Spectrum and transferability of β-lactam resistance in hospital strains of Enterobacter isolated in Bratislava and Innsbruck

Bujdáková, Helena; Klimáčková, J.; Allerberger, Franz; Moravčı́ková, M.; Bagová, Mária; Hanzen, Juraj; Michálková-Papajová, D.; Dierich, Manfred P.; Kettner, M.

doi:10.1016/s0924-8579(00)00195-3

Cited by 9 publications

(1 citation statement)

References 37 publications

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“…Several reasons might explain why conventional twice-daily dosing of vancomycin often fails to obtain microbiological and clinical cure in patients with Staphylococcus aureus (SA) pneumonia and bloodstream infections: poor penetration in infected and/or ventilated lung tissue, a subtle but significant increase in minimal inhibitory concentration (MIC) over time, also referred to as the MIC "creep," and the emergence of heteroresistant strains [1,2]. These observations have prompted experts to decrease the breakpoint of vancomycin susceptibility from 4 to 2 μg/mL and to recommend targeting serum vancomycin trough levels of 15-20 μg/mL for the treatment of methicillin-resistant SA (MRSA) pneumonia [3].…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients

Spapen

Doorn

Diltoer

et al. 2011

Ann. Intensive Care

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BackgroundContinuous infusion of vancomycin is increasingly preferred as an alternative to intermittent administration in critically ill patients. Intermittent vancomycin treatment is associated with an increased occurrence of nephrotoxicity. This study was designed to determine the incidence and risk factors of acute kidney injury (AKI) during continuous infusion of vancomycin.MethodsThis was a retrospective, observational, two-center, cohort study in patients with microbiologically documented Gram-positive pneumonia and/or bacteremia and normal baseline renal function. Vancomycin dose was adjusted daily aiming at plateau concentrations of 15-25 μg/mL. AKI was defined as an increase in serum creatinine of 0.3 mg/dL or a 1.5 to 2 times increase from baseline on at least 2 consecutive days after the initiation of vancomycin. Primary data analysis compared patients with AKI with patients who did not develop AKI. A binary logistic regression analysis using the forward stepwise method was used to assess the risk factors associated with AKI.ResultsA total of 129 patients were studied of whom 38 (29.5%) developed AKI. Patients with AKI had higher body weight (77.3 ± 15 vs. 70.5 ± 15.2 kg; p = 0.02), more diabetes (79% vs. 54%; p = 0.01), and a higher vasopressor need (87% vs. 59%; p = 0.002). Serum vancomycin levels, body weight, and SAPS 3 score were identified as variables contributing to AKI. The incidence of AKI increased substantially when treatment duration was prolonged (14.9 ± 9.8 vs. 9.2 ± 4.9 days; p = 0.05) and plasma levels exceeded 30 μg/mL.ConclusionsAKI is frequently observed during continuous vancomycin infusion, particularly when conditions that cause acute (shock) or chronic (diabetes) renal dysfunction are present and vancomycin levels above target range are achieved. Although this study challenges the concept that continuous vancomycin infusion might alleviate the risk of nephrotoxicity in critically ill patients, a direct relationship between vancomycin and nephrotoxicity remains to be proven.

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Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients

Spapen

Doorn

Diltoer

et al. 2011

Ann. Intensive Care

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Occurrence and transferability of β-lactam resistance inEnterobacteriaceae isolated inChildren's University Hospital in Bratislava

Bujdáková

Hanzen²,

Jankovičová

et al. 2001

Folia Microbiol

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Occurrence and transferability of beta-lactam resistance in 30 multi-resistant Escherichia coli, Klebsiella spp., Enterobacter spp., Pantoea agglomerans, Citrobacter freundii and Serratia marcescens strains isolated from children between 0 and 3 years of age is presented. The strains were resistant to ampicillin (30), cefoxitin (22), cefotaxime (30), ceftriaxone (30), ceftazidime (30) and aztreonam (28), but susceptible to cefepime (30) and imipenem (26). Twenty-eight of 30 isolates possessed a transferable resistance confirmed by conjugation and isolation of 79-89-kb plasmids. The beta-lactam resistance was due to production of beta-lactamases and ceftazidime proved to be stronger beta-lactamase inductor than ceftriaxone. Twenty-five clinical isolates expressed transferable extended spectrum beta-lactamases, and chromosomally encoded AmpC beta-lactamase.

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Accessory Gene Regulator Group II Polymorphism in Methicillin-Resistant Staphylococcus aureus Is Predictive of Failure of Vancomycin Therapy

Moise-Broder

Sakoulas

Eliopoulos

et al. 2004

Clinical Infectious Diseases

304

196

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We studied methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if the group II polymorphism at the accessory gene regulator (agr) locus demonstrated any relationship with the clinical efficacy of vancomycin. One hundred twenty-two MRSA isolates from 87 patients treated with vancomycin were evaluated. Forty-five of 87 patients had no clinical or bacteriological response to vancomycin. Among the 36 clinically evaluable patients with the agr group II polymorphism, 31 had an infection that failed to respond to vancomycin, whereas only 5 had an infection that responded successfully to vancomycin. This finding is of interest in light of our previous findings that glycopeptide-intermediately resistant S. aureus (GISA) and hetero-GISA clinical isolates in the United States and Japan are enriched for the agr group II polymorphism, and it suggests a possible intrinsic survival advantage of some S. aureus clones with this genetic marker under vancomycin selective pressure.

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Spectrum and transferability of β-lactam resistance in hospital strains of Enterobacter isolated in Bratislava and Innsbruck

Cited by 9 publications

References 37 publications

Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients

Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients

Occurrence and transferability of β-lactam resistance inEnterobacteriaceae isolated inChildren's University Hospital in Bratislava

Accessory Gene Regulator Group II Polymorphism in Methicillin-Resistant Staphylococcus aureus Is Predictive of Failure of Vancomycin Therapy

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