Recommendations and guidelines for the treatment of infections due to multidrug resistant organisms

Sy, Cheng Len; Chen, Pao-Yu; Cheng, Chun-Wen; Huang, Ling-Ju; Wang, Ching-Hsun; Chang, Tu‐Hsuan; Chang, Yi-Chin; Chang, Chia-Jung; Hii, Ing-Moi; Hsu, Yu-Lung; Hu, Yali; Hung, Pi-Lien; Kuo, Chen-Yen; Lin, Pei‐Chin; Liu, Po-Yen; Lo, Ching-Lung; Lo, Shih-Hao; Ting, Pei-Ju; Tseng, Chien-Fang; Wang, Hsiao-Wei; Yang, Chung-Tu; Lee, Susan Shin-Jung; Chen, Yao-Shen; Liu, Yung‐Ching; Wang, Fu‐Der

doi:10.1016/j.jmii.2022.02.001

Cited by 28 publications

(10 citation statements)

References 177 publications

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“…The higher risk of final in-hospital mortality may be associated with the greater likelihood of MDR bacteremia, which has been documented to be associated with a higher risk of treatment failure and infectious complications [ 10 , 26 , 27 , 28 ]. The occurrence of MDR bacteremia and infectious complications will lead to a higher risk of recurrent sepsis and then a vicious circle will occur, which can explain the prolonged duration of hospitalization in neonates with initial broad-spectrum antibiotics [ 27 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis

et al. 2023

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Background: Empiric antibiotics are often prescribed in critically ill and preterm neonates at birth until sepsis can be ruled out. Although the current guideline suggests narrow-spectrum antibiotics, an upgrade in antibiotics is common in the neonatal intensive care unit. The impacts of initial broad-spectrum antibiotics on the outcomes of critically ill neonates with respiratory failure requiring mechanical intubation have not been well studied. Methods: A total of 1162 neonates from a tertiary level neonatal intensive care unit (NICU) in Taiwan who were on mechanical ventilation for respiratory distress/failure at birth were enrolled, and neonates receiving ampicillin plus cefotaxime were compared with those receiving ampicillin plus gentamicin. Propensity score-matched analysis was used to investigate the effects of ampicillin plus cefotaxime on the outcomes of critically ill neonates. Results: Ampicillin plus cefotaxime was more frequently prescribed for intubated neonates with lower birth weight, higher severity of illness, and those with a high risk of early-onset sepsis. Only 11.1% of these neonates had blood culture-confirmed early-onset sepsis and/or congenital pneumonia. The use of ampicillin plus cefotaxime did not significantly contribute to improved outcomes among neonates with early-onset sepsis. After propensity score-matched analyses, the critically ill neonates receiving ampicillin plus cefotaxime had significantly worse outcomes than those receiving ampicillin plus gentamicin, including a higher risk of late-onset sepsis caused by multidrug-resistant pathogens (11.2% versus 7.1%, p = 0.027), longer duration of hospitalization (median [IQR], 86.5 [47–118.8] days versus 78 [45.0–106.0] days, p = 0.002), and a significantly higher risk of in-hospital mortality (14.2% versus 9.6%, p = 0.023). Conclusions: Ampicillin plus cefotaxime should not be routinely prescribed as the empiric antibiotics for critically ill neonates at birth because they were associated with a higher risk of infections caused by multidrug-resistant pathogens and final worse outcomes.

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Section: Discussionmentioning

confidence: 99%

Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis

et al. 2023

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“…S. maltophilia and E. anophelis are both considered MDROs because of their intrinsic resistance to multiple classes of antibiotics, including penicillin, cephalosporins, macrolides, aminoglycosides, FQs, and carbapenems [81,82]. The molecular mechanisms of antimicrobial resistance in S. maltophilia include chromosomal ß-lactamases ( bla L1 and/or bla L2 ), class 1 intergrons and ISCR elements, multiple efflux pumps, Sm qnr , antibiotic-modifying enzymes, phosphoglucomutase, mutations of topoisomerase and gyrase genes, and a reduction in outer membrane permeability [83,84–86]. For E. anophelis , several antimicrobial resistance genes, including bla B , bla GOB , bla CME , Sul2 , erm(F) , GyrA , Tet(X) , and catB, were identified in genomic analysis and were associated with ß-lactam, trimethoprim/sulfamethoxazole, macrolide, quinolone, and chloramphenicol resistance [87–90,91 ▪ ,92].…”

Section: Treatment Of Stenotrophomonas Maltophilia and Elizabethkingi...mentioning

confidence: 99%

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

Lee,

Hsueh

2023

Current Opinion in Infectious Diseases

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Purpose of review This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis. Recent findings Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. Summary Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.

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“…The "Guidelines Recommendations for Evidenced-based Antimicrobial use in Taiwan" (GREAT) working group has launched recommendations and guidelines for the treatment of infections caused by MDR organisms (Sy et al, 2022). In bloodstream infections caused by CRAB, the recommended treatment is colistin 5 mg/kg IV loading dose, followed by IV every 12 h of 2.5 mg × (1.5 × creatine clearance + 30) and/or imipenem/cilastatin 500 mg IV every 6 h or meropenem 2 g IV every 8 h. In pneumonia caused by CRAB, the recommended treatment is colistin 5 mg/kg IV loading dose, then IV every 12 h of 2.5 mg × (1.5 × creatine clearance + 30) and/or imipenem/cilastatin 500 mg IV every 6 h or meropenem 2 g IV every 8 h and adjunctive colistin inhalation 1.25-15 MIU/day in 2-3 divided doses.…”

Section: The Importance Of the Polymyxins In Non-fermentative Bacteri...mentioning

confidence: 99%

An Update of Mobile Colistin Resistance in Non-Fermentative Gram-Negative Bacilli

Khuntayaporn

Thirapanmethee

Chomnawang

2022

Front. Cell. Infect. Microbiol.

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Colistin, the last resort for multidrug and extensively drug-resistant bacterial infection treatment, was reintroduced after being avoided in clinical settings from the 1970s to the 1990s because of its high toxicity. Colistin is considered a crucial treatment option for Acinetobacter baumannii and Pseudomonas aeruginosa, which are listed as critical priority pathogens for new antibiotics by the World Health Organization. The resistance mechanisms of colistin are considered to be chromosomally encoded, and no horizontal transfer has been reported. Nevertheless, in November 2015, a transmissible resistance mechanism of colistin, called mobile colistin resistance (MCR), was discovered. Up to ten families with MCR and more than 100 variants of Gram-negative bacteria have been reported worldwide. Even though few have been reported from Acinetobacter spp. and Pseudomonas spp., it is important to closely monitor the epidemiology of mcr genes in these pathogens. Therefore, this review focuses on the most recent update on colistin resistance and the epidemiology of mcr genes among non-fermentative Gram-negative bacilli, especially Acinetobacter spp. and P. aeruginosa.

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Recommendations and guidelines for the treatment of infections due to multidrug resistant organisms

Cited by 28 publications

References 177 publications

Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis

Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

An Update of Mobile Colistin Resistance in Non-Fermentative Gram-Negative Bacilli

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