scholarly journals Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nagehan Didem Sari ◽  
Sevim Baltali ◽  
Istemi Serin ◽  
Veysel Antar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Success ◽  
Day Treatment ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Postoperative Meningitis

Introduction. Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. Results. Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.

A retrospective study on the effects of colistin therapy in children with multidrug-resistant Gram-negative bacterial pathogens: impact of HIV status on outcome

2013 ◽  
Vol 99 (3) ◽  
pp. 262-266 ◽  
Author(s):  
Konstantinos Dimitriades ◽  
Brenda May Morrow ◽  
Prakash Jeena
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Hiv Status ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Microbial Response ◽  
Significant Difference

BackgroundNosocomially acquired multidrug-resistant (MDR) Gram-negative bacteria are important contributors to paediatric intensive care unit (PICU) mortality and morbidity, with limited treatment options.AimTo investigate the outcomes of all children treated with colistin for infection with MDR Gram-negative bacteria while admitted to PICU.MethodsRetrospective observational study of 19 months. Primary endpoints were all-cause intensive care unit mortality and safety. Secondary endpoints evaluated clinical and microbiological outcomes. Cases were stratified according to HIV status.ResultsTwenty-seven children received 30 colistin courses during the study period. Eight patients (29.6%) were HIV infected, six (22.2%) were HIV uninfected but exposed, and 11 (40.7%) were HIV uninfected and unexposed. Common MDR Gram-negative bacteria cultured were: Acinetobacter species (n=22, 81.5%), Pseudomonas aeruginosa (n=11, 40.7%) and Klebsiella pneumoniae (n=7, 25.9%). Mortality was 37%, with no significant difference between HIV strata. No adverse drug reactions were noted. A composite clinical improvement was noted in 16 courses (53.3%) of colistin. Only 30% of colistin courses used in HIV-infected children resulted in an improved clinical assessment as compared with 83.3% of courses in HIV-uninfected/unexposed children (p=0.04). In HIV-infected children, five of 10 (50%) courses of colistin showed bacteriological clearance compared to the HIV uninfected/unexposed group where all cases showed bacterial eradication (p=0.02).ConclusionsHIV-infected children had poorer clinical and bacteriological responses to colistin treatment than HIV uninfected/unexposed. These results require confirmation with prospective studies to determine whether findings are due to poor microbial response, immunodeficiency or repeated reinfections.

scholarly journals Visualizing the Potential Impairment of Polymyxin B to Central Nervous System Through MR Susceptibility-Weighted Imaging

2021 ◽  
Vol 12 ◽  
Author(s):  
Ni Zhang ◽  
Lichong Zhu ◽  
Qiuhong Ouyang ◽  
Saisai Yue ◽  
Yichun Huang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Polymyxin B ◽  
Susceptibility Weighted Imaging ◽  
Gram Negative Bacteria ◽  
Severe Toxicity ◽  
Gram Negative ◽  
The Impact

Polymyxin B (PMB) exert bactericidal effects on the cell wall of Gram-negative bacteria, leading to changes in the permeability of the cytoplasmic membrane and resulting in cell death, which is sensitive to the multi-resistant Gram-negative bacteria. However, the severe toxicity and adverse side effects largely hamper the clinical application of PMB. Although the molecular pathology of PMB neurotoxicity has been adequately studied at the cellular and molecular level. However, the impact of PMB on the physiological states of central nervous system in vivo may be quite different from that in vitro, which need to be further studied. Therefore, in the current study, the biocompatible ultra-uniform Fe3O4 nanoparticles were employed for noninvasively in vivo visualizing the potential impairment of PMB to the central nervous system. Systematic studies clearly reveal that the prepared Fe3O4 nanoparticles can serve as an appropriate magnetic resonance contrast agent with high transverse relaxivity and outstanding biosafety, which thus enables the following in vivo susceptibility-weighted imaging (SWI) studies on the PMB-treated mice models. As a result, it is first found that the blood-brain barrier (BBB) of mice may be impaired by successive PMB administration, displaying by the discrete punctate SWI signals distributed asymmetrically across brain regions in brain parenchyma. This result may pave a noninvasive approach for in-depth studies of PMB medication strategy, monitoring the BBB changes during PMB treatment, and even assessing the risk after PMB successive medication in multidrug-resistant Gram-negative bacterial infected patients from the perspective of medical imaging.

scholarly journals Case Commentary: the Need for Cefiderocol Is Clear, but Are the Supporting Clinical Data?

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Ryan K. Shields
Keyword(s):  
Clinical Trials ◽  
Clinical Practice ◽  
Salvage Therapy ◽  
Randomized Clinical Trials ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Potential Utility ◽  
Gram Negative

ABSTRACT Cefiderocol is a newly approved siderophore cephalosporin that demonstrates expanded in vitro activity against multidrug-resistant Gram-negative bacteria. In two challenging cases reported here, cefiderocol shows potential utility as salvage therapy against difficult-to-treat pathogens with limited or no treatment options; however, two multicenter, randomized clinical trials have yielded mixed results among cefiderocol-treated patients. Taken together, clinicians must balance a clear need for cefiderocol in clinical practice with the uncertainties that have stemmed from the available data.

scholarly journals Assessment of Ceftazidime-Avibactam 30/20-μg Disk, Etest versus Broth Microdilution Results When Tested against Enterobacterales Clinical Isolates

2022 ◽  
Author(s):  
Renru Han ◽  
Xuelin Yang ◽  
Yang Yang ◽  
Yan Guo ◽  
Dandan Yin ◽  
...  
Keyword(s):  
Treatment Options ◽  
Multidrug Resistant ◽  
Clinical Isolates ◽  
Gram Negative Bacteria ◽  
Broth Microdilution ◽  
Gram Negative ◽  
Extended Spectrum ◽  
The World ◽  
Multidrug Resistant Pathogens ◽  
Combinational Therapies

Multidrug-resistant Gram-negative bacteria, especially for extended-spectrum β-lactamases-producing and carbapenemase-producing Enterobacterales , are disseminating rapidly around the world. Treatment options for these infections are limited, which prompt the development of novel or combinational therapies to combat the infections caused by multidrug-resistant pathogens.

scholarly journals Cefiderocol, a new antibiotic against multidrug-resistant Gram-negative bacteria

2021 ◽  
Vol 34 (Suppl 1) ◽  
pp. 41-43
Author(s):  
José Tiago Silva ◽  
Francisco López-Medrano
Keyword(s):  
Bacterial Pneumonia ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Phase Iii ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Tract Infections ◽  
Transport Channels ◽  
Hospital Acquired

Cefiderocol is a novel catechol-substituted siderophore cephalosporin that binds to the extracellular free iron, and uses the bacterial active iron transport channels to penetrate in the periplasmic space of Gram-negative bacteria (GNB). Cefiderocol overcomes many resistance mechanisms of these bacteria. Cefiderocol is approved for the treatment of complicated urinary tract infections, hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia in the case of adults with limited treatment options, based on the clinical data from the APEKS-cUTI, APEKS-NP and CREDIBLE-CR trials. In the CREDIBLE-CR trial, a higher all-cause mortality was observed in the group of patients who received cefiderocol, especially those with severe infections due to Acinetobacter spp. Further phase III clinical studies are necessary in order to evaluate cefiderocol´s efficacy in the treatment of serious infections.

scholarly journals Epidemiology, Pathogens Distribution, Antibiotic Susceptibility and the Risk Factors for Mortality of Patients With Central Nervous System Infections: a Retrospective Study From 2012 to 2019 in a Teaching Hospital in China

2021 ◽  
Author(s):  
Zheng Zhang ◽  
Yan Song ◽  
Jianbang Kang ◽  
Surong Duan ◽  
Qi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Pulmonary Infection ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Cns Infections

Abstract Background: Central nervous system (CNS) infections are relatively rare but associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the prognosis of patients with CNS infections, which should be based on the knowledge of pathogens distribution and antibiotic sensitivities. China is a vast country, and the pathogens distribution varies nationwide. The aim of this study is to investigate the features of pathogens in patients with CNS infections in north China and we tried to evaluate the risk factors for mortality.Methods: We retrospectively analyzed the patients with positive cerebrospinal fluid (CSF) culture in a teaching hospital between January 2012 and December 2019. The following information were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial susceptibility results. Univariate analysis and binary logistic regression analysis were performed to identify the risk factors for mortality.Results: In this eight-year retrospective study, a total of 72 patients were diagnosed with CNS infections and 86 isolates were identified. Among all the microorganisms detected, Gram-positive strains consisted of 59.3%, Gram-negative bacteria of 30.2% and fungi of 10.5%. The predominant Gram-positive isolate was coagulase-negative staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella were the common Gram-negative strains. Compared to 2012-2015 years, the proportion of Gram-negative bacteria increased markedly during 2016-2019 years. Vancomycin, teicoplanin and linezolid were still 100% sensitive to Gram-positive bacteria. For the multidrug-resistant Gram-negative bacteria, only tigecycline was the 100% sensitive antibiotics. The mortality of the 72 patients was 30.6%. In the multivariate analysis, age >50 years, combined pulmonary infection and CSF glucose < normal value were associated with poor prognosis. Conclusions: CNS infections cause high mortality worldwide. Although Gram-positive bacteria are still the primary pathogen of CNS infections, Gram-negative bacteria had increased in recent years and should be considered in the choice of empirical antibiotic treatment. Special attention should be given to older patients and those combined pulmonary infection and with low CSF glucose level.

scholarly journals Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Sarah Melissa Nørgaard ◽  
Camilla Skaarup Jensen ◽  
Josefine Aalestrup ◽  
Christina M. J. E. Vandenbroucke-Grauls ◽  
Mark G. J. de Boer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Antibiotic Treatment ◽  
Clinical Success ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Infection Site ◽  
Gram Negative ◽  
Group 2 ◽  
Group 1

Abstract Background Antimicrobial resistance is an increasingly serious threat to public health, and the increased occurrence of multidrug-resistant (MDR) bacteria is a concern in both high-income and low- and middle-income countries. The purpose of this systematic review was to identify and critically appraise current antimicrobial treatment options for infections with MDR Gram-negative bacteria. Methods A literature search for treatment of MDR extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa was conducted in MEDLINE in January 2019. Relevant studies published in English, German, and French that evaluated clinical success, microbiological success, and 30-day mortality outcomes were included. The population of interest was adult patients. Results Of 672 studies, 43 met the inclusion criteria. Carbapenems are the most common antibiotics used for the treatment of ESBL-producing Enterobacteriaceae. The clinical and microbiological success was similar for group 1 carbapenems (imipenem, meropenem, or doripenem), group 2 carbapenems (ertapenem), and non-carbapenem antibiotics. Mortality data were contradictory for group 1 carbapenems compared to group 2 carbapenems. The most common treatment option for A. baumannii and P. aeruginosa infections was intravenous colistin, regardless of infection site. Clinical success and mortality were similar in A. baumannii infections treated with colistin combination therapy vs. colistin monotherapy, whereas heterogeneous results were found with respect to microbiological success. Monotherapy and colistin combination therapy were used against P. aeruginosa with clinical and microbiological success (70–100%) depending on the infection site and severity, and the antibiotic used. Ceftazidime-avibactam therapy for ESBL-producing Enterobacteriaceae and P. aeruginosa showed good clinical success in one study. Conclusion We did not find robust evidence for antibiotic treatment of any infection with MDR Gram-negative bacteria, including ESBL-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa, that would lead to a firm recommendation for one specific antibiotic over another or for monotherapy over combination therapy. The choice of antibiotic treatment should be based on susceptibility testing balancing the expected clinical success rate against the risk of development of antibiotic resistance and the risk of severe side effects.

scholarly journals Clinical Treatment Options for Carbapenem-resistant Gram-negative Infections in China: a Single Centre Real-world Experience

2021 ◽  
Author(s):  
Ruanmei Sheng ◽  
Xuemin Wang ◽  
Yanqiang Hou ◽  
Jun Liu ◽  
Zhiwen Yang
Keyword(s):  
Success Rate ◽  
Bacterial Infections ◽  
Clinical Success ◽  
Treatment Options ◽  
Clinical Success Rate ◽  
Gram Negative Bacteria ◽  
Single Centre ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Clinical Strategies

Abstract Carbapenem-resistant gram-negative bacteria constitute a serious threat to public health worldwide. However, as a result of the complexities of clinical therapy, antibiotic options against carbapenem-resistant pathogens have not yet been fully standardized. Here, we conducted a retrospective study in 65,000 inpatients over a 2-year period that involved a total of 86 patients from whom carbapenem-resistant gram-negative bacteria were isolated. Monotherapy using trimethoprim/ sulfamethoxazole, amikacin, meropenem, and/or doxycycline in our hospital exhibited a clinical success rate of 83.3% for carbapenem-resistant Klebsiella pneumoniae, monotherapy using moxifloxacin, piperacillin/tazobactam, cefepime, and/or ceftazidime for carbapenem-resistant Pseudomonas aeruginosa exhibited a clinical success rate of 77.7%, and monotherapy using cefoperazone/sulbactam or combination therapy with tigecycline and cefoperazone/sulbactam for carbapenem-resistant Acinetobacter baumannii exhibited a clinical success rate of 62.1%. Our findings highlight the clinical strategies used in our hospital to successfully treat carbapenem-resistant gram-negative bacterial infections.

Sign in / Sign up

Export Citation Format

Share Document