Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit

Flaherty, John P.; Weinstein, Robert A.

doi:10.2307/30141027

Cited by 53 publications

(22 citation statements)

References 144 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bacteria such as vancomycin-resistant enterococci (VRE) and glycopeptide-intermediate sensitive Staphylococcus aureus present hospitals with the prospect of a postantibiotic era, in which few if any therapeutic antimicrobial agents remain effective (Weinstein et al 1 ). Compared to infections caused by susceptible strains, infections caused by antibiotic-resistant organisms are more likely to prolong hospitalization, to increase the risk of death, and to require treatment with more toxic or more expensive antibiotics (Flaherty and Weinstein 2 ). Patients admitted to healthcare institutions are the main reservoirs of ARB.…”

Section: Introductionmentioning

confidence: 99%

Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination*

Wang

Ruan

2017

Sci Rep

View full text Add to dashboard Cite

In this work, we investigate the role of environmental contamination on the clinical epidemiology of antibiotic-resistant bacteria in hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It is tougher to treat than most strains of Staphylococcus aureus or staph, because it is resistant to some commonly used antibiotics. Both deterministic and stochastic models are constructed to describe the transmission characteristics of MRSA in hospital setting. The deterministic epidemic model includes five compartments: colonized and uncolonized patients, contaminated and uncontaminated health care workers (HCWs), and bacterial load in environment. The basic reproduction number R 0 is calculated, and its numerical and sensitivity analysis has been performed to study the asymptotic behavior of the model, and to help identify factors responsible for observed patterns of infections. A stochastic epidemic model with stochastic simulations is also presented to supply a comprehensive analysis of its behavior. Data collected from Beijing Tongren Hospital will be used in the numerical simulations of our model. The results can be used to provide theoretical guidance for designing efficient control measures, such as increasing the hand hygiene compliance of HCWs and disinfection rate of environment, and decreasing the transmission rate between environment and patients and HCWs.

show abstract

Section: Introductionmentioning

confidence: 99%

Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination*

Wang

Ruan

2017

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Acinetobacter spp. was also resistant to ceftazidime in 93.2% of isolates [11] These findings were expected because several risk factors for antimicrobial resistance had been previously described in ICU patients [2,12,13], including acutely and severely-ill patients, widespread use of empirical polyvalent antimicrobial therapy and frequent need for invasive devices and procedures.…”

Section: Discussionmentioning

confidence: 92%

“…Nowadays, the problem of resistance is of great concern in the hospital setting due to multi-resistant S. aureus, Enterococcus spp., Acinetobacter spp., and Pseudomonas spp., giving birth to the so-called post-antibiotic era [2].…”

mentioning

confidence: 99%

Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

et al. 2007

View full text Add to dashboard Cite

Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU) and who had been previously treated with antimicrobials, especially third-generation cephalosporins. This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1) First period (September 1999 to February 2000); and 2) Second period (August 2000 to December 2000); empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004). Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002). Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004) and P. mirabilis (p=0.036), restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001) and reduction of ventilator-associated pneumonia rates (p<0.0001). However, there was an increase in P. aeruginosa incidence (p=0.005) and increases in ceftazidime (p=0.003) and meropenem (p<0.0001) susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

show abstract

“…Multiple antibiotic‐resistant strains of Gram‐negative bacilli and Gram‐positive cocci are increasingly causing epidemic and endemic nosocomial infections, particularly in intensive care units [1, 2]. Among the leading drug‐resistant Gram‐negative pathogens are Enterobacteriaceae resistant to extended spectrum cephalosporins (due to production of plasmid‐encoded extended spectrum beta‐lactamase, hyperproduction of chromosomal cephalosporinase, or both) and often cross‐resistant to other major classes of antibiotics such as aminoglycosides and fluoroquinolones [3–4]. Multiple‐drug‐resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii are also increasingly encountered in critically ill patients [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Among the leading drug‐resistant Gram‐negative pathogens are Enterobacteriaceae resistant to extended spectrum cephalosporins (due to production of plasmid‐encoded extended spectrum beta‐lactamase, hyperproduction of chromosomal cephalosporinase, or both) and often cross‐resistant to other major classes of antibiotics such as aminoglycosides and fluoroquinolones [3–4]. Multiple‐drug‐resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii are also increasingly encountered in critically ill patients [3, 4]. In Belgium, Enterobacter aerogenes has recently been recognized as an emerging multiple‐drug‐resistant nosocomial pathogen, often associated with invasive disease, including pneumonia and bacteremia [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic policy: a tool for controlling resistance of hospital pathogens

Struelens

Byl

Vincent

1999

Clinical Microbiology and Infection

View full text Add to dashboard Cite

Multiresistant Gram-negative bacilli, including strains of Klebsiella pneumoniae, Enterobacter spp, Acinetobacter baumannii and Pseudomonas aeruginosa, resistant to broad spectrum beta-lactams, aminoglycosides and fluoroquinolones, are recovered at increasing frequency from patients suffering from nosocomial infections, particularly from those receiving intensive care. The emergence and spread of resistant pathogens to endemic and epidemic levels has frequently been related in time and place to the intensive use of antibiotics to which these microorganisms have developed resistance, notably third generation cephalosporins and fluoroquinolones. Recent investigations have indicated that the prevalence of resistance can be reduced by scheduled changes of empiric treatment regimens, involving discontinuation of intensively prescribed drugs and substitution with newly introduced antibiotics of another class to which the prevalent resistant strains remain susceptible. Among these drugs, penicillins---beta-lactamase inhibitor combinations, 'fourth generation' cephalosporins and, where little used previously, fluoroquinolones, have been introduced successfully in high risk units where ceftazidime-resistant strains of K.pneumoniae, Enterobacter and Citrobacter spp or glycopeptide-resistant enterococci had become highly prevalent. However, these studies do not demonstrate a direct causal relationship between changes in prescribing practices and ecological improvements, because their observational design cannot be controlled. In most studies, several important factors influencing the dynamics of resistance were not monitored and the relative contribution of decreased emergence versus control of cross-transmission to the improved susceptibility rates is not clear. We propose that additional long-term studies are required to better track the ecological impact and to determine the optimal modalities of programmed changes of antibiotic prescribing as an antibiotic resistance prevention or control strategy.

show abstract

Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit

Cited by 53 publications

References 144 publications

Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination*

Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination*

Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

Antibiotic policy: a tool for controlling resistance of hospital pathogens

Contact Info

Product

Resources

About