Interventions to reduce infections caused by multidrug resistant Enterobacteriaceae (MDR-E): A systematic review and meta-analysis

Atamna-Mawassi, Heyam; Huberman-Samuel, Maayan; hershcovitz, Shimrit; Karny-Epstein, Nitzan; Kola, Axel; Cortés, Luis Eduardo López; Leibovici, Leonard; Yahav, Dafna

doi:10.1016/j.jinf.2021.05.005

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…[41][42][43][44] Nowadays, worldwide measures are taken to decrease the risk for MDR. 45,46 In the present study, most of the isolates with MDR were Acinetobacter baumannii, which can present into three distinct clinical entities. 47 Most isolates of Acinetobacter baumannii have MDR, as showed in a large study including 1861 isolates and showed more than 70% chance of MDR in these isolations.…”

Section: Discussionmentioning

confidence: 58%

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

Oweis¹,

Zeyad²,

Alshelleh³

et al. 2022

JMDH

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Background: Acute kidney injury (AKI) is a well-known complication for hospitalized patients. Sepsis and various infections play a significant role in increasing the incidence of AKI. The present study evaluated the risk for Multidrug-resistant (MDR) infections and its effect on the incidence of AKI, hospitalization, need for dialysis, and mortality. Methods: In a retrospective study design, data were collected from all adult patients with a positive multi-drug resistant culture who were admitted to King Abdullah University Hospital (KAUH). Records of 436 patients were reviewed between January 2017 -December 2018 with at least one year of follow-up. Results: The mean age was 57.3 years (SD± 23.1), and 58.5% were males. The most common source of positive cultures was sputum, with 50% positive cultures. The incidence of AKI was 59.2%. The most isolated microorganism was Acinetobacter baumannii (76.8%), followed by Pseudomonas aeruginosa (14.9%).On multivariate analysis, age (OR 1.1, 95% CI 1.1-1.2, P=0.001), HTN (OR 1.8, 95% CI 1.0-3.3, P=0.02), DM (OR 1.1, 95% CI 0.6-1.9, P=0.69) and the use of Foley catheter on chronic bases (OR 4.3, 95% CI 2.6-6.8, P<0.0001) were strong predictors of AKI. Among patients with AKI, 74.4% died compared to 44.4% among non-AKI patients (p<0.001). Conclusion:In patients with MDR, AKI incidence, hospitalization, and mortality were high. Early detection and addressing the problem may decrease bad outcomes, and health education for reducing antibiotic abuse is needed to lower MDR.

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Section: Discussionmentioning

confidence: 58%

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

Oweis¹,

Zeyad²,

Alshelleh³

et al. 2022

JMDH

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“…These risks are unique for patients colonized by CRE and not for patients colonized by Enterobacteriaceae resistant to cephalosporins or other β-lactams whatever enlightens the need of development of strategies of selective oral decontamination (SOD). One published meta-analysis included 11 studies of SOD against multidrug-resistant (MDR) Enterobacteriaceae and did not show any benefit 25 underlying how difficult eradication is. Two randomized clinical trials (RCTs) including limited number of patients colonized by MDR Enterobacteriaceae not-resistant to carbapenems showed that the use of either oral colistin/neomycin or short antibiotic treatment followed by fecal transplantation achieved temporary suppression of intestinal carriage; re-growth was observed following end of treatment 26 , 27 .…”

Section: Discussionmentioning

confidence: 99%

An animal model of limitation of gut colonization by carbapenemase-producing Klebsiella pneumoniae using rifaximin

Xenofontos

Renieris

Kalogridi

et al. 2022

Sci Rep

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Current knowledge suggests that infection by carbapenem-resistant enterobacteria is preceded by gut colonization. It is hypothesized that colonization is eradicated by non-absorbable antibiotics like rifaximin. We investigated the effect of rifaximin against carbapenem-resistant Klebsiella pneumoniae (CRKP) in vitro and in a mouse model. We studied the in vitro efficacy of rifaximin against 257 CRKP clinical isolates, 188 KPC producers and 69 OXA-48 producers, by minimum inhibitory concentration and time-kill assays. We then developed a model of gut colonization by feeding 30 C57Bl6 mice with 108 cfu of one KPC-KP isolate for 7 days; mice were pre-treated orally with saline, omeprazole or ampicillin. Then, another 60 mice with established KPC-2 gut colonization received orally for 7 consecutive days rifaximin 180 mg/kg dissolved in ethanol and 4% bile or vehicle. On days 0, 3 and 7 stool samples were collected; mice were sacrificed for determination of tissue outgrowth. At a concentration of 1000 μg/ml rifaximin inhibited 84.8% of CRKP isolates. Α 3 × log10 decrease of the starting inoculum was achieved by 100, 250 and 500 μg/ml of rifaximin after 24 h against 25, 55 and 55% of isolates. Pre-treatment with ampicillin was necessary for gut colonization by KPC-KP. Treatment with rifaximin succeeded in reducing KPC-KP load in stool and in the intestine. Rifaximin inhibits at clinically meaningful gut concentrations the majority of CRKP isolates and is efficient against gut colonization by KPC-KP.

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“…A recent systematic review and meta-analysis aiming to assess the various interventions for controlling the risk of transmission of multi-resistant Enterobacterales to hospitalized patients has suggested that the proper use of antibiotics is the only measure that considerably reduces colonization, in particular of those species belonging to Escherichia coli ( p < 0.0001). In their review, 63 studies were included; the most commonly assessed interventions were antimicrobial stewardship policies and selective oral or digestive decolonization procedures [ 103 ]. In a three-phase sequential study by Derde et al, 2014, improved hand hygiene was associated with a reduction in the acquisition of MRSA, though not with VRE or multidrug-resistant Enterobacterales [ 90 ].…”

Section: International Policies To Limit the Spread Of Mdrosmentioning

confidence: 99%

Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All

et al. 2023

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The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients’ being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

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Interventions to reduce infections caused by multidrug resistant Enterobacteriaceae (MDR-E): A systematic review and meta-analysis

Cited by 9 publications

References 26 publications

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

An animal model of limitation of gut colonization by carbapenemase-producing Klebsiella pneumoniae using rifaximin

Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All

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