1
|
Abate G, Stapleton JT, Rouphael N, Creech B, Stout JE, El Sahly HM, Jackson L, Leyva FJ, Tomashek KM, Tibbals M, Watson N, Miller A, Charbek E, Siegner J, Sokol-Anderson M, Nayak R, Dahlberg G, Winokur P, Alaaeddine G, Beydoun N, Sokolow K, Kown NP, Phillips S, Baker AW, Turner N, Walter E, Guy E, Frey S. Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease. Clin Infect Dis 2021; 72:1127-1137. [PMID: 32198521 PMCID: PMC8028102 DOI: 10.1093/cid/ciaa252] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The increasing global prevalence of pulmonary nontuberculous mycobacteria (NTM) disease has called attention to challenges in NTM diagnosis and management. This study was conducted to understand management and outcomes of patients with pulmonary NTM disease at diverse centers across the United States. METHODS We conducted a 10-year (2005-2015) retrospective study at 7 Vaccine and Treatment Evaluation Units to evaluate pulmonary NTM treatment outcomes in human immunodeficiency virus-negative adults. Demographic and clinical information was abstracted through medical record review. Microbiologic and clinical cure were evaluated using previously defined criteria. RESULTS Of 297 patients diagnosed with pulmonary NTM, the most frequent NTM species were Mycobacterium avium-intracellulare complex (83.2%), M. kansasii (7.7%), and M. abscessus (3.4%). Two hundred forty-five (82.5%) patients received treatment, while 45 (15.2%) were followed without treatment. Eighty-six patients had available drug susceptibility results; of these, >40% exhibited resistance to rifampin, ethambutol, or amikacin. Of the 138 patients with adequate outcome data, 78 (56.5%) experienced clinical and/or microbiologic cure. Adherence to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) treatment guidelines was significantly more common in patients who were cured (odds ratio, 4.5, 95% confidence interval, 2.0-10.4; P < .001). Overall mortality was 15.7%. CONCLUSIONS Despite ATS/IDSA Guidelines, management of pulmonary NTM disease was heterogeneous and cure rates were relatively low. Further work is required to understand which patients are suitable for monitoring without treatment and the impact of antimicrobial therapy on pulmonary NTM morbidity and mortality.
Collapse
Affiliation(s)
- Getahun Abate
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Buddy Creech
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason E Stout
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Francisco J Leyva
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Melinda Tibbals
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Nora Watson
- The Emmes Corporation, Rockville, Maryland, USA
| | - Aaron Miller
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Joan Siegner
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | | | - Ravi Nayak
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Greta Dahlberg
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Pat Winokur
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ghina Alaaeddine
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nour Beydoun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Sokolow
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Naomi Prashad Kown
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Shanda Phillips
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Arthur W Baker
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas Turner
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Emmanuel Walter
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Sharon Frey
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| |
Collapse
|
2
|
Abstract
Fourteen clinical isolates of Klebsiella pneumoniae with extended-spectrum beta-lactamases (ESBLs) were detected by the double disk synergy test and the Etest ESBL strip. Co-resistances included high MICs for aminoglycosides, fluoroquinolones, tetracyclines, and trimethoprim/sulphamethoxazole. Co-resistance was not observed in five of the 14 strains. These isolates were all genetically distinct as determined by the automated ribotyping method. Isoelectric focusing documented the presence of multiple beta-lactamases (one to four per isolate) with pIs ranging from 5.4 to 8.4. The majority of isolates contained beta-lactamases with pI values of 7.6 and 8.4 consistent with SHV-type ESBLs and an Amp C enzyme, respectively. Emerging ESBL strains in K. pneumoniae compromise the use of agents such as cefotaxime, ceftriaxone, ceftazidime in China; leading to the expansion of quality infection control practices and formulary management programmes to minimize clonal expansion.
Collapse
Affiliation(s)
- D Shen
- Department of Microbiology 301 Hospital 28, FuXing Road, Beijing 100853, People's Republic of China.
| | | | | |
Collapse
|
3
|
Gales AC, Biedenbach DJ, Winokur P, Hacek DM, Pfaller MA, Jones RN. Carbapenem-resistant Serratia marcescens isolates producing Bush group 2f beta-lactamase (SME-1) in the United States: results from the MYSTIC Programme. Diagn Microbiol Infect Dis 2001; 39:125-7. [PMID: 11248526 DOI: 10.1016/s0732-8893(00)00222-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two carbapenem (imipenem, meropenem)-resistant Serratia marcescens strains were isolated in the United States (Chicago, IL) through the 1999 MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) Programme. The S. marcescens antimicrobial susceptible patterns were: susceptible to ceftriaxone, ceftazidime, and cefepime (MICs, < or = 0.25 microg/ml), and resistance to the carbapenems (imipenem and meropenem; MIC, > 32 microg/ml) and aztreonam (MIC, > = 16 microg/ml). Each S. marcescens isolate shared an identical epidemiologic type (ribotype and PFGE) and the outer membrane protein profile was also identical to those of the wild type susceptible strains from the same medical center. The PCR utilizing bla(sme-1) primers amplified a gene product that was identified as consistent with SME-1 after DNA sequencing. Imipenem and meropenem resistance due to production of carbapenem-hydrolyzing enzymes among clinical isolates is still very rare, but microbiology laboratories should be aware of these chromosomally encoded enzymes among class C beta-lactamases producing enteric bacilli such as S. marcescens and Enterobacter cloacae.
Collapse
Affiliation(s)
- A C Gales
- Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | | | | | | | | | | |
Collapse
|
4
|
Sader HS, Jones RN, Gales AC, Winokur P, Kugler KC, Pfaller MA, Doern GV. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997). SENTRY Latin America Study Group. Diagn Microbiol Infect Dis 1998; 32:289-301. [PMID: 9934546 DOI: 10.1016/s0732-8893(98)00124-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pneumonia is the most common fatal hospital-acquired infection, with attributable mortality rates ranging from 30 to 60%. Rapid initiation of optimal antimicrobial therapy is essential for obtaining treatment success. In this report the antimicrobial susceptibility of 556 strains from the lower respiratory tract were collected by the SENTRY Antimicrobial Surveillance Program (1997). These strains were isolated from hospitalized patients with pneumonia in 10 Latin American centers (6 countries) as part of this 68-center worldwide program. The isolates were susceptibility tested against more than 70 drugs (35 reported) by the reference broth microdilution method. Klebsiella pneumoniae and Escherichia coli phenotypically consistent with extended spectrum beta-lactamase (ESBL) production were characterized further by ribotyping and pulsed-field gel electrophoresis. The five most frequently isolated species were (n/%): Pseudomonas aeruginosa (149/26.8%), Staphylococcus aureus (127/22.8%), Acinetobacter spp. (66/11.9%), Klebsiella spp. (56/10.1%), and Enterobacter spp. (40/7.2%). P. aeruginosa demonstrated high rates of resistance to a majority of the antimicrobial drugs tested. Carbapenems, amikacin, and piperacillin/tazobactam demonstrated the highest susceptibility rates (73.8-77.2%) against P. aeruginosa, however the lowest resistance rate was observed for cefepime (6.7%). Acinetobacter spp. also showed very high rates of resistance and the most active compounds were imipenem and meropenem (89.0% susceptibility) followed by the tetracyclines. Cephalosporin susceptibilities among Klebsiella spp. were low: cefoxitin, 73.0%; ceftazidime, 69.4%; and ceftriaxone, 65.9%. Approximately 37% and 28% of K. pneumoniae and E. coli isolates, respectively, were considered ESBL producers based on NCCLS criteria. Ceftriaxone was active against only 52.5% of Enterobacter spp. isolates, whereas cefepime was active against 90.0% of isolates (MIC50, < or = 0.12 microgram/mL). Oxacillin resistance was detected in nearly 50% of S. aureus isolates. The most active drugs against S. aureus were vancomycin, teicoplanin, and quinupristin/dalfopristin (MIC90, 1 microgram/mL). In summary, our study of pneumonias in Latin American medical centers demonstrated a greatly increased prevalence of Acinetobacter spp. and higher resistance rates among Gram-negative bacilli when compared with similar controlled studies from North America.
Collapse
Affiliation(s)
- H S Sader
- Laboratório Especial de Microbiologia Clinica, Federal University of São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|