Multi-Drug-Resistant<i>Klebsiella pneumoniae</i>Pancreatitis: A New Challenge in a Serious Surgical Infection

Tugal, Derin; Lynch, Marcus; Hujer, Andrea M.; Rudin, Susan D.; Pérez, Federico

doi:10.1089/sur.2012.175

Cited by 19 publications

(17 citation statements)

References 25 publications

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“…In a study of isolates collected between 2002 and 2008, DHA-1 was the most prevalent acquired AmpC (94%), which was first identified in 2003 and was detected throughout the studied period in different institutions (13). Klebsiella pneumoniae is an important cause of nosocomial infection, and ESBLs and carbapenemases are a cause of emergency in multidrug-resistant (MDR) Klebsiella pneumoniae treatment (14). In a study of Enterobacter cloacae, a major nosocomial bacterium causing severe infections, the majority of the strains produced CTX-M type ESBLs, while a limited number produced SHV-type ESBLs, leading to the conclusion that the emergence of resistance genes is a public health problem (15).…”

Section: Introductionmentioning

confidence: 99%

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Liu

2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the phenotype and genotype of plasmid-mediated AmpC (pAmpC) β-lactamase in Klebsiella pneumoniae and its antibiotic resistance. A total of 130 non-repetitive clinical isolates of Klebsiella pneumoniae, obtained from tertiary hospitals, were phenotypically screened for pAmpC β-lactamase production with the cefoxitin disk diffusion test. β-lactamase genes in the screened isolates were detected using multiplex polymerase chain reaction (PCR); carbapenemase genes in pAmpC β-lactamase-producing isolates that were resistant to imipenem were detected using PCR. Out of the 130 isolates of Klebsiella pneumoniae, 62 strains (47.7%) were resistant to cefoxitin, including 14 strains (10.8%) positive for pAmpC β-lactamase (DHA type), among which 12 strains (85.7%) were susceptible to imipenem, and 2 strains, which were carrying Klebsiella pneumoniae carbapenemase (KPC)-2 gene, were resistant to imipenem. The pAmpC β-lactamase-producing Klebsiella pneumoniae isolates from the tertiary hospitals were mainly of DHA-1 genotype, and the majority were susceptible to carbapenems; drug-resistant strains were associated with KPC-2 expression. IntroductionAmpC β-lactamase, which is a type of cephalosporinase (1), is known to be responsible for antimicrobial resistance in gram-negative bacilli (2). The knowledge of potential risk factors for that resistance may help to limit its impact by enabling the implementation of effective control measures and judicious antimicrobial therapy (3). AmpC β-lactamases are either plasmid-or chromosomal-mediated (4). With regard to plasmid-mediated AmpC (pAmpC), no single phenotypic method is satisfactory for its detection; the combined application of phenotypic tests is necessary for the screening and confirmation of the presence of pAmpC-mediated resistance (5). Chromosomal-mediated AmpC hyperproducing Escherichia coli (E. coli) continues to be mostly susceptible to third-generation cephalosporins (6). Polymerase chain reaction (PCR) remains the gold standard for the detection of AmpC β-lactamases (7). As β-lactam antibiotics are widely used, the production of AmpC β-lactamases by bacteria results in considerable antibiotic resistance (8).Resistance to broad-spectrum β-lactams mediated by extended spectrum broad-spectrum β-lactamases (ESBLs) and AmpC β-lactamase enzymes is an increasing problem worldwide (9). In Portugal, 104/124 (83.9%) of Enterobacteriaceae isolates that were resistant to third generation cephalosporins were also resistant to fourth generation cephalosporins (10). In comparison with ESBL-producing gram-negative bacilli, AmpC β-lactamase-producing strains show more extensive antibiotic resistance; 29% of Acinetobacter strains, for example, were found to produce both ESBL and AmpC enzymes (11). To be more specific, the majority of Acinetobacter baumannii isolates were producers of carbapenemase and metallo-β-lactamase (12). In a study of isolates collected between 2002 and 2008, DHA-1 was the most prevalent acquired AmpC (94%)...

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Section: Introductionmentioning

confidence: 99%

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Liu

2016

Experimental and Therapeutic Medicine

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“…Fosfomycin is active against multidrug‐resistant Enterobacteriaceae in vitro ; however, the clinical experience is very limited and this drug is not available in our hospital. TGC exhibits activity in vitro (Gupta et al, ; Sader et al, ) and in vivo (De Pascale et al, ; Tugal et al, ) against difficult‐to‐treat pathogens. Because of its large distribution of apparent volume, high plasma protein binding rate (71–89%) and poor ability to cross the BBB, TGC was administered intravenously and intraventricularly every 12 h with multiple dosage to maintain an effective drug concentration.…”

Section: Methodsmentioning

confidence: 99%

“…TGC exhibits in vitro (Bradford, Weaver‐Sands, & Petersen, ; Gupta, Aruna, Nagaraj, Dias, & Muralidharan, ; Sader, Farrell, Flamm, & Jones, ) and in vivo (Babinchak et al, ; Ellis‐Grosse et al, ) potency against Gram‐positive and ‐negative bacteria. TGC also exhibits activity in vitro (Gupta et al, ; Sader et al, ) and in vivo (De Pascale et al, ; Tugal et al, ) against difficult‐to‐treat pathogens such as vancomycin‐resistant Enterococcus faecalis , carbapenem‐resistant Acinetobacter baumannii and Klebsiella pneumoniae , extended‐spectrum β ‐lactamase (ESBL)‐phenotype K. pneumonia and meropenem‐resistant K. pneumoniae .…”

Section: Introductionmentioning

confidence: 99%

Development and validation of an LC‐MS/MS method for the determination of tigecycline in human plasma and cerebrospinal fluid and its application to a pharmacokinetic study

Mei

Luo

et al. 2016

Biomedical Chromatography

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Tigecycline (TGC) is an important antibiotic in treating various drug-resistant bacteria. The dosage regimen for cerebral intraventricular TGC is still unknown. The aim of the study was to develop and validate liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods for the determination of TGC in human plasma and cerebrospinal fluid (CSF) to obtain an applicable regimen. The ion transitions under ESI positive model were performed at m/z 586.3 > 513.2 and m/z 595.3 > 514.3 for TGC and d9-TGC internal standard (IS). For plasma and CSF samples, the calibration curve of TGC was linear within the ranges 25-2000 and 250-100,000 ng/mL; the IS normalized matrix effect was within the ranges 96.46-101.06% and 101.13-103.58%, respectively, for all. TGC was stable under all tested conditions. The patient received 1 mg intraventricular and 49 mg intravenous administration of TGC. The AUC in plasma and CSF calculated according to our noncompartment model were 4713 and 23,0238 h ng/mL, respectively. Given our findings cerebral intraventricular TGC may be a choice for clinicians to treat drug-resistant Gram-negative bacterial-induced meningitis and the safety and efficacy of this administration route warrants further study.

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“…The mortality rate may be up to 30% 1 due to local and systemic complications, including systemic in ammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS) or multiple organ dysfunction syndrome (MODS) in the early stage [2][3][4] . Subsequently, infectious pancreatic necrosis (IPN) will appear in approximately 40% to 70% of patients in the second stage [5][6] , and the mortality rate can be as high as 32% to 50% [7][8] Currently, the treatment of IPN has evolved from open surgery to comprehensive treatment based on minimally invasive techniques, such as endoscopic treatments, percutaneous drainage and minimally invasive necrotic tissue removal 9-11 . Antibiotics are used for almost the entire treatment process 12 . This is because pancreatic and peripancreatic infectious necrosis is mainly caused by intestinal bacterial translocation [13][14] .…”

Section: Introductionmentioning

confidence: 99%

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

Fan

Hong

et al. 2020

Preprint

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Background: Infection is one of the important causes of death in patients with severe acute pancreatitis (SAP) , but the bacterial spectrum and antibiotic resistance are constantly changing. Making good use of antibiotics and controlling multi-drug-resistant (MDR) bacterial infections are of vital importance in improving the cure rate of SAP. We conducted a retrospective study in the hope of providing references for antibiotic selection and control of drug-resistant bacteria. Methods: Retrospective analysis was performed on the data of patients hospitalized in our hospital due to acute pancreatitis (AP) in the past 5 years. General data were classified and statistically analyzed. Subsequently, the bacterial spectrum characteristics and the data related to drug-resistant bacterial infection of 569 AP patients were analyzed. Finally, unconditional logistic regression analysis was conducted to analyze the risk factors of MDR infection. Results: A total of 398 patients were enrolled in this study and the hospitalization data and associated results were analyzed. A total of 461 strains of pathogenic bacteria were detected, including 223 (48.4%) gram-negative bacterial strains, 190 (41.2%) gram-positive bacterial strains and 48 (10.4%) fungal strains. The detection rates of resistance in gram-negative and gram-positive bacterial strains were 48.0% (107/223) and 25.3% (48/190), respectively. There were significant differences between the MDR group and the non-MDR group for the factors of precautionary antibiotic use, kinds of antibiotics used, receipt of carbapenem, tracheal intubation, hemofiltration and number of hospitalization days in the intensive care unit. Unconditional logistic regression revealed 2 risk factors for MDR bacterial infection. Conclusions: Our results illustrate that gram-negative bacteria were the most common pathogens in SAP infection, and the proportion of gram-positive bacteria increased notably. The rate of antibiotic resistance was higher than previously reported. Unconditional logistic regression analysis showed that using more types of antibiotics and the number of hospitalization days in the ICU were the risk factors associated with MDR bacterial infection.

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Multi-Drug-ResistantKlebsiella pneumoniaePancreatitis: A New Challenge in a Serious Surgical Infection

Abstract: As the prevalence of K. pneumoniae bearing KPC continues to increase in the healthcare setting, SAP caused by this MDR pathogen will become more common. Tigecycline plus colistin was a successful antibiotic regimen for the treatment of SAP due to K. pneumoniae bearing KPC.

Cited by 19 publications

References 25 publications

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Development and validation of an LC‐MS/MS method for the determination of tigecycline in human plasma and cerebrospinal fluid and its application to a pharmacokinetic study

Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study

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