Multidrug resistant bacteria in critically ill patients: a step further antibiotic therapy

Tosi, Martina; Roat, Erika; Biasi, Sara De; Munari, Elena; Venturelli, Sophie; Coloretti, Irene; Biagioni, Emanuela; Cossarizza, Andrea; Girardis, Massimo

doi:10.21037/jeccm.2018.11.08

Cited by 39 publications

(37 citation statements)

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“…In the absence of effective characterization of immune status, nosocomial MDR infection can be considered a surrogate marker for immunosuppression, although this must be considered within the context of local resistance patterns [116]. Cytomegalovirus (CMV) and herpes simplex virus (HSV) reactivation also reflect acquired immunosuppression manifesting as T-cell exhaustion [117].…”

Section: Patients With Immunosuppression Clinical Phenotypementioning

confidence: 99%

Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis

Nierhaus

Berlot

Kindgen‐Milles

et al. 2020

Ann. Intensive Care

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Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Despite treatment being in line with current guidelines, mortality remains high in those with septic shock. Intravenous immunoglobulins represent a promising therapy to modulate both the pro- and anti-inflammatory processes and can contribute to the elimination of pathogens. In this context, there is evidence of the benefits of immunoglobulin M (IgM)- and immunoglobulin A (IgA)-enriched immunoglobulin therapy for sepsis. This manuscript aims to summarize current relevant data to provide expert opinions on best practice for the use of an IgM- and IgA-enriched immunoglobulin (Pentaglobin) in adult patients with sepsis. Main text Sepsis patients with hyperinflammation and patients with immunosuppression may benefit most from treatment with IgM- and IgA-enriched immunoglobulin (Pentaglobin). Patients with hyperinflammation present with phenotypes that manifest throughout the body, whilst the clinical characteristics of immunosuppression are less clear. Potential biomarkers for hyperinflammation include elevated procalcitonin, interleukin-6, endotoxin activity and C-reactive protein, although thresholds for these are not well-defined. Convenient biomarkers for identifying patients in a stage of immune-paralysis are still matter of debate, though human leukocyte antigen–antigen D related expression on monocytes, lymphocyte count and viral reactivation have been proposed. The timing of treatment is potentially more critical for treatment efficacy in patients with hyperinflammation compared with patients who are in an immunosuppressed stage. Due to the lack of evidence, definitive dosage recommendations for either population cannot be made, though we suggest that patients with hyperinflammation should receive an initial bolus at a rate of up to 0.6 mL (30 mg)/kg/h for 6 h followed by a continuous maintenance rate of 0.2 mL (10 mg)/kg/hour for ≥ 72 h (total dose ≥ 0.9 g/kg). For immunosuppressed patients, dosage is more conservative (0.2 mL [10 mg]/kg/h) for ≥ 72 h, without an initial bolus (total dose ≥ 0.72 g/kg). Conclusions Two distinct populations that may benefit most from Pentaglobin therapy are described in this review. However, further clinical evidence is required to strengthen support for the recommendations given here regarding timing, duration and dosage of treatment.

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Section: Patients With Immunosuppression Clinical Phenotypementioning

confidence: 99%

Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis

Nierhaus

Berlot

Kindgen‐Milles

et al. 2020

Ann. Intensive Care

Self Cite

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“…The spread of MDR bacteria in healthcare settings presents a challenge, as treating infected patients becomes increasingly difficult with poorer outcomes [6]. MDR Gram-negative bacteria (MDR-GNB) such as beta-lactamase (extended spectrum beta-lactamase (ESBL), Amp-C betalactamase and carbapenemases) producing Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa are frequently reported, causing infections in critical care units globally [9][10][11][12]. These organisms are responsible for bloodstream infections (BSIs), urinary tract infections (UTIs), pneumonia, and skin and soft tissue infections, resulting in high morbidity and mortality [13].…”

Section: Introductionmentioning

confidence: 99%

Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria

Silago

Kovacs

Msanga

et al. 2020

Antimicrob Resist Infect Control

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Background: Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR infections, this study aimed to determine, among other factors, the role of MDR-Gram-negative bacteria (GNB) contaminating neonatal cots and hands of mothers as possible role in transmission of bacteremia at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: This cross-sectional, hospital-based study was conducted among neonates and their mothers in a neonatal intensive care unit and a neonatology unit at BMC from December 2018 to April 2019. Blood specimens (n = 200) were subcultured on 5% sheep blood agar (SBA) and MacConkey agar (MCA) plates. Other specimens (200 neonatal rectal swabs, 200 maternal hand swabs and 200 neonatal cot swabs) were directly inoculated on MCA plates supplemented with 2 μg/ml cefotaxime (MCA-C) for screening of GNB resistant to third generation cephalosporins, r-3GCs. Conventional biochemical tests, Kirby-Bauer technique and resistance to cefoxitin 30 μg were used for identification of bacteria, antibiotic susceptibility testing and detection of MDR-GNB and screening of potential Amp-C beta lactamase producing GNB, respectively.

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“…Acinetobacter baumannii is a Gram-negative coccobacillus that has the ability to easily acquire antibiotic resistance and to persist in hospital environments [1]. This organism is considered an opportunistic pathogen responsible for nosocomial infections, especially in intensive care units [2]. A. baumannii commonly causes bacteremia, nosocomial-acquired pneumonia or ventilator-associated pneumonia, catheter-related infections, meningitis, peritonitis, skin and wound infections, urinary tract infections, and endocarditis [3].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

et al. 2020

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Carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical health concern for the treatment of infectious diseases. The aim of this study was to investigate the molecular epidemiology of CRAB emphasizing the presence of oxacillinase (OXA)-type β-lactamase-encoding genes, one of the most important carbapenem resistance mechanisms. In this study, a total of 183 non-repetitive CRAB isolates collected from 11 tertiary care hospitals across Thailand were investigated. As a result, the blaoxa-51-like gene, an intrinsic enzyme marker, was detected in all clinical isolates. The blaoxa-23-like gene was presented in the majority of isolates (68.31%). In contrast, the prevalence rates of blaoxa-40/24-like and blaoxa-58-like gene occurrences in CRAB isolates were only 4.92% and 1.09%, respectively. All isolates were resistant to carbapenems, with 100% resistance to imipenem, followed by meropenem (98.91%) and doripenem (94.54%). Most isolates showed high resistance rates to ciprofloxacin (97.81%), ceftazidime (96.72%), gentamicin (91.26%), and amikacin (80.87%). Interestingly, colistin was found to be a potential drug of choice due to the high susceptibility of the tested isolates to this antimicrobial (87.98%). Most CRAB isolates in Thailand were of ST2 lineage, but some belonged to ST25, ST98, ST129, ST164, ST215, ST338, and ST745. Further studies to monitor the spread of carbapenem-resistant OXA-type β-lactamase genes from A. baumannii in hospital settings are warranted.

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Multidrug resistant bacteria in critically ill patients: a step further antibiotic therapy

Cited by 39 publications

References 0 publications

Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis

Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis

Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria

Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

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