Diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology

Cisneros, José Miguel; Cobos-Trigueros, Nazaret; Fresco, Gema; Francisco, Carolina Navarro-San; Gudiol, Carlota; Horcajada, Juan Pablo; López-Cerero, Lorena; Martínez, José Antonio; Molina, José Antonio; Montero, Milagro; Paño‐Pardo, José Ramón; Pascual, Álvaro; Peña, Carmen; Pintado, Vicente; Retamar, Pilar; Tomás, María; Borges-Sa, Marcío; Garnacho‐Montero, José; Bou, Germán

doi:10.1016/j.eimc.2014.11.009

Cited by 35 publications

(45 citation statements)

References 251 publications

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“…Often, polymyxins (e.g., colistin or polymyxin B), tigecycline, fosfomycin, and sometimes selected aminoglycosides are the only agents with in vitro activity. Other antimicrobials, such as fosfomycin and nitrofurantoin, can be used if found to be active, but their use as monotherapy is generally limited to lower UTIs (102). Since carbapenemase producers are mostly resistant to various other important antibiotic classes, such as fluoroquinolones and aminoglycosides, it is important to test for susceptibility to last-resort agents such as polymyxins (e.g., colistin), fosfomycin, tigecycline, and rifampin.…”

Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

“…Source control, in addition to antimicrobial therapy, is essential for the effective management of these infections and is especially significant for the successful treatment of UTIs and intra-abdominal infections. Empirical combination therapy including colistin, a carbapenem, or an aminoglycoside, based on the local resistance epidemiology, might be justified for severely ill patients with suspected infections due to K. pneumoniae strains with carbapenemases (102).…”

Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

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Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Pitout

Nordmann

Poirel

2015

Antimicrob Agents Chemother

685

569

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The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of ␤-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with bla KPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.

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Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Pitout

Nordmann

Poirel

2015

Antimicrob Agents Chemother

685

569

View full text Add to dashboard Cite

show abstract

“…Un régimen posible a recomendar, basado en mg de colistina o colistina base activa (CBA), es el de 2,5 a 5 mg/kg/día fraccionada idealmente en dos dosis de acuerdo a la gravedad de la infección (1,40) . En el caso de pacientes con infección grave es complicado recomendar la posología más adecuada.…”

Section: Vía Intravenosaunclassified

“…En particular para el tratamiento de enterobacterias productoras de carbapenemasas tipo KPC o NDM (New Delhi metalobetalactamasa), así como de bacilos gramnegativos no fermentadores, los clínicos han tenido que emplear antimicrobianos como la fosfomicina, la tigeciclina y las polimixinas, ya sea en terapia combinada doble o triple, dada la escasez de moléculas farmacológicamente activas disponibles (1) .…”

Section: Introductionunclassified

Actualización acerca de colistina (polimixina E): aspectos clínicos, PK/PD y equivalencias

Medina

Paciel

Noceti

et al. 2017

RMU

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ResumenEn los últimos diez años, en esta era posantibiótica, la colistina ha resurgido como un último recurso frente a infecciones por patógenos como Pseudomonas aeruginosa, Acinetobacter baumannii complex y enterobacterias productoras de carbapenemasas. Cayó en desuso previamente dados sus efectos adversos potencialmente graves, como la nefro y neurotoxicidad, pero hoy revive como parte fundamental de los planes antibióticos frente a patógenos extremadamente resistentes. El aumento de su uso conlleva a la emergencia de resistencia, encontrándonos frente a una situación potencialmente catastrófi-ca, en particular dada la recientemente descrita presencia de plásmidos transferibles entre especies conteniendo genes que confieren resistencia a colistina (gen mcr-1), mecanismo detectado también en nuestro país.En la presente revisión, basados en los conocimientos actuales sobre la farmacocinética y la farmacodinamia, se describe en detalle la dosificación apropiada con necesidad de realizar dosis carga para alcanzar los niveles terapéuticos adecuados, así como aspectos prácticos de la administración en casos de meningitis/ventriculitis posquirúrgica y del empleo por vía nebulizada para el tratamiento de la neumonía asociada a la ventilación. Se destaca la necesidad de su uso combinado con otro antibiótico activo in vitro, en particular en pacientes críticos y en aquellos con un clearance de creatininemia mayor a 80 ml/min. La biterapia es necesaria en particular si la concentración inhibitoria mínima (CIM) del patógeno es mayor a 1 mg/l, debido al riesgo de subdosificación y emergencia de resistencia intratratamiento.En una segunda sección se aborda la complejidad de la dosificación en función de las distintas presentaciones comercializadas a nivel nacional que han conducido a errores en la posología, con un riesgo mayor de eventual toxicidad. Con el objetivo de mejorar la comprensión referente a la rotulación de la dosis a administrar de colistina se revisaron los insertos y envases primarios de las presentaciones de colistina comercialmente disponibles en Uruguay, a efectos de solicitar formal y documentalmente a las empresas farmacéuticas representantes, se expidan en cuanto a los contenidos de colistina (droga activa) y de su profármaco, el colistimetato sódico (CMS). Finalmente se elaboraron una serie de recomendaciones en cuanto a la información que a entender de los autores debieran exhibir las distintas presentaciones de colistina comercialmente disponibles para no inducir a errores en la prescripción. Palabras clave: COLISTINA MONITOREO DE DROGAS PARÁMETROS PK/PD

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“…2 The empirical administration of ertapenem for suspected ESBL Enterobacteriacae is not recommended, since some concerns are rising regarding the isolated in vitro resistance to this drug and the need for further data on severely ill patients. 25,26 However, according to recent data, BLBLIs, if active in vitro, appear to be as effective as carbapenems for empirical therapy of bloodstream infections due to ESLB-Enterobacteriaceae, regardless of the source and specific species, if used at appropriate doses. 27 Therefore, high dosage with loading dose and semicontinuous administration of BLBLIs, supported by therapeutic drug monitoring should be preferred for clinically stable patients.…”

Section: Targeted Treatment Extended-spectrum-b-lactamases-producing mentioning

confidence: 99%

Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

2016

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IntroductionIn the last decade, we have witnessed a dramatic increase worldwide in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Due to the resistance to the most common antibiotics prescribed as empiric regimens, MDRGN bugs have been associated with delays in an adequate treatment, leading to significant increases in morbidity and mortality.1 In addition, the spread of MDRGN pathogens resulted over last years in a vicious circle of an indiscriminate prescription of broad-spectrum antimicrobials and further resistance selection. 2The aim of this review is to describe the mechanism of resistance, epidemiology, risk factors, clinical issues, and therapeutic options of MDRGN pathogens. Mechanism of resistance of Gram-negative bacteriaMGRGN bacteria are defined as pathogens carrying resistance to one or more antimicrobials from at least three different classes. The most common mechanism of resistance is represented by intrinsic and acquired production of b-lactamases, which can be chromosomal or plasmid mediated. b-lactamases are hydrolytic enzymes able to disrupt the b-lactam ring, thus inactivating different classes of b-lactams.3,4 The most common enzymes in clinical practice are the extended-spectrum-b-lactamases (ESBLs), which are mostly expressed by Enterobacteriaceae. A novel type of class C b-lactamases also showing activity against cefepime and denominated extended spectrum AmpC b-lactamases has been described. 4 The consequent abuse of carbapenems, representing the first choice for ESBL infections, led to a progressive increase in carbapenem resistance, mainly due to the production of carbapenem-hydrolyzing b-lactamases, or carbapenemases, that usually confer clinical resistance to most b-lactams.5,6 K. pneumoniae carbapenemases (KPCs) are the most relevant enzymes among Enterobacteriaceae, and confer resistance to all the blactams, including b-lactam/b-lactamase inhibitors combinations. Class B enzymes, named metallo-b-lactamases are expressed by both enterics and P. aeruginosa and confer resistance to all b-lactams with the exception of aztreonam. Oxacillinases belong to the class D b-lactamases, and are mostly expressed in P. Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic optionsMatteo Bassetti, Davide Pecori, Maddalena Peghin Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy ABSTRACTIn the last decade, we have witnessed a dramatic increase in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, both in Italy and worldwide, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Inadequate empirical antimicrobial therapy of severe infections caused by MDR Enterobacteriacae has been associated with an increa...

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Diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology

Cited by 35 publications

References 251 publications

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Actualización acerca de colistina (polimixina E): aspectos clínicos, PK/PD y equivalencias

Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

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