“Swimming in resistance”: Co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa

Marchaim, Dror; Pérez, Federico; Lee, Jiha; Bheemreddy, Suchitha; Hujer, Andrea M.; Rudin, Susan D.; Hayakawa, Kayoko; Lephart, Paul; Blunden, Christopher; Shango, Maryann; Campbell, Michelle; Varkey, Jastin; Manickam, Palaniappan; Patel, Dhiren; Pogue, Jason M.; Chopra, Teena; Martin, Emily T.; Dhar, Sorabh; Bonomo, Robert A.; Kaye, Keith S.

doi:10.1016/j.ajic.2011.10.013

Cited by 65 publications

(63 citation statements)

References 23 publications

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“…Interestingly, Marchaim et al, also found that previous therapy with antimicrobials with solely Gram-positive spectra was significantly associated with co-colonisation of patients with CRE, CRAb and CRPa. Likewise, in our study, the clinical history (data not shown) of patients shows that all four patients were also treated with vancomycin post-surgery, supporting the Marchaim et al's suggestion that suppression of the Gram-positive flora in these patients may have facilitated the acquisition of opportunistic infections with MDR Gram-negative organisms [21].…”

Section: Discussionsupporting

confidence: 85%

“…Previous studies have also suggested that Acinetobacter infections are associated with increased morbidity and mortality [18][19][20]. In addition, Marchaim et al, found that cocolonisation with carbapenem-resistant Enterobacteriaceae (CRE), CRAb and/or CRPa was the strongest independent predictor for 90-day mortality [21]. These features can also be recognised in our study, where three patients co-infected/ colonised with ColRKp, CRPa and/or CRAb died, whilst the fourth patient with a mono-microbial K. pneumoniae infection survived.…”

Section: Discussionmentioning

confidence: 94%

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Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit

Timofte

Dan²,

Maciuca

et al. 2015

Eur J Clin Microbiol Infect Dis

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We report the emergence and analysis of a cluster of concurrent infections/colonisations with colistin-resistant Klebsiella pneumoniae and OXA-23 carbapenemase-producing Acinetobacter baumannii in patients who had undergone cardiac surgery. We describe the emergence of colistin-resistant K. pneumoniae harbouring blaCTX-M-15, blaSHV-11, blaOXA-1, blaTEM-1 beta-lactamases and aac(6')-Ib-cr fluoroquinolone resistance. Colistin-resistant K. pneumoniae infections (pneumonia, wound infection, urinary tract infections and bacteraemia) occurred in critically ill patients previously treated with colistin for post-surgery infections with carbapenem-resistant Pseudomonas aeruginosa and/or A. baumannii. Although the cause of death could not be directly attributed to a single pathogen, three patients co-infected/colonised with K. pneumoniae, P. aeruginosa and/or A. baumannii died, whilst a fourth patient who had a mono-microbial infection with colistin-resistant K. pneumoniae only survived. The use of mobile intubation equipment in patients that shared the same ward, the clustering of cases over a short period of time, as well as the pulsed-field gel electrophoresis (PFGE) data all suggest cross-contamination between patients, either through equipment or by staff contact transmission. This report presents the 'worst-case scenario' where concurrent infection/colonisation with pathogens exhibiting resistance to different types of last-resort antimicrobials occurred in some of the most debilitated intensive care unit (ICU) patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 94%

Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit

Timofte

Dan²,

Maciuca

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…Co-colonization of patients with carbapenem-resistant Enterobacteriaceae and A. baumannii or P. aeruginosa has been shown to be associated with increased antibiotic resistance and mortality (10). As potential interspecies interactions may enhance bacterial virulence and antibiotic resistance, co-colonization or co-infection of patients with the intrinsically carbapenem-resistant S. maltophilia and A. baumannii or P. aeruginosa might be associated with increased antibiotic resistance and mortality.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Activity of Colistin and Trimethoprim/Sulfamethoxazole Against Consortia of Multidrug Resistant Non-Fermenting Gram-Negative Bacilli Isolated from Lower Respiratory Tract

Juhász

Kovács

Pongrácz

et al. 2017

Jundishapur J Microbiol

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Background: Multidrug resistant (MDR) Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia have a leading role in nosocomial infections, including lower respiratory tract (LRT) infections. When polymicrobial infection by these three bacteria occurs, colistin against MDR P. aeruginosa and A. baumannii and trimethoprim/sulfamethoxazole (SXT) against S. maltophilia can be an optional antimicrobial strategy. Objectives: The aim of this study was to investigate the potential synergic effect of colistin-plus-SXT against those MDR P. aeruginosa, A. baumannii and S. maltophilia isolates that were isolated at the same time, from the same LRT sample of patients. Methods: Sixty connected isolates from 20 different patients were collected in a two-year study period. The checkerboard method and time-kill assays were used for synergy testing. Results: All P. aeruginosa and A. baumannii strains were susceptible to colistin, whereas all S. maltophilia isolates were resistant to it. Fifteen percent of MDR A. baumannii strains and all S. maltophilia isolates were susceptible to SXT. By the checkerboard method, colistin-plus-SXT showed synergy in 50%, 35% and 45% of S. maltophilia, MDR P. aeruginosa and MDR A. baumannii strains, respectively. Antagonistic effect was not found. A time-kill assay was performed on strains which showed synergy by the checkerboard method: 70%, 57% and 56% of S. maltophilia, P. aeruginosa and A. baumannii strains showed the same results. Synergic activity of the combination was already detected after 6 h incubation in 86% of S. maltophilia isolates and 50% of P. aeruginosa strains. Regrowth of A. baumannii after 24 hour in the presence of colistin was prevented by the combination. The results gained by CB and TKA methods

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“…usually XDR pathogens), but could also result from MDR pathogens of the same species as well (i.e. ampicillinresistant vancomycin-susceptible enterococci, ESBL-producing enterobacteriaceae, carbapenem-susceptible A. baumannii or carbapenem-susceptible P. aeruginosa) [3].…”

Section: Prediction Scoresmentioning

confidence: 99%

“…Certain MDR, XDR and PDR organisms (to be referred to collectively as MDROs), in certain regions, have become prevalent pathogens [3], and some successfully have spread to community settings as well [4][5][6][7][8][9][10][11]. The IDSA formulated an acronym ESKAPE, in order to emphasize the group of pathogens that cause hospital infections and effectively "escape" the effects of antibacterial drugs.…”

Section: Epidemiology Of Multidrug Resistant Organismsmentioning

confidence: 99%

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

120

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The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities.

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“Swimming in resistance”: Co-colonization with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii or Pseudomonas aeruginosa

Cited by 65 publications

References 23 publications

Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit

Emergence of concurrent infections with colistin-resistant ESBL-positive Klebsiella pneumoniae and OXA-23-producing Acinetobacter baumannii sensitive to colistin only in a Romanian cardiac intensive care unit

In Vitro Activity of Colistin and Trimethoprim/Sulfamethoxazole Against Consortia of Multidrug Resistant Non-Fermenting Gram-Negative Bacilli Isolated from Lower Respiratory Tract

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

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