High mortality by nosocomial infections caused by carbapenem-resistant P. aeruginosa in a referral hospital in Brazil: facing the perfect storm

Urzedo, Jane Eire; Menezes, Ralciane de Paula; Porto, Juliana Pena; Ferreira, Melina Lorraine; Gonçalves, Iara Rossi; Brito, Cristiane Silveira de; Gontijo-Filho, Paulo Pinto; Ribas, Rosineide Marques

doi:10.1099/jmm.0.001273

Cited by 7 publications

(9 citation statements)

References 39 publications

(83 reference statements)

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“…Previous meta-analysis showed that pooled crude mortality ofcarbapenem resistant Klebsiella pneumoniae was 42.14% [14]. Other studies reported the 30-day mortality of carbapenem-resistant Pseudomonas aeruginosa was 36.6% [15], whereas the mortality of carbapenem-resistant A. baumannii ranged from 16%-76% [16], which were higher than the crude mortality of CREC in our hospital. Besides, all four patients who died were accompanied with other infections.…”

Section: Discussioncontrasting

confidence: 48%

Carbapenem-Resistant Enterobacter cloacae Complex in a Tertiary Hospital in Northeast China, 2010-2019

Chen¹,

Song²,

Ni³

et al. 2021

Preprint

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Background: Carbapenem-resistant Enterobacter cloacae complex (CREC) is a new emerging threat to global public health. The objective of the study was to investigate the clinical characteristics and molecular epidemiology of CREC infections in the medical center of northeast China.Methods: Twenty-nine patients were infected/colonized with CREC during a ten-year period (2010-2019) by WHONET analysis. Antibiotic susceptibilities were tested with VITEK 2 and micro broth dilution method (for polymyxin B and tigecycline). Carbapenemase encoding genes, β-lactamase genes, and seven housekeeping genes for MLST genes were amplified and sequenced for 18 cryopreserved CREC isolates. Maximum likelihood phylogenetic tree was built with the concentrated sequences to show the relatedness between the 18 isolates.Results: There was a rapid increase in CREC detection rate during the ten-year period, reaching 8.11% in 2018 and 6.48% in 2019. The resistance rate of CREC isolates to imipenem and meropenem were 100.0% and 72.2%, however, they showed high sensitivity to tigecycline, polymyxin B and amikacin. The 30-day crude mortality of CREC infection/colonization was 13.8%, indicating that it may be a low-virulence bacterium. Furthermore, molecular epidemiology revealed that ST93 was the predominant sequence type followed by ST171 and ST145, with NDM-1 and NDM-5 as the main carbapenemase-encoding genes. E. hormaechei subsp. steigerwaltii and E. hormaechei subsp. oharae were the main species, which showed different resistance patterns.Conclusions: Rising detection rate of CREC was observed in a tertiary hospital, which showed heterogeneity in drug resistance patterns, resistance genes, and MLST types. Effective infection prevention and control measures should be taken to reduce the spread of CREC.

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Section: Discussioncontrasting

confidence: 48%

Carbapenem-Resistant Enterobacter cloacae Complex in a Tertiary Hospital in Northeast China, 2010-2019

Chen¹,

Song²,

Ni³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous meta-analysis showed that pooled crude mortality of carbapenem resistant Klebsiella pneumoniae was 42.1% [ 15 ]. Other studies reported the 30-day mortality of carbapenem-resistant Pseudomonas aeruginosa was 36.6% [ 16 ], whereas the mortality of carbapenem-resistant A. baumannii ranged from 16 to 76% [ 17 ], which were higher than the crude mortality of CREC in our hospital. Besides, all four patients who died were accompanied with other serious infections.…”

Section: Discussionmentioning

confidence: 54%

Carbapenem-resistant Enterobacter cloacae complex in a tertiary Hospital in Northeast China, 2010–2019

Chen

Song

et al. 2021

BMC Infect Dis

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Background Carbapenem-resistant Enterobacter cloacae complex (CREC) is a new emerging threat to global public health. The objective of the study was to investigate the clinical characteristics and molecular epidemiology of CREC infections in the medical center of northeast China. Methods Twenty-nine patients were infected/colonized with CREC during a ten-year period (2010–2019) by WHONET analysis. Antibiotic susceptibilities were tested with VITEK 2 and micro broth dilution method (for polymyxin B and tigecycline). Carbapenemase encoding genes, β-lactamase genes, and seven housekeeping genes for MLST were amplified and sequenced for 18 cryopreserved CREC isolates. Maximum likelihood phylogenetic tree was built with the concentrated sequences to show the relatedness between the 18 isolates. Results There was a rapid increase in CREC detection rate during the ten-year period, reaching 8.11% in 2018 and 6.48% in 2019. The resistance rate of CREC isolates to imipenem and meropenem were 100.0 and 77.8%, however, they showed high sensitivity to tigecycline, polymyxin B and amikacin. The 30-day crude mortality of CREC infection was 17.4%, indicating that it may be a low-virulence bacterium. Furthermore, molecular epidemiology revealed that ST93 was the predominant sequence type followed by ST171 and ST145, with NDM-1 and NDM-5 as the main carbapenemase-encoding genes. Moreover, E. hormaechei subsp. steigerwaltii and E. hormaechei subsp. oharae were the main species, which showed different resistance patterns. Conclusion Rising detection rate of CREC was observed in a tertiary hospital, which showed heterogeneity in drug resistance patterns, resistance genes, and MLST types. Effective infection prevention and control measures should be taken to reduce the spread of CREC.

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“…As stated in several studies, septicemia or pneumonia caused by MDR-P. aeruginosa isolates resulted in poor patient outcomes (Hirsch and Tam, 2010b;Morata et al, 2012;Micek et al, 2015;Matos et al, 2018;Urzedo et al, 2020). Recommendations for the treatment of MDR/XDR-GNB infections have been published based on the susceptibility and PK/PD profiles of conventional and novel antibiotics (Bassetti et al, 2019;Jean et al, 2019;Jean et al, 2020).…”

Section: Antibiotic Treatment Against Cr-or Xdr-gnb Conventional Anti...mentioning

confidence: 99%

Global Threat of Carbapenem-Resistant Gram-Negative Bacteria

Jean

Harnod

Hsueh

2022

Front. Cell. Infect. Microbiol.

122

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Infections caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), including carbapenem-resistant (CR) Enterobacterales (CRE; harboring mainly blaKPC, blaNDM, and blaOXA-48-like genes), CR- or MDR/XDR-Pseudomonas aeruginosa (production of VIM, IMP, or NDM carbapenemases combined with porin alteration), and Acinetobacter baumannii complex (producing mainly OXA-23, OXA-58-like carbapenemases), have gradually worsened and become a major challenge to public health because of limited antibiotic choice and high case-fatality rates. Diverse MDR/XDR-GNB isolates have been predominantly cultured from inpatients and hospital equipment/settings, but CRE has also been identified in community settings and long-term care facilities. Several CRE outbreaks cost hospitals and healthcare institutions huge economic burdens for disinfection and containment of their disseminations. Parenteral polymyxin B/E has been observed to have a poor pharmacokinetic profile for the treatment of CR- and XDR-GNB. It has been determined that tigecycline is suitable for the treatment of bloodstream infections owing to GNB, with a minimum inhibitory concentration of ≤ 0.5 mg/L. Ceftazidime-avibactam is a last-resort antibiotic against GNB of Ambler class A/C/D enzyme-producers and a majority of CR-P. aeruginosa isolates. Furthermore, ceftolozane-tazobactam is shown to exhibit excellent in vitro activity against CR- and XDR-P. aeruginosa isolates. Several pharmaceuticals have devoted to exploring novel antibiotics to combat these troublesome XDR-GNBs. Nevertheless, only few antibiotics are shown to be effective in vitro against CR/XDR-A. baumannii complex isolates. In this era of antibiotic pipelines, strict implementation of antibiotic stewardship is as important as in-time isolation cohorts in limiting the spread of CR/XDR-GNB and alleviating the worsening trends of resistance.

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High mortality by nosocomial infections caused by carbapenem-resistant P. aeruginosa in a referral hospital in Brazil: facing the perfect storm

Cited by 7 publications

References 39 publications

Carbapenem-Resistant Enterobacter cloacae Complex in a Tertiary Hospital in Northeast China, 2010-2019

Carbapenem-Resistant Enterobacter cloacae Complex in a Tertiary Hospital in Northeast China, 2010-2019

Carbapenem-resistant Enterobacter cloacae complex in a tertiary Hospital in Northeast China, 2010–2019

Global Threat of Carbapenem-Resistant Gram-Negative Bacteria

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