scholarly journals Diminishing returns, increasing risks: Impact of antibiotic duration of therapy on respiratory bacterial isolates in hospitalized patients during the coronavirus disease 2019 (COVID-19) pandemic

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Catherine Li ◽  
Ryan W. Chapin ◽  
Nicholas J. Mercuro ◽  
Christina F. Yen ◽  
Howard S. Gold ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Duration Of Therapy ◽  
Antibiotic Duration ◽  
Case Control Analysis ◽  
Hospital Days

Abstract In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case–control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%.

scholarly journals Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Adrian Schmid ◽  
Aline Wolfensberger ◽  
Johannes Nemeth ◽  
Peter W. Schreiber ◽  
Hugo Sax ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Case Control Studies ◽  
Gram Negative ◽  
Cure Rates

Abstract Infections caused by carbapenemase-producing, multidrug-resistant (MDR), or extensively drug-resistant (XDR) Gram-negative bacteria constitute a major therapeutic challenge. Whether combination antibiotic therapy is superior to monotherapy remains unknown. In this systematic review and meta-analysis OVID MEDLINE, EMBASE, PubMed, The Cochrane Library, and Scopus databases were searched for randomized controlled trials (RCTs) and observational studies published by December 2016 comparing mono- with combination antibiotic therapy for infections with carbapenemase-producing, MDR, or XDR Gram-negative bacteria. Mortality and clinical cure rates served as primary and secondary outcome measures, respectively. Of 8847 initially identified studies, 53 studies – covering pneumonia (n = 10 studies), blood stream (n = 15), osteoarticular (n = 1), and mixed infections (n = 27) - were included. 41% (n = 1848) of patients underwent monotherapy, and 59% (n = 2666) combination therapy. In case series/cohort studies (n = 45) mortality was lower with combination- vs. monotherapy (RR 0.83, CI 0.73–0.93, p = 0.002, I2 = 24%). Subgroup analysis revealed lower mortality with combination therapy with at least two in-vitro active antibiotics, in blood stream infections, and carbapenemase-producing Enterobacteriaceae. No mortality difference was seen in case-control studies (n = 6) and RCTs (n = 2). Cure rates did not differ regardless of study type. The two included RCTs had a high and unknown risk of bias, respectively. 16.7% (1/6) of case-control studies and 37.8% (17/45) of cases series/cohort studies were of good quality, whereas quality was poor in the remaining studies. In conclusion, combination antimicrobial therapy of multidrug-resistant Gram-negative bacteria appears to be superior to monotherapy with regard to mortality.

scholarly journals 2217. Frequency and Antimicrobial Susceptibility of Bacteria Isolated from Patients Hospitalized with Pneumonia in US Medical Centers During 2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S756-S756
Author(s):  
Helio S Sader ◽  
Michael D Huband ◽  
Cecilia G Carvalhaes ◽  
Mariana Castanheira
Keyword(s):  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Central Laboratory ◽  
Active Compounds ◽  
Gram Negative ◽  
E Coli ◽  
Medical Centers ◽  
Carbapenem Resistant ◽  
Esbl Producers

Abstract Background Rapidly introducing appropriate antimicrobial therapy is crucial to reduce morbidity and mortality of patients hospitalized with pneumonia (PHP), and therapy is determined mostly by understanding causative pathogens. Ceftazidime–avibactam (CAZ-AVI) was recently approved and ceftolozane–tazobactam (C-T) is in late-stage clinical development for treating nosocomial pneumonia, including ventilator-associated. Methods Bacterial isolates were consecutively collected from PHP (1/patient) in 67 US medical centers in 2018 and the Gram-negative bacilli (GNB) were tested by reference broth microdilution methods for susceptibility (S) to CAZ-AVI, C-T, and many comparators at a central laboratory. Results The most common organisms isolated from PHP were S. aureus (27.0%), P. aeruginosa (PSA) (24.6%), K. pneumoniae (KPN; 7.6%), E. coli (6.8%), S. marcescens (5.4%), and S. maltophilia (XM; 4.5%). Colistin (99.7%S), CAZ-AVI (95.7%S), and C-T (94.9%S) were the most active compounds against PSA; CAZ-AVI (99.9%S), amikacin (AMK; 98.8%S), and meropenem (MEM; 97.6%S) were the most active compounds against Enterobacterales (ENT). CAZ-AVI and C-T retained activity against PSA isolates non-S (NS) to piperacillin–tazobactam (PIP-TAZ), MEM, and cefepime (FEP), whereas PSA isolates NS to PIP-TAZ, MEM, or FEP exhibited low S rates to PIP-TAZ (≤ 39.2%), MEM (≤ 37.8%), and FEP (≤ 38.0%; Table). CAZ-AVI and tigecycline were the only compounds with good activity against carbapenem-resistant ENT (CRE), both with 96.6%S. Among ENT, the most common ESBL and carbapenemase were CTX-M-15 (73%) and KPC-2/3 (76%), respectively. CAZ-AVI was active against all ESBL producers (100.0%S), whereas the S rate to C-T was 82.4%. The most active compounds against multidrug-resistant (MDR) ENT were CAZ-AVI (98.9%S), AMK (91.5%S), and MEM (80.8%S). XM and A. baumannii exhibited low S rates to most antimicrobials tested. Conclusion Gram-negative bacteria were isolated from 70% of PHP, and PSA and ENT represented >80% of these organisms. CAZ-AVI and C-T showed similar coverage (%S) against PSA (95.7–94.9%S). In contrast, C-T was less active than CAZ-AVI against ENT in general and exhibited limited activity against ENT-resistant subsets. Disclosures All authors: No reported disclosures.

Multidrug-ResistantPseudomonas aeruginosaCholangitis After Endoscopic Retrograde Cholangiopancreatography: Failure of Routine Endoscope Cultures to Prevent an Outbreak

2004 ◽  
Vol 25 (10) ◽  
pp. 856-859 ◽  
Author(s):  
Thomas G. Fraser ◽  
Sandra Reiner ◽  
Michael Malczynski ◽  
Paul R. Yarnold ◽  
John Warren ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Surveillance Culture ◽  
Endoscopic Retrograde ◽  
Infectious Morbidity ◽  
Surveillance Cultures ◽  
Case Control Analysis

AbstractBackground:Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistantPseudomonas aeruginosaafter endoscopic retrograde cholangiopancreatography (ERCP).Objective:To describe an outbreak of multidrug-resistantP. aeruginosasepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes.Design:A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope.Setting:A tertiary-care academic medical center.Results:The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive forPseudomonas(P= .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier.Conclusions:Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

scholarly journals Prevalence of Multidrug-Resistant and Extended-spectrum Betalactamase Producing Bacterial Isolates from Infected Wounds of patients in Kathmandu Model Hospital

2020 ◽  
Vol 19 (1) ◽  
pp. 171-179
Author(s):  
Kabita Adhikari ◽  
Shaila Basnyat ◽  
Basudha Shrestha
Keyword(s):  
Wound Infection ◽  
Antibiotic Susceptibility ◽  
Agar Plate ◽  
Multidrug Resistant ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Mueller Hinton Agar ◽  
Living Tissues

   The wound is an injury to living tissues caused by a cut, puncture, bite, blow, or other impacts. An infection is caused when germs enter wounds. This study was designed to isolate and identify the causative agents of wound infections and their antibiotic susceptibility pattern. A total of 339 samples were collected from January to June 2016 from Kathmandu Model Hospital, Kathmandu. Samples were inoculated on the Blood Agar and MacConkey agar plates were incubated at 37 °C for 24 hours. After incubation, all isolates were identified by using gram stain and biochemical methods. Antibiotic susceptibility tests were performed on Mueller Hinton agar plate by Kirby Bauers Disk Diffusion Technique. During the study period, altogether, 339 specimens were collected and processed as per the standard microbiological protocol. The overall prevalence of wound infection was 56.9%. Among 244 bacterial isolates, Escherichiacoli (24.2%) was most predominant bacteria followed by Staphylococcus aureus (19.7%), Coagulase-negative Staphylococcus (17.6%), Klebsiella pneumoniae (10.7%), Pseudomonasaeruginosa(8.6%), Acinetobacterspp (5.7%), Citrobacterfreundii(4.9%) Proteus mirabilis (3.3%), Streptococcus viridans (2.0%), Klebsiellaoxytoca (0.8%), Proteus vulgaris (0.4%), Serratiamarcescens (0.4%), Enterobacteraerogens (1.2%), Enterobacterfaecalis (0.4%). The most effective drug for Gram-negative bacteria and Gram-positive bacteria were amikacin and chloramphenicol, respectively. A total of Gram-negative bacteria, 77.55% were multidrug-resistant. The total Gram-negative bacteria most ESBL producers were E. coli (82.9%). We found S. aureus 33.3% of isolates were resistant to cefoxitin which indicates the increasing rate of Methicillin-resistant S. aureus(MRSA) in wound infection.

Prevalence of Multidrug Resistant Bacteria in Refugees: A Prospective Case Control Study in an Obstetric Cohort

2017 ◽  
Vol 221 (03) ◽  
pp. 132-136 ◽  
Author(s):  
Kathrin Oelmeier de Murcia ◽  
Birgit Glatz ◽  
Stephanie Willems ◽  
Annelene Kossow ◽  
Marlit Strobel ◽  
...  
Keyword(s):  
Case Control Study ◽  
Multidrug Resistant ◽  
Case Control ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Refugee Women ◽  
Surveillance Cultures ◽  
Control Study ◽  
Prospective Case Control Study

Abstract Purpose To determine the prevalence of multidrug resistant (MDR) bacteria in a cohort of pregnant refugee women. Methods In a prospective case control study, surveillance cultures for MDR bacteria (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], MDR Gram-negative bacteria [MRGN]) were analysed between October 2015 and June 2016 from a cohort of 50 pregnant refugee women and 50 resident controls in the obstetric unit of a German tertiary referral hospital. Results Prevalence of MRSA was noticeably higher among refugee women compared to residents (6 vs. 0%). In addition, a trend towards a higher prevalence of VRE and MDR Gram-negative bacteria in refugees was shown (1.8 vs. 0%). Conclusions Due to the higher prevalence of MDR bacteria, surveillance cultures are justified in order to prevent nosocomial spread of MDR bacteria.

scholarly journals Co-expression of 16S rRNA Methyltransferase and Carbapenemase in Multidrug Resistant Gram Negative Bacteria

2020 ◽  
Author(s):  
Sandeep Kumar Tipparthi ◽  
Swathi Akula ◽  
HRV Rajkumar ◽  
A Ravishankar Reddy ◽  
Guru Prasad Manderwad
Keyword(s):  
Drug Resistance ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Drug Resistant ◽  
Bacterial Isolates ◽  
Aminoglycoside Resistance ◽  
Gram Negative ◽  
Multiple Mode ◽  
Bacterial Drug Resistance

Introduction: The drug resistance caused by bacteria has complicated the fight against the infectious diseases and recovery of the patients from the diseases. Multiple mode of drug resistant mechanisms including epigenetic and enzymatic mode have been involved in the genesis of drug resistance leaving only fewer antibiotics for the treatment. Studies has shown the presence of 16S methyltransferase which is associated with carbapenem drug resistance. Early detection of different multimode of bacterial drug resistance helps in reducing the dissemination rate and treatment failures. Aim: To detect the genes related to the methylation mode of bacterial drug resistant mechanism including armA (aminoglycoside resistance methylase), rmtA, rmtB, rmtC and rmtD (rmt-RNA methyltrasferase) as well as genes OXA-48 (Oxacillinase), VIM (Verona intergron metallo-β lactamase) and KPC (Klebsiella pneumoniae carbapenemase) in the production of carbapenemases and also to identify the co-expression of these genes in the gram negative bacterial isolates. Materials and Methods: Prospective study was conducted through application of multiplex Polymerase Chain Reaction (PCR)for detection of 16S methyltransferase genes including armA, rmtA, rmtB, rmtC and rmtD and carbpenemase VIM, KPC and OXA-48 genes, respectively. A total of 200 multidrug resistant gram negative bacilli were evaluated for presence of these genes. The antibiotic sensitivity was evaluated using Kirby-Bauer disc diffusion method. Results: The gram negative bacteria which were isolated includes Acinetobacter spp. 20, E.coli-85, Klebsiella spp.-55 and Pseudomonas aeruginosa-40 from several specimens such as urine, endotracheal tube-secretion, wound swab, sputum, pus etc. A total of 121 (61%) of the bacterial isolates were resistant to either gentamicin or amikacin and netilimycin and 50 (25%) bacterial isolates were resistant to either imipenem or carbapenem. A total of 48 (24%) isolates were resistant to both aminoglycosides and carbapenems. The 16S methyltransferase genes including armA gene was detected in 16 isolates, rmtB in 15 isolates, rmtC in 10 isolates and rmtD detected in 13 isolates The carbapenem genes detected including VIM in 20 isolates, OXA-48 in 25 isolates and KPC was detected in 13 bacterial isolates. Co-expression of both methyltransferase and carbapenemase were detected in nine isolates. Conclusion: The presence of multiple mode of bacterial drug resistance mechanisms including epigenetic and enzymatic modes have been found to be associated with resistance to different classes of antibiotics. The application of multiplex PCR helps in detection of multiple genes involved in bacterial drug resistance and helps in prevention of rapid spread of bacterial drug resistance and prevention of overuse of antibiotics.

scholarly journals A novel chemical biology and computational approach to expedite the discovery of new-generation polymyxins against life-threatening Acinetobacter baumannii

2021 ◽  
Author(s):  
Xukai Jiang ◽  
Nitin A. Patil ◽  
Mohammad A. K. Azad ◽  
Hasini Wickremasinghe ◽  
Heidi Yu ◽  
...  
Keyword(s):  
Public Health ◽  
Chemical Biology ◽  
Multidrug Resistant ◽  
Computational Approach ◽  
Gram Negative Bacteria ◽  
Global Public Health ◽  
Gram Negative ◽  
Life Threatening ◽  
New Generation ◽  
Novel Antibiotics

Multidrug-resistant Gram-negative bacteria have been an urgent threat to global public health. Novel antibiotics are desperately needed to combat these 'superbugs'.

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