Outbreaks of colistin-resistant and colistin-susceptible KPC-producing Klebsiella pneumoniae in a Brazilian intensive care unit

Gonçalves, Iara Rossi; Ferreira, Melina Lorraine; Araújo, Bruna Fuga; Campos, Paola Amaral de; Royer, Sabrina; Batistão, Deivid William da Fonseca; Souza, Leandro Peixoto Ferreira de; Brito, Cristiane Silveira de; Urzedo, Jane Eire; Gontijo-Filho, Paulo Pinto; Ribas, Rosineide Marques

doi:10.1016/j.jhin.2016.08.019

Cited by 55 publications

(45 citation statements)

References 16 publications

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“…Resistance to polymyxins is increasing, with outbreaks of colistin-resistant CRE reported in different parts of the world (285)(286)(287)(288)(289). Colistin resistance has been associated with an increased risk of mortality (213,290,291), and exposure to colistin has been identified as a risk factor for infections due to colistin-resistant CPE (288).…”

Section: Polymyxinsmentioning

confidence: 99%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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Therapy of invasive infections due to multidrug-resistant (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.

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Section: Polymyxinsmentioning

confidence: 99%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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“…As of April 2016, 48 states in the USA had reported the presence of CRE arising from KPC, 25 reporting NDM, 19 reporting OXA-48 and 6 reporting VIM [20]. Colistin is one of the few treatment options available for CRE, yet increasing accounts of colistin resistance are also being documented [21,22]. The first report of plasmid-borne colistin resistance ( mcr-1 ) has been identified among multidrug-resistant E. coli in the USA, leading to concerns of pandrug-resistant bacteria [23].…”

Section: Epidemiology Of Carbapenem Resistancementioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Kelly

Mathema

Larson

2017

International Journal of Antimicrobial Agents

181

141

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Carbapenem antibiotics are used as a last resort to treat serious Gram-negative bacteria (GNB) infections, however carbapenemase-producing strains of GNB have emerged as a major source of resistance. Owing to the highly transmissible nature of plasmid-borne carbapenemases, numerous reports have warned about the likely spread into the community from healthcare settings. Since the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in the community is largely unknown, we conducted a scoping review of the literature to assess the percentage of CRE isolates that could be associated with the community. Initially, 361 studies were assessed and 15 met the inclusion criteria. Although 5 studies (33.3%) found no community-associated CRE, the remaining 10 studies identified percentages ranging from 0.04% to 29.5% of either community-associated or community-onset CRE among their samples, with US-based studies alone ranging from 5.6–10.8%. The presence of CRE in the community poses an urgent public health threat.

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“…Treatment regimens can be formed with combinations that include these agents [11]. Recent studies showed that tigecycline and phosphomycin were the most commonly used agents in the treatment of colistin-resistant K. pneumoniae infections [19]. Apart from these, ertapenem-and imipenem-containing combinations are also used.…”

Section: Department Of Infectious Diseases and Clinical Microbiologymentioning

confidence: 99%

Treatment Strategies for Multiple Antimicrobial-Resistant Bacterial Infections

Ozkaya¹

2017

J Infect Dis Med, an open access journal

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Outbreaks of colistin-resistant and colistin-susceptible KPC-producing Klebsiella pneumoniae in a Brazilian intensive care unit

Cited by 55 publications

References 16 publications

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

Treatment Strategies for Multiple Antimicrobial-Resistant Bacterial Infections

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