC9230571 DOI: 10.3390/pathogens11060679] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequent opportunistic microorganisms causing infections in oncological patients, especially those with neutropenia. Through its ability to adapt to difficult environmental conditions and high intrinsic resistance to antibiotics, it successfully adapts and survives in the hospital environment, causing sporadic infections and outbreaks. It produces a variety of virulence factors that damage host cells, evade host immune responses, and permit colonization and infections of hospitalized patients, who usually develop blood stream, respiratory, urinary tract and skin infections. The wide intrinsic and the increasing acquired resistance of P. aeruginosa to antibiotics make the treatment of infections caused by this microorganism a growing challenge. Although novel antibiotics expand the arsenal of antipseudomonal drugs, they do not show activity against all strains, e.g., MBL (metalo-β-lactamase) producers. Moreover, resistance to novel antibiotics has already emerged. Consequently, preventive methods such as limiting the transmission of resistant strains, active surveillance screening for MDR (multidrug-resistant) strains colonization, microbiological diagnostics, antimicrobial stewardship and antibiotic prophylaxis are of particular importance in cancer patients. Unfortunately, surveillance screening in the case of P. aeruginosa is not highly effective, and a fluoroquinolone prophylaxis in the era of increasing resistance to antibiotics is controversial.
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Affiliation(s)
- Paulina Paprocka
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (P.P.); (B.D.); (A.M.); (G.K.)
| | - Bonita Durnaś
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (P.P.); (B.D.); (A.M.); (G.K.)
| | - Angelika Mańkowska
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (P.P.); (B.D.); (A.M.); (G.K.)
| | - Grzegorz Król
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (P.P.); (B.D.); (A.M.); (G.K.)
| | - Tomasz Wollny
- Holy Cross Oncology Center of Kielce, Artwińskiego 3, 25-734 Kielce, Poland;
| | - Robert Bucki
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (P.P.); (B.D.); (A.M.); (G.K.)
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Jana Kilińśkiego 1 Białystok, 15-089 Białystok, Poland
- Correspondence: ; Tel.: +48-85-748-54-83
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5
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Pu D, Zhang Z, Feng B. Alterations and Potential Applications of Gut Microbiota in Biological Therapy for Inflammatory Bowel Diseases. Front Pharmacol 2022; 13:906419. [PMID: 35734396 PMCID: PMC9207480 DOI: 10.3389/fphar.2022.906419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic immune-mediated inflammatory disorder of the gastrointestinal tract that is closely associated with dysbiosis of the intestinal microbiota. Currently, biologic agents are the mainstream therapies for IBD. With the increasing incidence of IBD, limitations of biologic agents have gradually emerged during treatment. Recent studies have indicated that gut microbiota is highly correlated with the efficacy of biologic agents. This review focuses on alterations in both the components and metabolites of gut microbiota during biological therapy for IBD, systematically summarises the specific gut microbiota closely related to the clinical efficacy, and compares current predictive models for the efficacy of biologics, further highlighting the predictive value of intestinal microbiota. Based on the mechanistic analysis of faecal microbiota transplantation (FMT) and biologic agents, a new therapeutic strategy, comprising a combination of FMT and biologics, has been proposed as a promising treatment for IBD with improved efficacy.
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Affiliation(s)
| | - Zhe Zhang
- *Correspondence: Zhe Zhang, ; Baisui Feng,
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6
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Pérez-Nadales E, Cano Á, Recio M, Artacho MJ, Guzmán-Puche J, Doblas A, Vidal E, Natera C, Martínez-Martínez L, Torre-Cisneros J, Castón JJ. Randomised, double-blind, placebo-controlled, phase 2, superiority trial to demonstrate the effectiveness of faecal microbiota transplantation for selective intestinal decolonisation of patients colonised by carbapenemase-producing Klebsiella pneumoniae (KAPEDIS). BMJ Open 2022; 12:e058124. [PMID: 35387830 PMCID: PMC8987760 DOI: 10.1136/bmjopen-2021-058124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Infections caused by carbapenemase-producing Enterobacterales are frequent and associated with high rates of mortality. Intestinal carriers are at increased risk of infection by these microorganisms. Decolonisation strategies with antibiotics have not obtained conclusive results. Faecal microbiota transplantation (FMT) could be an effective and safe strategy to decolonise intestinal carriers of KPC-producing Klebsiella pneumoniae (KPC-Kp) but this hypothesis needs evaluation in appropriate clinical trials. METHODS AND ANALYSIS The KAPEDIS trial is a single-centre, randomised, double-blind, placebo-controlled, phase 2, superiority clinical trial of FMT for eradication of intestinal colonisation by KPC-Kp. One hundred and twenty patients with rectal colonisation by KPC-Kp will be randomised 1:1 to receive encapsulated lyophilised FMT or placebo. The primary outcome is KPC-Kp eradication at 30 days. Secondary outcomes are: (1) frequency of adverse events; (2) changes in KPC-Kp relative load within the intestinal microbiota at 7, 30 and 90 days, estimated by real-time quantitative PCR analysis of rectal swab samples and (3) rates of persistent eradication, KPC-Kp infection and crude mortality at 90 days. Participants will be monitored for adverse effects throughout the intervention. ETHICS AND DISSEMINATION Ethical approval was obtained from Reina Sofía University Hospital Institutional Review Board (approval reference number: 2019-003808-13). Trial results will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER NCT04760665.
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Grants
- Plan Estatal de I+D+I 2013-2016, co-financed by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación and the Fondo Europeo de Desarrollo Regional (FEDER)
- Grant to EPN from Consejería de Salud y Familias, Junta de Andalucía
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
- Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (RD16/0016/0008) ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020.
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Affiliation(s)
- Elena Pérez-Nadales
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Cordoba, Cordoba, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
| | - Ángela Cano
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
| | - Manuel Recio
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
| | - María José Artacho
- Unidad de Gestión Clínica de Microbiología, Hospital Santa Ana, Motril, Granada, Spain
| | - Julia Guzmán-Puche
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Antonio Doblas
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
| | - Elisa Vidal
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
| | - Clara Natera
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
| | - Luis Martínez-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Cordoba, Cordoba, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Julian Torre-Cisneros
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Córdoba, Cordoba, Spain
| | - Juan José Castón
- Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofía/Universidad de Córdoba (IMIBIC/HURS/UCO), Cordoba, Spain
- Red Española de Investigación en Patologías Infecciosas (REIPI), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00049)), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Cordoba, Spain
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7
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Fecal microbiota transplantation for Carbapenem-Resistant Enterobacteriaceae: A systematic review. J Infect 2022; 84:749-759. [DOI: 10.1016/j.jinf.2022.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023]
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8
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Yan R, Lu Y, Wu X, Yu P, Lan P, Wu X, Jiang Y, Li Q, Pi X, Liu W, Zhou J, Yu Y. Anticolonization of Carbapenem-Resistant Klebsiella pneumoniae by Lactobacillus plantarum LP1812 Through Accumulated Acetic Acid in Mice Intestinal. Front Cell Infect Microbiol 2022; 11:804253. [PMID: 34976873 PMCID: PMC8714838 DOI: 10.3389/fcimb.2021.804253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is highly prevalent and poses a significant threat to public health. In critically ill patients, gut colonization is considered to be the reservoir of recurrent CRKP infection. Therefore, eliminating CRKP carriage in the intestine is critical for preventing subsequent CRKP infection. In the present study, Lactobacillus plantarum LP1812, a probiotic that can inhibit CRKP in vitro, was used as a candidate probiotic to investigate its efficacy for CRKP anticolonization. Compared with the control, mice fed with 1×10 8 CFU L. plantarum LP1812 exhibited significant CRKP clearance from 1×10 4 CFU/mg to less than 10 CFU/mg in mice feces. Furthermore, 16S RNA gene sequencing revealed that L. plantarum LP1812 modulated mice microbiota by increasing the relative abundance of the genus Halomanas, Blautia, and Holdemania. Further KEGG pathway enrichment analysis revealed that fatty acid-utilizing bacteria, such as acetate-producing Bacteroidetes and Blautia flourished in mice fed with L. plantarum LP1812. Moreover, we found that the concentration of acetic acid was higher in L. plantarum LP1812, which inhibited the growth of K. pneumoniae strains in vitro. Meanwhile, mice intragastrically administered with acetic acid exhibited significantly increased CRKP elimination in vivo. In conclusion, L. plantarum LP1812 is a potential candidate for intestinal CRKP anticolonization by regulating the intestinal microbiota and inhibiting CRKP via increased acetic acid in the intestinal lumen.
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Affiliation(s)
- Rushuang Yan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Ye Lu
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xiaoqing Wu
- Department of Rehabilitation, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peihao Yu
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Peng Lan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China
| | - Xueqing Wu
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China.,Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Jiang
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China.,Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Li
- Department of Emergency Medicine, Lanxi People's Hospital, Lanxi, China
| | - Xionge Pi
- Institute of Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Wei Liu
- Institute of Plant Protection and Microbiology, Zhejiang Academy of Agricultural Sciences, Hangzhou, China
| | - Jiancang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunsong Yu
- Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Sir Run Run Shaw Hospital, Hangzhou, China.,Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wuethrich I, W. Pelzer B, Khodamoradi Y, Vehreschild MJGT. The role of the human gut microbiota in colonization and infection with multidrug-resistant bacteria. Gut Microbes 2022; 13:1-13. [PMID: 33870869 PMCID: PMC8078746 DOI: 10.1080/19490976.2021.1911279] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
About 100 years ago, the first antibiotic drug was introduced into health care. Since then, antibiotics have made an outstanding impact on human medicine. However, our society increasingly suffers from collateral damage exerted by these highly effective drugs. The rise of resistant pathogen strains, combined with a reduction of microbiota diversity upon antibiotic treatment, has become a significant obstacle in the fight against invasive infections worldwide.Alternative and complementary strategies to classical "Fleming antibiotics" comprise microbiota-based treatments such as fecal microbiota transfer and administration of probiotics, live-biotherapeutics, prebiotics, and postbiotics. Other promising interventions, whose efficacy may also be influenced by the human microbiota, are phages and vaccines. They will facilitate antimicrobial stewardship, to date the only globally applied antibiotic resistance mitigation strategy.In this review, we present the available evidence on these nontraditional interventions, highlight their interaction with the human microbiota, and discuss their clinical applicability.
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Affiliation(s)
- Irene Wuethrich
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Benedikt W. Pelzer
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Maria J. G. T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt Am Main, Germany,CONTACT Maria J. G. T. Vehreschild Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt Am Main, Germany
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10
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Bavaro DF, Belati A, Diella L, Stufano M, Romanelli F, Scalone L, Stolfa S, Ronga L, Maurmo L, Dell’Aera M, Mosca A, Dalfino L, Grasso S, Saracino A. Cefiderocol-Based Combination Therapy for "Difficult-to-Treat" Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives. Antibiotics (Basel) 2021; 10:antibiotics10060652. [PMID: 34072342 PMCID: PMC8227820 DOI: 10.3390/antibiotics10060652] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
- Correspondence:
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Lucia Diella
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Monica Stufano
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Federica Romanelli
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luca Scalone
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Stefania Stolfa
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luigi Ronga
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Leonarda Maurmo
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Maria Dell’Aera
- Direttore Farmacia Ospedaliera AOU Policlinico di Bari, University of Bari, 70124 Bari, Italy;
| | - Adriana Mosca
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Salvatore Grasso
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
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11
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Su F, Luo Y, Yu J, Shi J, Zhao Y, Yan M, Huang H, Tan Y. Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review. Eur J Med Res 2021; 26:37. [PMID: 33910622 PMCID: PMC8080403 DOI: 10.1186/s40001-021-00508-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Due to limited antibiotic options, carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high non-relapse mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Also, intestinal CRE colonization is a risk factor for subsequent CRE infection. Several clinical studies have reported successful fecal microbiota transplantation (FMT) for the gut decontamination of a variety of multidrug-resistant bacteria (MDRB), even in immunosuppressed patients. Similarly, other studies have also indicated that multiple FMTs may increase or lead to successful therapeutic outcomes. CASE PRESENTATION We report CRE colonization in an allo-HSCT patient with recurrent CRE infections, and its successful eradication using tandem FMT cycles at 488 days after allo-HSCT. We also performed a comprehensive microbiota analysis. No acute or delayed adverse events (AEs) were observed. The patient remained clinically stable with CRE-negative stool culture at 26-month follow-up. Our analyses also showed some gut microbiota reconstruction. We also reviewed the current literature on decolonization strategies for CRE. CONCLUSIONS CRE colonization led to a high no-relapse mortality after allo-HSCT; however, well-established decolonization strategies are currently lacking. The successful decolonization of this patient suggests that multiple FMT cycles may be potential options for CRE decolonization.
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Affiliation(s)
- Fengqin Su
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jian Yu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jimin Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yanmin Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Mengni Yan
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yamin Tan
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China. .,Hematology Department, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China.
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12
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Cieślik M, Bagińska N, Górski A, Jończyk-Matysiak E. Animal Models in the Evaluation of the Effectiveness of Phage Therapy for Infections Caused by Gram-Negative Bacteria from the ESKAPE Group and the Reliability of Its Use in Humans. Microorganisms 2021; 9:206. [PMID: 33498243 PMCID: PMC7909267 DOI: 10.3390/microorganisms9020206] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
The authors emphasize how extremely important it is to highlight the role played by animal models in an attempt to determine possible phage interactions with the organism into which it was introduced as well as to determine the safety and effectiveness of phage therapy in vivo taking into account the individual conditions of a given organism and its physiology. Animal models in which phages are used make it possible, among other things, to evaluate the effective therapeutic dose and to choose the possible route of phage administration depending on the type of infection developed. These results cannot be applied in detail to the human body, but the knowledge gained from animal experiments is invaluable and very helpful. We would like to highlight how useful animal models may be for the possible effectiveness evaluation of phage therapy in the case of infections caused by gram-negative bacteria from the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) group of pathogens. In this review, we focus specifically on the data from the last few years.
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Affiliation(s)
- Martyna Cieślik
- Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.C.); (N.B.); (A.G.)
| | - Natalia Bagińska
- Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.C.); (N.B.); (A.G.)
| | - Andrzej Górski
- Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.C.); (N.B.); (A.G.)
- Phage Therapy Unit, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - Ewa Jończyk-Matysiak
- Bacteriophage Laboratory, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.C.); (N.B.); (A.G.)
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13
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Sahitya DSK, Jandiyal A, Jain A, Senapati J, Nanda S, Aggarwal M, Kumar P, Mohapatra S, Ray P, Malhotra P, Mahapatra M, Dhawan R. Prevention and management of carbapenem-resistant Enterobacteriaceae in haematopoietic cell transplantation. Ther Adv Infect Dis 2021; 8:20499361211053480. [PMID: 34733507 PMCID: PMC8558808 DOI: 10.1177/20499361211053480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high morbidity and mortality rates in haematopoietic cell transplantation (HCT) recipients. Factors like mucositis, neutropenia, prolonged hospital stay, and frequent use of prophylactic antimicrobials make HCT recipients especially susceptible to CRE infections. Low culture positivity rates, delay in microbiological diagnosis, and resistance to empirical antimicrobial therapy for febrile neutropenia are responsible for high mortality rates in HCT recipients infected with CRE. In this review we discuss the epidemiology, diagnosis, and management of CRE infections with particular emphasis on patients undergoing HCT. We emphasise the need for preventive strategies like multidisciplinary antimicrobial stewardship, and pre-emptive screening for CRE colonisation in prospective HCT patients as measures to mitigate the adverse impact of CRE on HCT outcomes. Newer diagnostic tests like polymerase chain reaction and matrix-assisted laser desorption ionisation-time of flight (MALDI-TOF) assay that enable earlier and better identification of CRE isolates are discussed. Antimicrobial agents available against CRE, including newer agents like ceftazidime-avibactam and meropenem-vaborbactam, have been reviewed. We also discuss the data on promising experimental treatments against CRE: phage therapy and healthy donor faecal microbiota transplant. Finally, this review puts forth recommendations as per existing literature on diagnosis and management of CRE infections in blood and marrow transplant (BMT) unit.
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Affiliation(s)
| | - Aditya Jandiyal
- Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | - Arihant Jain
- Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | - Jayastu Senapati
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Saumya Nanda
- Lady Hardinge Medical College, New Delhi, New Delhi, India
| | - Mukul Aggarwal
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Pradeep Kumar
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Sarita Mohapatra
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Pallab Ray
- Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | - Pankaj Malhotra
- Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | | | - Rishi Dhawan
- All India Institute of Medical Sciences, New Delhi, New Delhi 110029, India
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