Pseudomonas aeruginosa Outbreak in a Burn Unit: Role of Antimicrobials in the Emergence of Multiply Resistant Strains

Richard, P; Floch, R. Le; Chamoux, C; Pannier, Michel; Espaze, E.; Richet, Hervé

doi:10.1093/infdis/170.2.377

Cited by 151 publications

(97 citation statements)

References 21 publications

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“…The MDR AFLP35 strain belonged to serogroup O12. Epidemic strains are frequently of serotypes O11 and O12 (13,14,15,19,43,47,55). Detection of the simultaneous presence of three distinct P. aeruginosa O12 strains, one of which was an environmental strain from the BWC, by AFLP analysis illustrates the advantage of genotyping over serotyping.…”

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confidence: 99%

Molecular Epidemiology of Pseudomonas aeruginosa Colonization in a Burn Unit: Persistence of a Multidrug-Resistant Clone and a Silver Sulfadiazine-Resistant Clone

et al. 2003

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To study the epidemiology of Pseudomonas aeruginosa colonization in a 32-bed burn wound center (BWC), 321 clinical and 45 environmental P. aeruginosa isolates were collected by prospective surveillance culture over a 1-year period and analyzed by serotyping, drug susceptibility testing, and amplified fragment length polymorphism (AFLP) analysis. Among 441 patients treated at the center, 70 (16%) were colonized with P. aeruginosa, including 12 (17%) patients who were colonized on admission and 58 (83%) patients who acquired the organism during their stay. Of the 48 distinct AFLP genotypes found, 21 were found exclusively in the environment, 15 were isolated from individual patients only, and 12 were responsible for the colonization of 57 patients, of which 2 were also isolated from the environment, but secondary to patient carriage. Polyclonal P. aeruginosa colonization with strains of two to four genotypes, often with different antibiotic susceptibility patterns, was observed in 19 patients (27%). Two predominant genotypes were responsible for recurrent outbreaks and the colonization of 42 patients (60% of all colonized patients). The strain with one of those genotypes appeared to be endemic to the BWC and developed multidrug resistance (MDR) at the end of the study period, whereas the strain with the other genotype was antibiotic susceptible but resistant to silver sulfadiazine (SSD r ). The MDR strain was found at a higher frequency in sputum samples than the SSD r strain, which showed a higher prevalence in burn wound samples, suggesting that anatomic habitat selection was associated with adaptive resistance to antimicrobial drugs. Repeated and thorough surveys of the hospital environment failed to detect a primary reservoir for any of those genotypes. Cross-acquisition, resulting from insufficient compliance with infection control measures, was the major route of colonization in our BWC. In addition to the AFLP pattern and serotype, analysis of the nucleotide sequences of three (lipo)protein genes (oprI, oprL, and oprD) and the pyoverdine type revealed that all predominant strains except the SSD r strain belonged to recently identified clonal complexes. These successful clones are widespread in nature and therefore predominate in the patient population, in whom variants accumulate drug resistance mechanisms that allow their transmission and persistence in the BWC.

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Molecular Epidemiology of Pseudomonas aeruginosa Colonization in a Burn Unit: Persistence of a Multidrug-Resistant Clone and a Silver Sulfadiazine-Resistant Clone

et al. 2003

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“…Using several classes of antibiotics to treat infections caused by this bacterium can lead to the emergence of new mutant strains, which have a high level of resistance to many antibiotics [6]. Multidrug-resistant (MDR) Pseudomonas aeruginosa has been described mainly in patients who are immunocompromised, or patients with cystic fibrosis or neoplastic diseases, or patients in Intensive Care Units [7][8][9].…”

Section: Pseudomonas Aeruginosa: Microbiological Clinical and Epidemmentioning

confidence: 99%

A New Treatment Choice against Multi-Drug Resistant Pseudomonas aeruginosa: Doripenem

Barrios¹,

Oliver²

2014

J Bacteriol Parasitol

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Pseudomonas aeruginosa is a Gram-negative strict aerobic Bacillus that causes around 10% of nosocomial infections. This bacillus can become resistant to multiple antibiotics, and it has been described mainly in inmuno compromised patients. The prevalence of multidrug resistant Pseudomonas has been increasing over the last few years. Currently we have new agents to treat this type of infection. Doripenem is the new B-lactam from the carbapenem family, which has demonstrated in vitro the best activity against multidrug resistant Pseudomonas aeruginosa in different studies. Its mechanism of action consists of the inactivation of penicillin-binding proteins in the cell wall. This agent has been indicated in the treatment of several infections, such as complicated intraabdominal infections, complicated urinary tract infections and nosocomial pneumonia. The principal difference between doripenem and the other carbapenems, is the capacity of preventing the generation of resistant strains of Pseudomonas aeruginosa, so it is especially useful for severe infections caused by multidrug resistant Pseudomonas aeruginosa. But this situation may change if we don't use antibiotics properly. Promoting rationale use of antibiotics to treat infections caused by Pseudomonas aeruginosa may be critical to make the emergence of multidrug resistant strains difficult. The present review describes the main features of doripenem and its potential role in managing infections due to multi-drug resistant Pseudomonas aeruginosa.Keywords: Doripenem; Carbapenems; Pseudomonas aeruginosa; Multidrug-resistance; Nosocomial infection Pseudomonas aeruginosa: Microbiological, Clinical and Epidemiological FeaturesPseudomonas aeruginosa is a Gram-negative aerobic and facultative anaerobic bacillus which belongs to the Pseudomonadaceae family. It is a small microorganism, straight or slightly curved, non-fermenting glucose and not sporulated. It has motility due to a single polar flagellum and twitching. Its identification in the laboratory is simple, because the germ grows easily in a wide variety of media and the requirements for its identification are scarce. Most cultures of this bacteria produce a blue-green pigment pyocyanin; it is useful for identification of the microorganism, and because of the characteristic color of copper oxide, the bacteria is named aeruginosa [1].This germ is typically associated with nosocomial infections, causing about 10% of infections acquired in the hospital, but community-acquired infections also contributes to a substantial number of cases [2,3]. Pseudomonas causes a variety of infections, mainly urinary tract infections, respiratory infections, ocular infections, endocarditis, bone and joint infections, burn infections and other skin infections, such as ecthyma gangrenosum or cellulitis.These infections are often difficult to treat because the bacteria is sensitive to few antibiotics, and also can produce multiple resistance to other antibiotics during the infection treatment [4,5]. Using several classes of ...

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“…D espite recent advances in patient care, bacterial infections remain a leading cause of death in severely burned patients (1)(2)(3). In our previous study (4,5) we demonstrated that burn injury suppresses the production of IFN-␥ after Escherichia coli challenge in a mouse model whereas IL-18 treatment restores the IFN-␥ production, thereby improving the survival of burn-injured mice after infection.…”

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confidence: 93%

“…In our previous study (4,5) we demonstrated that burn injury suppresses the production of IFN-␥ after Escherichia coli challenge in a mouse model whereas IL-18 treatment restores the IFN-␥ production, thereby improving the survival of burn-injured mice after infection. However, many clinical studies have described Pseudomonas aeruginosa and methicillinresistant Staphylococcus aureus, but not E. coli, as the most common agents of postburn infections (1)(2)(3). P. aeruginosa infection especially has a high mortality rate and remains a major cause of death in burned patients (1,2).…”

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confidence: 99%

“…However, many clinical studies have described Pseudomonas aeruginosa and methicillinresistant Staphylococcus aureus, but not E. coli, as the most common agents of postburn infections (1)(2)(3). P. aeruginosa infection especially has a high mortality rate and remains a major cause of death in burned patients (1,2). To improve the prognosis of burned patients, the potentiation of postburn defense mechanisms against P. aeruginosa infection is therefore considered to be very important.…”

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Restoration of Natural IgM Production from Liver B Cells by Exogenous IL-18 Improves the Survival of Burn-Injured Mice Infected with Pseudomonas aeruginosa

Kinoshita

Shinomiya²,

Ono

et al. 2006

The Journal of Immunology

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Pseudomonas aeruginosa is the most common bacterium of postburn infection. In the present study we investigated the immune mechanism of susceptibility to this type of postburn infection and also examined the efficacy of IL-18 treatment. C57BL/6 mice were challenged with P. aeruginosa on day 7 after burn injury. Although the burn-injured mice showed a poor survival rate after bacterial challenge, they retained their IFN-γ production. The burned mice showed lower serum IgM levels and a poor IgM response following P. aeruginosa challenge in comparison with the sham mice, whereas IL-18 treatment after burn injury (alternate day injections for 1 wk) greatly improved the serum IgM levels, which are P. aeruginosa-independent natural IgM before bacterial challenge, thereby increasing the survival rate after the challenge. IL-18 treatment also induced specific IgM to P. aeruginosa in the sera 5 days after bacterial challenge in the burned mice. Interestingly, CD43+CD5−CD23−B220dim cells, namely B-1b cells, increased in the liver after the IL-18 treatment and were found to actively produce IgM in vitro without any additional stimulation. Furthermore, the IL-18 treatment up-regulated the neutrophil count and the C3a levels in the blood as a result of the increased IgM level, which may thus play a critical role in the opsonization and elimination of any invading bacteria. IL-18 treatment for the burned mice and their resultant natural IgM production were thus found to strengthen the host defense against P. aeruginosa infection.

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Pseudomonas aeruginosa Outbreak in a Burn Unit: Role of Antimicrobials in the Emergence of Multiply Resistant Strains

Cited by 151 publications

References 21 publications

Molecular Epidemiology of Pseudomonas aeruginosa Colonization in a Burn Unit: Persistence of a Multidrug-Resistant Clone and a Silver Sulfadiazine-Resistant Clone

Molecular Epidemiology of Pseudomonas aeruginosa Colonization in a Burn Unit: Persistence of a Multidrug-Resistant Clone and a Silver Sulfadiazine-Resistant Clone

A New Treatment Choice against Multi-Drug Resistant Pseudomonas aeruginosa: Doripenem

Restoration of Natural IgM Production from Liver B Cells by Exogenous IL-18 Improves the Survival of Burn-Injured Mice Infected with Pseudomonas aeruginosa

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