Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Manian, Farrin A.; Meyer, Lynn; Jenne, Joane; Owen, Amy; Taff, Terry

doi:10.1017/s0195941700003799

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…The decrease in antibiotic susceptibility of clinical strains of S. maltophilia relative to environmental strains does not necessarily imply that the more resistant environmental strains are most likely to colonize patients. Because S. maltophilia is noted for its ability to become increasingly resistant to a variety of antimicrobial agents during therapy (16,23), many clinical strains may have been more susceptible at the time of initial acquisition.…”

Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology of Stenotrophomonas maltophilia Isolated from Clinical Specimens from Patients with Cystic Fibrosis and Associated Environmental Samples

Todd²,

et al. 1998

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Stenotrophomonas maltophilia was isolated from the respiratory tracts of 41 (25%) of 163 children attending our pediatric cystic fibrosis unit between September 1993 and December 1995. The extents of S. maltophilia contamination of environmental sites frequented by these patients were investigated with a selective medium incorporating vancomycin, imipenem, and amphotericin B. Eighty-two isolates of S. maltophilia were cultured from 67 different environmental sites sampled between January and July 1996. The organism was widespread in the home environment, with 20 (36%) and 25 (42%) of sampled sites positive in the homes of colonized and noncolonized patients, respectively. In the nosocomial setting, it was isolated from 18 (32%) sites in the hospital ward and from 4 (17%) sites in the outpatient clinic area. The most common sites of contamination were sink drains, faucets, and other items frequently in contact with water. All environmental and clinical isolates were genotyped with enterobacterial repetitive intergenic consensus sequences as primers. A total of 33 of the 41 patients were colonized with unique strains, and four pairs of patients shared strains. Further characterization by pulsed-field gel electrophoresis after digestion with XbaI found that there was no evidence of patient-to-patient transmission; however, there was some evidence that a small number of patients may have acquired the organism from the hospital environment. Resampling of environmental sites in the hospital ward in January 1997 revealed evidence of genetic drift, complicating the accurate determination of environmental sources for clinical strains. The source of the majority of S. maltophiliastrains colonizing the respiratory tracts of these patients with cystic fibrosis remained uncertain but may have represented multiple, independent acquisitions from a variety of environmental sites both within and outside the hospital.

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Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology of Stenotrophomonas maltophilia Isolated from Clinical Specimens from Patients with Cystic Fibrosis and Associated Environmental Samples

Todd²,

et al. 1998

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“…126 There are also potential disadvantages related to combination therapy, such as increased risk for toxicity, higher costs, possible antagonism between specific drug combinations, and selection of resistant strains. 127 Despite efforts to address the issue of whether two antimicrobials improve outcome in sepsis and septic shock compared with a single agent, the results of published clinical studies and meta-analyses on combination therapy for gramnegative bacteremia and/or sepsis are contradictory. The question has not been definitively answered.…”

Section: Combination Therapymentioning

confidence: 99%

Optimizing Antimicrobial Therapy of Sepsis and Septic Shock: Focus on Antibiotic Combination Therapy

Vázquez-Grande

Kumar

2015

Semin Respir Crit Care Med

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Severe sepsis and septic shock with sepsis-associated multiple organ failure represent the major causes of infection-associated mortality and remain the most common cause of death in intensive care units (ICUs) of developed countries. They account for 10 to 15% of all ICU admissions and 25% of sepsis cases 1 ; up to 50 to 75% of severe sepsis cases progress to septic shock. 2 Septic shock alone represents 5 to 8% of all ICU admissions. 3 Historically, the mortality associated with sepsis and septic shock has been 50 to 75%. [4][5][6] This decreased after the development of modern antimicrobial therapies, starting with penicillin in the early 1940s. Since then sepsis-associated mortality has fallen to the 30 to 50% range. 4,5 Since the development of modern antimicrobials, bacterial pathogens have continuously evolved under their selective pressure. There has also been a gradual increase in the incidence of sepsis over the intervening decades. 7 Current estimates suggest a doubling of total cases of severe sepsis in United States by 2050 (from the actual 800,000 cases per year AbstractThere has been little improvement in septic shock mortality in the past 70 years, despite ever more broad-spectrum and potent antimicrobials. In the past, resuscitative elements have been the primary area of clinical septic shock management and research. The question of the optimal use of antimicrobial therapy was relatively ignored in recent decades. This review explores the pathophysiology of sepsis in an attempt to produce a better understanding and define key determinants of antimicrobial therapy response in septic shock. Optimizing existing antimicrobials delivery can drive significant improvements in the outcome of sepsis and septic shock. Inappropriate antimicrobial selection and dosing or delays in the administration substantially increase mortality and morbidity in life-threatening infections. Definitive combination therapy (where a pathogen known to be susceptible to a given agent is additionally covered by another agent) remains controversial. Although some in vitro studies, animal models, and clinical studies of infection including endocarditis, gram-negative bacteremia, and neutropenic infections have supported combination therapy, the potential clinical benefit in other severe infections has been questioned. Several meta-analyses have failed to demonstrate improvement of outcome with combination therapy in immunocompetent patients with sepsis and/or gram-negative bacteremia. These meta-analyses did not undertake subgroup analyses of the septic shock population. This article reviews the existing evidence supporting combination therapy for severe infections, sepsis, and septic shock.

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“…For example, a significant correlation was noted in a single medical center between antecedent use of ceftriaxone, cefotaxime, ceftazidime, and piperacillin and resistance to these compounds among bacterial strains that typically produce type I chromosomal beta-lactamase, including 155 isolates of P. aeruginosa. 28 Similarly, Manian and colleagues 29 analyzed resistance rates among 594 initial and repeat gram-negative isolates from 287 patients in ICUs. Sixty-one percent of these were Enterobacter and P. aeruginosa isolates.…”

Section: Microbiologymentioning

confidence: 99%

Pseudomonas aeruginosaInfections in the Intensive Care Unit

Quinn¹

2003

Seminars in Respiratory and Critical Care Medicine

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Pseudomonas aeruginosa is a common and highly lethal agent of nosocomial infection, especially among intensive care unit patients. It is widespread in the environment and commonly recovered from water in nature and in hospital settings. P. aeruginosa is endowed with a formidable array of virulence factors that facilitate attachment to host cells, tissue invasion, and systemic disease. It is intrinsically resistant to many commonly employed antibiotics due to a complex variety of mechanisms briefly reviewed here. Resistance to fluoroquinolones appears to be increasing particularly rapidly. Recent advances in the understanding of the molecular biology of this organism have shed considerable light on its ability to form biofilms, which facilitate adherence, especially in cystic fibrosis patients, and confer resistance to clearance by host immune mechanisms and antimicrobial killing. Treatment studies have demonstrated a significant risk of emergence of resistance during therapy with a variety of agents. Several studies suggest that two drugs are better than one for therapy of serious infections, although dual therapy does not always prevent emergence of resistant strains. The sequencing of the genome will lead to new understanding of pathogenesis and may identify new drug targets.

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Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Cited by 10 publications

References 7 publications

Molecular Epidemiology of Stenotrophomonas maltophilia Isolated from Clinical Specimens from Patients with Cystic Fibrosis and Associated Environmental Samples

Molecular Epidemiology of Stenotrophomonas maltophilia Isolated from Clinical Specimens from Patients with Cystic Fibrosis and Associated Environmental Samples

Optimizing Antimicrobial Therapy of Sepsis and Septic Shock: Focus on Antibiotic Combination Therapy

Pseudomonas aeruginosaInfections in the Intensive Care Unit

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