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Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistant Enterobacteriaceae?

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World Journal of Clinical Cases 2017年第8期5卷 324-332页

作者： Fatema Alhashem Nicolette Leonie Tiren-Verbeet Emine Alp Mehmet Doganay Department of Pediatrics King Hamad University Hospital Bone marrow Transplantation Department Erciyes University Hospital Department of Infectious Diseases Faculty of MedicineErciyes University

Sepsis is one of the major challenges of today. Although gram-positive bacteria related infections are more prevalent in hospital setting, the highest mortality rate is associated with gram-negative microorganisms especially Enterobacteriaceae. Enterobacteriaceae, including Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp. and Serratia spp. Resistance to β-lactams in Enterobacteriaceae is primarily attributed to the production of B-lactamase enzymes with subsequent antibiotic hydrolysis and to a lesser extent by alteration of efflux pump or porins expression. carbapenem resistant Enterobacteriaceae(CRE) and Acinetobacter baumannii are the most notorious pathogens due to the high incidence of morbidity and mortality especially in the immunocompromised patients in the intensive care unit. The most appropriate antimicrobial therapy to treat CRE is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage of micro-organisms, due to its synergetic effect and to prevent development of further resistance. Current suggested therapies for CRE resistance as well as promising antibiotics that are currently under investigation for winning the war against the emerging CRE resistance are reviewed and discussed.

关键词： carbapenem resistant Enterobacteriaceae Sepsis Bacteraemia Bacteremia Treatment Antibiotics

Molecular typing and resistance mechanisms of carbapenem resistantPseudomonas aeruginosa isolated from a Chinese surgical intensivecare unit

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Chinese Medical Journal 2014年第6期127卷 1071-1076页

作者： Yi Meiying Wang Pengyuan Liu Yucun China 100029 China 100034

Background carbapenems are an important class of drugs for the treatment of Pseudomonas aeruginosa(P. aeruginosa) infections. However, carbapenem resistance has been commonly observed in nonfermenter species of bacteria. The purpose of this study was to investigate the molecular epidemiology and carbapenem resistant mechanisms of P. aeruginosa isolated from a surgical intensive care unit(SICU) in China. Methods The molecular typing was analyzed by REP-PCR. Enzyme activity was measured with a 260 nm wavelength spectrophotometer. The levels of outer membrane proteins OprD and OprN were measured by Western blotting. The levels of mexA gene transcriptional expression were measured by quantitative real-time PCR. The metallo-beta-lactamase genes IMP, VIM, SPM, GES, and GIM were amplified by PCR. DNA fragments were sequenced by an automated ABI PRISM *** Forty-two strains resistant to carbapenems isolated from a SICU were analyzed. REP-PCR revealed 34 belonging to type A, a predominant strain in this SICU. But we did not find metallo-beta-lactamases IMP, VIM, SPM, GES, or GIM genes by PCR. With a three-dimensional extract test, we found 34 strains producing high levels of AmpC enzymes. We also observed the activity of beta-lactamases enzymes in the imipenem resistant group, which was statistically different from the sensitive group. Western blotting revealed that 23 strains showed loss of OprD, 18 strains had decreased OprD expression, and 14 strains expressed OprN. We discovered 27 strains that overexpressed mexA by quantitative real-time PCR, and the resistance rate to meropenem was statistically different between the overexpressing group and the lowexpressing group. Nucleotide sequences and deduced amino acid sequence analysis revealed that eight strains carried mutations in the mexR gene operon down regulating MexAB-OprM. The nucleotide sequences of mexR genes from PA36, PA41 and PA48 were submitted to the Genebank with accession numbers of AY899299, AY899300,

关键词： Pseudomonas aeruginosa fl-lactamase AmpC porin protein OprD elflux pump carbapenem resistance

Trends in the Annual Incidence of carbapenem Resistant among Gram Negative Bacilli in a Large Teaching Hospital in Makah City, Saudi Arabia

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Journal of Tuberculosis Research 2017年第4期5卷 229-236页

作者： Hani S. Faidah Aiman M. Momenah Hamdi M. El-Said Abeer A. A. Barhameen Sami S. Ashgar Ayman Johargy Abdelrahman Elsawy Wafaa Almalki Samah Al Qurashi Department of Medical Microbiology Faculty of Medicine Umm Al-Qura University Makkah Saudi Arabia Al-Noor Specialist Hospital Makah Saudi Arabia Department of Medical Microbiology Faculty of Medicine Al-Azhar University Cairo Egypt Faculty of Medicine Umm Al-Qura University Makkah Saudi Arabia

Objective: To detect the prevalence of carbapenem resistance among Gram negative bacilli at the Al-Noor Specialist Hospital in the western part of Saudi Arabia. Materials and Methods: This study was conducted in the Microbiology department, Al-Noor Specialist Hospital, Makah city, Saudi Arabia. The clinical samples were collected from admitted patients in the wards, Intensive Care Units (ICUs), urology unit and surgery unit, these samples included blood, urine, sputum, pus and wound. The identification and antibiotic susceptibility testing of all bacterial isolates were performed via the Vitek 2 Compact System. Results: Out of 4803 Gram negative bacterial bacilli were isolated, the prevalence rate of carbapenem resistance among these isolates was 2797/4803 (58.23%), and sensitivity rate was 2006/4803 (41.77%) of the total isolates. The rate of resistance to carbapenem was among Acinetobacter baumannii 1710 (99.13%), followed by Pseudomonas aeruginosa 575 (62.4%), Klebsiella pneumoniae 459 (38%) and Escherichia coli 56 (5.59%). The trend of carbapenem resistance among Gram negative bacterial isolates from 2013-2015 was 53.99%, 59.88% and 61.43% respectively. Conclusion: A. baumannii rec-orded, the highest rate of carbapenem resistance through three year, 98.19%, 99.48% and 99.81% respectively and the lowest rate of resistance recorded with E. coli, 4.63%, 5.79% and 6.31% respectively.

关键词： carbapenem Resistance Acinetobacter baumannii Makah Pathogens

Low Prevalence of carbapenem Resistance in Clinical Isolates of Extended Spectrum Beta Lactamase (ESBL) Producing Escherichia coliin North Central, Nigeria

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Advances in Infectious Diseases 2018年第3期8卷 109-120页

作者： Kenneth I. Onyedibe Emmanuel O. Shobowale Mark O. Okolo Michael O. Iroezindu Tolulope O. Afolaranmi Francisca O. Nwaokorie Solomon O. Opajobi Samson E. Isa Daniel Z. Egah Department of Medical Microbiology University of Jos Jos Nigeria Department of Medical Microbiology Babcock University Ilishan-Remo Nigeria Department of Medicine University of Nigeria Nsukka Nigeria Department of Epidemiology & Community Health University of Jos Jos Nigeria Division of Molecular Biology Nigerian Institute of Medical Research Lagos Nigeria Department of Medicine University of Jos Jos Nigeria

Extended Spectrum Beta Lactamase (ESBL) producing Escherichia coli is a global cause of life threatening infections. We determined the presence of ESBL and carbapenemase production in clinical isolates of E. coli and their antibiotic susceptibility. Clinical isolates of community and hospital acquired E. coli from 220 patients seen at a tertiary hospital were evaluated. Antibiotic susceptibility testing was by the modified Kirby-Bauer protocol while ESBL production was determined by the Double Disk Synergy Test (DDST). carbapenem resistance was confirmed by the Modified Hodge Test. Of the 220 isolates, 122 (55.5%) were from females;41 (18.6%) were ESBL positive. About 90% of the ESBL producing isolates were resistant to nine of the 15 antimicrobial agents tested. However, only one (2.4%) of the 41 ESBL producing isolates exhibited carbapenem resistance. The ESBL negative isolates were susceptible to Meropenem (100%), Cefepime (97.8%), Ceftriaxone (96.6%) and Cefotaxime (96.6%). All the ESBL producing isolates harbored detectable plasmids with sizes ranging from 2322 to 23,130 base pairs. Our findings show that although multidrug resistant ESBL producing E. coli are prevalent in both the hospital and the community in this environment, carbapenem resistance is still low. We recommend that institutions develop guidelines for the early phenotypic detection of ESBLs and carbapenem resistance.

关键词： E. coli ESBL Plasmids carbapenem Resistance Nigeria

Patient Demographics and Characteristics of Infection with carbapenem-Resistant Acinetobacter baumanniiin a Teaching Hospital from the United States

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Advances in Infectious Diseases 2013年第1期3卷 10-16页

作者： Nachiket D. Vaze Christopher L. Emery Richard J. Hamilton Ari D. Brooks Suresh G. Joshi Surgical & Nosocomial Infection Research and Bacterial Pathogenesis Program Drexel University College of Medicine Hahnemann University Hospital Philadelphia USA

A characterization of the clinical demographic features of patients with infection caused Acinetobacter baumannii, and the antibiotyping of the isolates recovered from these patients was undertaken, with a special reference to carbapenem-resistant variants, and their risk factors. This study was conducted retrospectively from January 2010 to March 2011 at a 616-bed tertiary care university hospital. Sixty-four patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk and odds ratio. We identified 100 A. baumannii from 64 patients during 15 months period. Significant risk factors were working age (18 - 60 years), male gender, hospital stay (>1 week but Pseudomonas aeruginosa, and Klebsiella pneumoniae were the significant co-infecting agents. The antibiogram demonstrated multidrug resistance in a majority of the isolates. Relative risk associated with ventilator, diabetes, and surgery was higher in repeat isolates than in first isolates and were multidrug resistant. Repeat isolates were more resistant that the first isolates to most anti-acinetobacter agents, but the overall crude mortality was not significant during this study period, and couldn’t correlated to the choice of treatment. In conclusion, a resistance against all clinically used carbapenems, and colistin is rapidly increasing in repeat isolates of A. baumannii;leaves narrow therapeutic options to treat multidrug-resistant and pandrug-resistant A. baumannii infection. For the first time we report rising incidence of colistin resistance by 20 percent in repeat isolates, and is worrisome for healthcare centers. A combination therapy should be adopted to treat such infection to avoid the emergence of colistin-resistant phenotypes in the United States.

关键词： Acinetobacter baumannii carbapenem Resistance Colistin Imipenem Meropenem Multidrug Resistance Risk Factor

Characterization of Imipenem Unsusceptible Pseudomonas Aeruginosa Isolates from Inpatients without carbapenem Treatment

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国际感染病学（电子版） 2013年第1期2卷 1-5页

作者： Yi-hai Gu Xiao Zhu Jing-yun Li Jun Zhang Qing-yuan Zhou Yue Ma Chang-qin Hu Shao-hong Jin Sheng-hui Cui Department of Microbiology 3201 Hospital The National Center for Surveillance of Antimicrobial Resistance the State Food and Drug Administration

Objective To identify the risk factors for imipenem resistance development and transmission of clinical Pseudomonas aeruginosa *** Thirty-seven imipenem unsusceptible Pseudomonas aeruginosa isolates collected from patients in absence of carbapenem treatment were characterized by antimicrobial susceptibility test,pulsed field gel electrophoresis(PFGE)and carbapenem resistant mechanism *** Before the collection of imipenem unsusceptible Pseudomonas aeruginosa isolates,the average time of patients treated with more than one antimicrobial(20.0±9.5 days,n=16)was significantly longer than those treated with only one antimicrobial(12.6±4.4 days,n=21;t-test,Welch,t=-2.9004,Pcarbapenem drug classes,especially fluoroquinolones andβ-lactams,may be important risk factors for the spread of carbapenem resistant Pseudomonas aeruginosa.

关键词： Pseudomonas aeruginosa Imipenem resistance carbapenem

A Case of carbapenem Resistant Non-K1/K2 Serotype Klebsiella pneumoniaeLiver Abscess

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Advances in Infectious Diseases 2013年第3期3卷 219-222页

作者： Lucy Cheng Leung Kristopher Siu Tom Chiang Department of Medicine Rutgers New Jersey Medical School Newark USA

Klebsiella pneumoniae liver abscess (KPLA) has been described as an invasive syndrome with extrahepatic complications. The majority of KPLA is caused by capsular serotype K1 and K2 isolates. We report a case of carbapenem resistant Klebsiella pneumoniae liver abscess. The patient initially presented with infected right above-the-knee amputation and was later found with a large liver abscess. Initial antimicrobial susceptibility showed carbapenem resistant K. pneumoniae (CRKP). Further molecular workup revealed that the isolate was a less virulent non-K1/K2 serotype, and both rmpA and kfu genes were negative. The lack of outer membrane porins likely contributed to the carbapenem resistance. To our knowledge, this is a first reported case of carbapenem resistant, non-K1/K2 serotype K. pneumoniae liver abscess in the United States.

关键词： Liver Abscess Klebsiella pneumoniae Capsular Serotype carbapenem Resistance

In Vitro Antibacterial Activity of Galla Chinensis Combined with Different Antibacterial Drugs against carbapenem-Resistant ***

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Journal of Advances in Medicine Science 2019年第4期2卷 19-23页

作者： Zhizhi Xie Changzhi Xu Yanhua Yi Donglin Zhu Yun Xi Department of Laboratory Medicine The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdong510630China Department of Emergency The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdong510630China

Objective:To evaluate the antibacterial effects of meropenem and levofloxacin respectively combined with Galla chinensis on carbapenem-resistant Escherichia coli in ***:The protocol was designed with checkerboard method and the carbapenem-resistant *** was isolated in our *** minimum inhibitory concentrations(MICs)of *** alone and combined with 2 antimicrobial agents against carbapenem-resistant *** were determined by broth dilution method and the fractional inhibitory concentration index(FICI)was calculated according to MICs ***:the combined use of *** and meropenem(or levofloxacin)significantly decreased both MIC50 and MIC90;After the combination of *** and meropenem,the synergistic effect was 86.7%,and the additive effect was 13.3%,no irrelevant and antagonistic *** combined use of *** and levofloxacin,the synergistic effect was 66.7%,and the additive effect was 33.3%.No irrelevant and antagonistic ***:Galla chinensis combined with meropenem or levofloxacin has synergistic and additive antibacterial effect,with certain combined antibacterial activity.

关键词： Galla chinensis carbapenem resistance Escherichia coli Combination therapy

A Retrospective Study of Risk Factors,especially Antibiotic Use,for carbapenem-Resistant Klebsiella Pneumoniae Acquisition among ICU Patients

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A Retrospective Study of Risk Factors,especially Antibiotic ...