Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection

Suárez, Cristina; Peña, Carmen; Gavaldà, Laura; Tubau, Fé; Manzur, A.; Domı́nguez, M.A.; Pujol, Miquel; Gudiol, Francesc; Ariza, Javier

doi:10.1016/j.ijid.2009.11.019

Cited by 53 publications

(48 citation statements)

References 42 publications

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“…also showed high prevalence of antimicrobial resistance in neutropenic patients. [25][26][27][28][29][30][31] Less common were CR Enterobacteriaceae, documented mainly from countries with high CR-Kp prevalence. 11,13,15 Only two studies in our review analysed molecular mechanisms of carbapenem resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Antimicrobial susceptibility testing was documented according to the CLSI in 16 studies 12,14,17,18,22,23,25,28,[31][32][33][35][36][37][38]40 and according to EUCAST or to Swedish Reference Group for Antibiotics (SRGA) breakpoints in two studies, 11,21 while for the others the testing method was not documented. Only two reports performed molecular characterization of CR strains.…”

Section: 39mentioning

confidence: 99%

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Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

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Section: Discussionmentioning

confidence: 99%

Section: 39mentioning

confidence: 99%

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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“…The bacterium can colonize implanted devices, catheters, heart valves, ventilators or dental implants resulting in device-associated hospital acquired infections which are of major concern globally (El-Kholy et al, 2012). P. aeruginosa is associated with different types of infections which cause morbidity and mortality (Driscoll et al, 2007;Suárez et al, 2010). The high prevalence of P. aeruginosa in developing countries and resource-limited parts of the world as well as other parts of the world owes much to its battery of secreted virulence factors as well as to its high resistance to antimicrobial and var ious chemical agents (Van Delden and Iglewski, 1998).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

Zowalaty

Gyetvai

2016

Polish Journal of Microbiology

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A b s t r a c tPseudomonas aeruginosa is a leading human pathogen that causes serious infections at various tissues and organs leading to life threatening health problems and possible deadly outcomes. Resistance patterns vary widely whether it is from hospitals or community acquired infections. Reporting resistance profiles to a certain antibiotics provide valuable information in a given setting, but may be extrapolated outside the sampling location. In the present study, P. aeruginosa isolates were screened to determine their susceptibilities against antipseudomonal antimicrobial agents and possible existing mechanisms of resistance were determined. Eighty-six isolates of P. aeruginosa were recovered. Isolates representing different resistance profiles were screened for the existence of three different resistance mechanisms including drug inactivation due to metallo-β-lactamases, drug impermeability by outer membrane proteins and drug efflux. All tested isolates showed uniform susceptibility (100%, n = 86/86) to piperacillin, meropenem, amikacin, and polymyxin B. A single isolate was found to be imipenem resistant (99%, n = 85/86). The possible mechanisms of resistance of P. aeruginosa to imipenem involve active drug efflux pumps, outer membrane impermeability as well as drug inactivating enzymes. These findings demonstrate the fundamental importance of the in vitro susceptibility testing of antibiotics prior to antipseudomonal therapy and highlight the need for a continuous antimicrobial resistance surveillance programs to monitor the changing resistance patterns so that clinicians and health care officials are updated as to the most effective therapeutic agents to combat the serious outcomes of P. aeruginosa infections. This copy is for personal use only -distribution prohibited.El Zowalaty M.E. and Gyetvai B.1 24 anti biotics (El Zowalaty et al., 2015). The literature is rich in surveillance studies from all over the world reporting varying resistance rates among P. aeruginosa against different antimicrobial agent. Recently, studies have focused on the decreased susceptibility of P. aeru ginosa to currently used antipseudomonal agents, including β-lactams, aminoglycosides, and fluoroquinolones (Al-Tawfiq, 2007) since resistance of P. aeru ginosa to carbapenems, piperacillin, and other highly active antibiotics has emerged and is increasing which makes treatment of P. aeruginosa infections troublesome (Strateva et al., 2007).Recently, resistance rates of P. aeruginosa clinical isolates recovered from patients admitted to Zagazig University hospitals in Egypt against different classes of antimicrobial agents were reported (El Zowalaty, 2012). The current study further examined the susceptibilities and possible resistance mechanisms of P. aeruginosa isolates collected from hospitalized patients against selected antipseudomonal agents that are available in the Egyptian pharmaceutical market and are frequently prescribed to patients. Experimental Materials and MethodsStudy site. The specimens were collected from ...

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“…P. aeruginosa can cause infections in patients with serious underlying disorders, such as a suppressed immune system or cystic fibrosis (CF), or in patients in intensive care units (ICU) (2,3). Further, infections with P. aeruginosa in such patients lead to increased morbidity and mortality (2)(3)(4).…”

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confidence: 99%

A Systematic Review and Meta-Analyses Show that Carbapenem Use and Medical Devices Are the Leading Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa

holt¹,

Severin²,

Lesaffre

et al. 2014

Antimicrob Agents Chemother

107

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A systematic review and meta-analyses were performed to identify the risk factors associated with carbapenem-resistant Pseudomonas aeruginosa and to identify sources and reservoirs for the pathogen. A systematic search of PubMed and Embase databases from 1 January 1987 until 27 January 2012 identified 1,662 articles, 53 of which were included in a systematic review and 38 in a random-effects meta-analysis study. The use of carbapenem, use of fluoroquinolones, use of vancomycin, use of other antibiotics, having medical devices, intensive care unit (ICU) admission, having underlying diseases, patient characteristics, and length of hospital stay were significant risk factors in multivariate analyses. The meta-analyses showed that carbapenem use (odds ratio [OR] ‫؍‬ 7.09; 95% confidence interval [CI] ‫؍‬ 5.43 to 9.25) and medical devices (OR ‫؍‬ 5.11; 95% CI ‫؍‬ 3.55 to 7.37) generated the highest pooled estimates. Cumulative meta-analyses showed that the pooled estimate of carbapenem use was stable and that the pooled estimate of the risk factor "having medical devices" increased with time. We conclude that our results highlight the importance of antibiotic stewardship and the thoughtful use of medical devices in helping prevent outbreaks of carbapenem-resistant P. aeruginosa.

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Influence of carbapenem resistance on mortality and the dynamics of mortality in Pseudomonas aeruginosa bloodstream infection

Abstract: According to our data, carbapenem resistance was not associated with higher mortality in patients with P. aeruginosa bacteremia. The slower initial mortality in the CRPA group might have implications in the design of the optimal antibiotic policy strategy.

Cited by 53 publications

References 42 publications

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

A Systematic Review and Meta-Analyses Show that Carbapenem Use and Medical Devices Are the Leading Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa

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