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Chaudhary M, Kumar D, Meena DS, Midha NK, Bohra GK, Tak V, Samantaray S, Kaur N, Neetha TR, Mohammed S, Sharma A, Kothari N, Bhatia PK, Garg MK. 'Effectiveness of various sulbactam-based combination antibiotic therapy in the management of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a tertiary care Health centre'. Indian J Med Microbiol 2024; 52:100737. [PMID: 39349137 DOI: 10.1016/j.ijmmb.2024.100737] [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: 12/27/2023] [Revised: 06/24/2024] [Accepted: 09/28/2024] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Carbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. METHODS Adult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. RESULTS A total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %-44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %-38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %-38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. CONCLUSION Treatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.
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Affiliation(s)
- Monika Chaudhary
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Deepak Kumar
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Durga Shankar Meena
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Naresh Kumar Midha
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Gopal Krishana Bohra
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Subhashree Samantaray
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Navneet Kaur
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - T R Neetha
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Sadik Mohammed
- Department of Critical Care and Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Ankur Sharma
- Department of Critical Care and Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Nikhil Kothari
- Department of Critical Care and Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Pradeep Kumar Bhatia
- Department of Critical Care and Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - M K Garg
- Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Chen S, Li Z, Shi J, Zhou W, Zhang H, Chang H, Cao X, Gu C, Chen G, Kang Y, Chen Y, Wu C. A Nonlinear Time-Series Analysis to Identify the Thresholds in Relationships Between Antimicrobial Consumption and Resistance in a Chinese Tertiary Hospital. Infect Dis Ther 2022; 11:1019-1032. [PMID: 35290657 PMCID: PMC9124282 DOI: 10.1007/s40121-022-00608-w] [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: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Balancing the benefits and risks of antimicrobials in health care requires an understanding of their effects on antimicrobial resistance at the population scale. Therefore, we aimed to investigate the association between the population antibiotics use and resistance rates and further identify their critical thresholds. Methods Data for monthly consumption of six antibiotics (daily defined doses [DDDs]/1000 inpatient-days) and the number of cases caused by five common drug-resistant bacteria (occupied bed days [OBDs]/10,000 inpatient-days) from inpatients during 2009–2020 were retrieved from the electronic prescription system at Nanjing Drum Tower Hospital, a tertiary hospital in Jiangsu Province, China. Then, a nonlinear time series analysis method, named generalized additive models (GAM), was applied to analyze the pairwise relationships and thresholds of these antibiotic consumption and resistance. Results The incidence densities of carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), and aminoglycoside-resistant Pseudomonas aeruginosa were all strongly synchronized with recent hospital use of carbapenems and glycopeptides. Besides, the prevalence of carbapenem-resistant Escherichia coli was also highly connected the consumption of carbapenems and fluoroquinolones. To lessen resistance, we determined a threshold for carbapenem and glycopeptide usage, where the maximum consumption should not exceed 31.042 and 25.152 DDDs per 1000 OBDs, respectively; however, the thresholds of fluoroquinolones, third-generation cephalosporin, aminoglycosides, and β-lactams have not been identified. Conclusions The inappropriate usage of carbapenems and glycopeptides was proved to drive the incidence of common drug-resistant bacteria in hospitals. Nonlinear time series analysis provided an efficient and simple way to determine the thresholds of these antibiotics, which could provide population-specific quantitative targets for antibiotic stewardship.
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Affiliation(s)
- Shixing Chen
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Zepeng Li
- Business School, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
| | - Jiping Shi
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wanqing Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Haixia Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Haiyan Chang
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical College, Weihui, Henan, People's Republic of China
| | - Xiaoli Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Changgui Gu
- Business School, University of Shanghai for Science and Technology, Shanghai, 200093, People's Republic of China
| | - Guangmei Chen
- Department of Infectious Diseases, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Yi Kang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, People's Republic of China.
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, People's Republic of China.
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Wu X, Zhong G, Wang H, Zhu J. Temporal association between antibiotic use and resistance in Gram-negative bacteria. BRAZ J BIOL 2021; 83:e239323. [PMID: 34524371 DOI: 10.1590/1519-6984.239323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
The β-lactam/lactamase inhibitors (BLBLIs) combination drugs are considered an effective alternative to carbapenems. However, there is a growing concern that the increased use of BLBLIs may lead to increased resistance. This study determined the temporal association between the consumption of BLBLI and the antimicrobial resistance in Gram-negative bacteria. In this retrospective study, electronic data on the Gram-negative bacterial isolates, including A. baumannii, P. aeruginosa, E. coli, and K. pneumoniae from in-patients and susceptibility testing results were retrieved from the medical records of the clinical laboratory. A linear regression and cross-correlation analysis were performed on the acquired data. Increasing trends (p<0.05) in the consumption of BIBLI and carbapenem with a median use of 27.68 and 34.46 DDD/1000 PD per quarter were observed, respectively. A decreased trend (p=0.023) in the consumption of fluoroquinolones with a median use of 29.13 DDD/1000 PD per quarter was observed. The resistance rate of K. pneumoniae was synchronized with the BIBLI and carbapenem consumptions with a correlation coefficient of 0.893 (p=0.012) and 0.951 (p=0.016), respectively. The cross-correlation analysis against the consumption of BIBLI and meropenem resistant K. pneumoniae was peaked at 0-quarter lag (r=951, p=0.016). There was an increasing trend in the consumption of BLBLI and carbapenems. The increasing trend in the rates of resistance to piperacillin/tazobactam, in line with the increasing consumption of BLBLI, suggests that BLBLI has to be used with caution and cannot be directly considered as a long-term alternative to carbapenems.
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Affiliation(s)
- X Wu
- Central South University, Affiliated Haikou Hospital of Xiangya Medical College, Department of Clinical Laboratory, Haikou, Hainan, China
| | - G Zhong
- Haikou Hospital of the Maternal and Child Health, Department of Pharmacy, Haikou, Hainan, China
| | - H Wang
- Hainan Provincial People's Hospital (Hainan Hospital Affiliated to Hainan Medical College), Department of Health Management Centre, Haikou, Hainan, China
| | - J Zhu
- The Third Xiangya Hospital of Central South University, Department of Laboratory Medicine, Changsha, Hunan, China
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Hao Y, Chen S, Chang H, Yan X, Zhou W, Cao X, Huang R, Zhang Z, Zhang H, Jia B, Wu W, Xiong Y, Chen Y, Wu C. Temporal association between carbapenems usage and antimicrobial resistance in gram-negative bacteria at a tertiary hospital in Nanjing, China. Diagn Microbiol Infect Dis 2020; 98:115083. [PMID: 32650282 DOI: 10.1016/j.diagmicrobio.2020.115083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
In this study, we investigated the temporal association between carbapenems usage and antimicrobial resistance among major Gram-negative bacteria, using the data of quarterly carbapenems consumptions and percentages of antibiotic resistance for Gram-negative bacteria from inpatients from 2013 to 2017 in a tertiary hospital from Jiangsu Province, China. First, carbapenems consumption showed an increasing trend in the past 5 years, accompanied with the rising rates of A. baumannii and P. aeruginosa resistance against imipenem. In A. baumannii, we identified correlations between carbapenems consumption and antimicrobial resistance against piperacillin/tazobactam, ceftazidime, ciprofloxacin and imipenem, respectively. Additionally, close correlations were observed between carbapenems consumption and antimicrobial resistance against ceftazidime and ciprofloxacin in E. coli. Our data indicated that a significant positive correlation between the usage of carbapenems and the rate of antimicrobial resistance among A. baumannii and E. coli, respectively. Carbapenems should be cautiously prescribed to prevent antimicrobial resistance outbreak in A. baumannii and E. coli.
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Affiliation(s)
- Yingying Hao
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shixing Chen
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyan Chang
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical College, Weihui, Hennan
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wanqing Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaoli Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhaoping Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haixia Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Bei Jia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weihua Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yali Xiong
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
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Hasanin A, Mukhtar A, El-adawy A, Elazizi H, Lotfy A, Nassar H, Ghaith D. Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ahmed Hasanin
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Mukhtar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Akram El-adawy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Hossam Elazizi
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Lotfy
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Heba Nassar
- Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt
| | - Doaa Ghaith
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt
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Elbrolosy AM, Labeeb AZ, Hassan DM. New Delhi metallo-β-lactamase-producing Acinetobacter isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome. Infect Drug Resist 2019; 12:373-384. [PMID: 30809098 PMCID: PMC6377045 DOI: 10.2147/idr.s186924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Acinetobacter spp. are increasingly important microbes involved in late-onset ventilator-associated pneumonia (VAP). Purpose The aims of this study were to determine the prevalence of New Delhi metallo-β-lactamase (MβL) (blaNDM-1)-producing Acinetobacter spp. among late-onset VAP patients in different intensive care units (ICUs) of Menoufia and Kasr Al Ainy University Hospitals, to investigate the possible risk factors contributing to the acquisition of blaNDM-1-producing Acinetobacter infection, and to correlate between antimicrobial resistance pattern and therapeutic efficacy as well as clinical outcomes of these patients. Materials and methods Sixty-four Acinetobacter isolates were collected from mechanically ventilated patients with suspected late-onset VAP and subjected to antimicrobial susceptibility testing. The modified Hodge test (MHT) and combined disk tests (CDT) were applied for blaNDM-1 MβL detection. Acinetobacter isolates with phenotypically confirmed MβLs production were subjected to a PCR assay to verify the presence of blaNDM-1 gene. The most obvious risk factors for acquisition of carbapenem resistance in VAP patients and treatment outcomes were also analyzed. Results Out of 64 Acinetobacter isolates, 42 (65.6%) proved to be blaNDM-1 positive. The sensitivity and specificity of MHT were 52.38% and 41.67%, while for CDT they were 92.86% and 83.33%, respectively. Acinetobacter isolates showed high susceptibility to colistin (85.7%). The clinical response was better among VAP patients who received combined carbapenem plus colistin therapy than those who received colistin alone. Relapse of infection was detected in 12.5% (8/64) of VAP cases. The reported mortality reached 46.8% (30/64) of which 27 (64.3%) were infected with blaNDM-1-positive isolates. Prolonged duration of mechanical ventilation, longer hospital and ICU stays, and prior exposure to antibiotic therapy were by far the most important factors predisposing to carbapenem resistance among VAP patients. Conclusion A worldwide spread of Acinetobacter spp. expressing carbapenemases represents a significant threat to the medical community. The current study addressed the high prevalence of blaNDM-1-producing Acinetobacter isolates among late-onset VAP patients.
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Affiliation(s)
- Asmaa M Elbrolosy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt,
| | - Azza Z Labeeb
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt,
| | - Dina M Hassan
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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8
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Khilnani, GC, Zirpe, K, Hadda, V, Mehta, Y, Madan, K, Kulkarni, A, Mohan, A, Dixit, S, Guleria, R, Bhattacharya, P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med 2019; 23:S1-S63. [PMID: 31516211 PMCID: PMC6734471 DOI: 10.5005/jp-journals-10071-23101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
How to cite this article: Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian Journal of Critical Care Medicine 2019;23 (Suppl 1):1-63.
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Affiliation(s)
- GC Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Vijay Hadda,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Mehta,
- Indian Society of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesiology, Gurugram, Haryana, India
| | - Karan Madan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kulkarni,
- Department of Anaesthesiology, Division of Critical Care Medicine, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Mohan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Subhal Dixit,
- Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Randeep Guleria,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Bhattacharya,
- Department of Anaesthesiology, Critical Care and Emergency Services, Bhopal, Madhya Pradesh, India
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9
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Cheng IL, Chen YH, Lai CC, Tang HJ. Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials. J Clin Med 2018; 7:jcm7080208. [PMID: 30103414 PMCID: PMC6111980 DOI: 10.3390/jcm7080208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/02/2018] [Accepted: 08/09/2018] [Indexed: 11/25/2022] Open
Abstract
This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89–1.20, I2 = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91–1.67, I2 = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72–1.04, I2 = 62%). In addition, no significant difference was observed in the subgroup analysis—high or low dose, with or without a loading dose, carbapenem-resistant Acinetobacter baumannii infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84–1.21, I2 = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for A. baumannii infections.
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Affiliation(s)
- I-Ling Cheng
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
| | - Yu-Hung Chen
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan.
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Agarwal S, Kakati B, Khanduri S, Gupta S. Emergence of Carbapenem Resistant Non-Fermenting Gram-Negative Bacilli Isolated in an ICU of a Tertiary Care Hospital. J Clin Diagn Res 2017; 11:DC04-DC07. [PMID: 28273965 DOI: 10.7860/jcdr/2017/24023.9317] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The emergence and spread of Multi-Drug Resistant (MDR) Non-Fermenting Gram-Negative Bacilli (NFGNB) in Intensive Care Units (ICU) and their genetic potential to transmit diverse antibiotic resistance regardless of their ability to ferment glucose poses a major threat in hospitals. The complex interplay of clonal spread, persistence, transmission of resistance elements and cell-cell interaction leads to the difficulty in controlling infections caused by these multi drug-resistant strains. Among non-fermenting Gram-negative rods, the most clinically significant species Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia are increasingly acquiring resistant to carbapenems. Carbapenems once considered as a backbone of treatment of life threatening infections appears to be broken as the resistance to carbapenems is on rise. AIM To document the prevalence of carbapenem resistance in non-fermenting Gram-negative bacilli isolated from patients with respiratory tract infections in the ICU of Himalayan Institute of Medical Sciences, Dehradun. MATERIALS AND METHODS This is a cross-sectional study conducted in ICU patients between October 2015 to March 2016. A total of 366 lower respiratory tract samples were collected from 356 patients with clinical evidence of lower respiratory tract infections in form of Endotracheal (ET) aspirate, Tracheal Tube (TT) aspirate and Bronchoalveolar Lavage (BAL) specimen. Organism identification and the susceptibility testing was done by using an automated system VITEK 2. RESULTS Out of 366 samples received 99 NFGNB were isolated and most common sample was ET aspirate sample 256 (64.5%). Acinetobacter baumannii was the most common NFGNB isolated 63 (63.63%) followed by Pseudomonas aeruginosa 25 (25.25%), Elizabethkingia meningoseptica seven (7.07%) and Strenotrophomonas maltophilia four (4.04%). We observed that 90.5% Acinetobacter baumannii were resistant to imipenem and 95.2% resistant to meropenem, Pseudomonas aeruginosa came out to be 52% resistant to imipenem and 56% resistant to meropenem while Stenotrophomonas maltophilia and Elizabethkingia meningoseptica were 100% resistant to carbapenems as they are intrinsically resistant to carbapenems. CONCLUSION The resistance rate of carbapenems for NFGNB infections is very high in our study and variable in different regions. Overall carbapenem resistance is on rise. So, the infection control team and microbiologist needs to work together to determine the risk carried by multi drug resistant non-fermenting gram-negative infections and the resistance surveillance programs are mandatory to control these bacteria in ICU settings.
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Affiliation(s)
- Sonika Agarwal
- Assistant Professor, Department of Critical Care Medicine, Himalayan Institute of Medical Sciences, SRHU , Dehradun, Uttarakhand, India
| | - Barnali Kakati
- Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences, SRHU , Dehradun, Uttarakhand, India
| | - Sushant Khanduri
- Assistant Professor, Department of Critical Care Medicine, Himalayan Institute of Medical Sciences, SRHU , Dehradun, Uttarakhand, India
| | - Shalini Gupta
- Senior Resident, Department of Microbiology, Himalayan Institute of Medical Sciences, SRHU , Dehradun, Uttarakhand, India
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Buppajarntham A, Apisarnthanarak A, Khawcharoenporn T, Rutjanawech S, Singh N. National Survey of Thai Infectious Disease Physicians on Treatment of Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia: The Role of Infection Control Awareness. Infect Control Hosp Epidemiol 2016; 37:61-9. [PMID: 26510383 DOI: 10.1017/ice.2015.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP) METHODS From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then compared with standard clinical response rates archived in the existing literature. RESULTS Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates (r=0.58; P<.001). CONCLUSIONS Awareness of IC among IDPs can improve physicians' expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success. Infect. Control Hosp. Epidemiol. 2015;37(1):61-69.
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Affiliation(s)
- Aubonphan Buppajarntham
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Anucha Apisarnthanarak
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Thana Khawcharoenporn
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Sasinuch Rutjanawech
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Nalini Singh
- 2Division of Infectious Diseases,Children's National Medical Center,Department of Pediatrics,Epidemiology and Global Health,George Washington University,School of Medicine and Health Sciences,School of Public Health,Washington DC,United States
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Özvatan T, Akalın H, Sınırtaş M, Ocakoğlu G, Yılmaz E, Heper Y, Kelebek N, İşçimen R, Kahveci F. Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases. Respirology 2015; 21:363-9. [PMID: 26635315 DOI: 10.1111/resp.12698] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/13/2015] [Accepted: 08/31/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. METHODS The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. RESULTS Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains. CONCLUSION Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.
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Affiliation(s)
- Tülay Özvatan
- Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Melda Sınırtaş
- Department of Microbiology and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Gökhan Ocakoğlu
- Department of Biostatistics, Uludag University, Bursa, Turkey
| | - Emel Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Yasemin Heper
- Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Nermin Kelebek
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Remzi İşçimen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ferda Kahveci
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
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Ghafur A. Superbugs and we intensivists: A time for introspection…. Indian J Crit Care Med 2013; 17:125-6. [PMID: 24082606 PMCID: PMC3777363 DOI: 10.4103/0972-5229.117034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Abdul Ghafur
- Coordinator, Chennai Declaration, Consultant, Department of Infectious Diseases, Apollo Specialty Hospital, Chennai, Tamil Nadu, India
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