Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

Hospital-acquired infections are a global health problem that threatens patients’ treatment in intensive care units, causing thousands of deaths and a considerable increase in hospitalization costs. The endotracheal tube (ETT) is a medical device placed in the patient’s trachea to assist breathing and delivering oxygen into the lungs. However, bacterial biofilms forming at the surface of the ETT and the development of multidrug-resistant bacteria are considered the primary causes of ventilator-associated pneumonia (VAP), a severe hospital-acquired infection for significant mortality. Under these circumstances, there has been a need to administrate antibiotics together. Although necessary, it has led to a rapid increase in bacterial resistance to antibiotics. Therefore, it becomes necessary to develop alternatives to prevent and combat these bacterial infections. One possibility is to turn the ETT itself into a bactericide. Some examples reported in the literature present drawbacks. To overcome those issues, we have designed a photosensitizer-containing ETT to be used in photodynamic inactivation (PDI) to avoid bacteria biofilm formation and prevent VAP occurrence during tracheal intubation. This work describes ETT’s functionalization with curcumin photosensitizer, as well as its evaluation in PDI against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. A significant photoinactivation (up to 95%) against Gram-negative and Gram-positive bacteria was observed when curcumin-functionalized endotracheal (ETT-curc) was used. These remarkable results demonstrate this strategy’s potential to combat hospital-acquired infections and contribute to fighting antimicrobial resistance.

Download Full-text

Acinetobacter baumannii Ventilator-Associated Pneumonia: Clinical Efficacy of Combined Antimicrobial Therapy and in vitro Drug Sensitivity Test Results

Frontiers in Pharmacology ◽

10.3389/fphar.2019.00092 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 5

Author(s):

Yuqin Huang ◽

Quan Zhou ◽

Wenguo Wang ◽

Qiang Huang ◽

Juan Liao ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Clinical Efficacy ◽

Antimicrobial Therapy ◽

Drug Sensitivity ◽

Sensitivity Test ◽

Ventilator Associated Pneumonia ◽

Test Results ◽

Drug Sensitivity Test

Download Full-text

Staphylococcus Aureus Bacteremia Due to Central Venous Catheter Infection: A Clinical Comparison of Infections Caused by Methicillin-Resistant and Methicillin-Susceptible Strains

10.21203/rs.3.rs-127180/v1 ◽

2021 ◽

Author(s):

Kazuhiro Ishikawa ◽

Keichi Furukawa ◽

Eri Hoshino

Keyword(s):

Staphylococcus Aureus ◽

Septic Shock ◽

Mortality Rate ◽

Central Venous Catheter ◽

Antimicrobial Therapy ◽

Time Lag ◽

Venous Catheter ◽

Mortality Rates ◽

Background Characteristics ◽

Central Venous

Abstract Background: Staphylococcus aureus (S.aureus) bacteremia has a mortality rate ranging from 20-40%. Central venous catheter (CVC) infection is the leading cause of S.aureus bacteremia. We investigated the differences in background characteristics, complications, and prognosis between patients with methicillin resistant S.aureus (MRSA) and methicillin sensitive S.aureus (MSSA) bacteremia due to CVC infection.Methods: We retrospectively investigated patients who had positive peripheral blood cultures versus positive semi-quantitative cultures for MRSA or MSSA from the CVC tip. We compared the clinical background characteristics, complications, and 60-day mortality rates between both groups. We analyzed our data using Mann-Whitney U test, chi-square test, and Fisher’s exact test.Results: This study had 17 (47%) and 19 (53%) MRSA and MSSA bacteremia patients, respectively. The median ages for MRSA and MSSA patients were 72 ± 27 and 55 ± 33 years, respectively (P<0.01). Comparison between baseline disease occurrence (MRSA vs. MSSA) was 10(59%) patients vs. 3(16%) patients (P=0.01), while complications included septic shock were 8(48%) vs. 3(16%) (P=0.07), respectively. The duration of catheter placement, time lag from onset of fever to CVC removal, and time lag from onset of fever to starting antimicrobial therapy were similar in both groups. Sixty-day mortality rates were 35%(6/17) vs. 5.3%(1/19), (P=0.04), in MRSA vs. MSSA groups, respectively. Conclusions: MRSA carriers and older patients were at a higher risk of MRSA CVC infection compared to MSSA bacteremia patients. MRSA bacteremia patients showed relatively higher rate of septic shock, and had significantly higher 60-day mortality rate despite appropriate antimicrobial therapy.

Download Full-text

A gut reaction

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i1.4200 ◽

2016 ◽

Vol 85 (1) ◽

pp. 5-7

Author(s):

Dalia Hasan ◽

Kristen Reilly

Keyword(s):

Bacterial Resistance ◽

Medical Literature ◽

Antibiotic Use ◽

Mortality Rates ◽

Modern Medicine ◽

Prescribing Patterns ◽

Current Evidence ◽

Antibiotic Prescribing ◽

Antibiotic Overuse ◽

Obesity And Diabetes

The development of antibiotics is one of the greatest advances of modern medicine. While antibiotics have dramatically improved morbidity and mortality rates worldwide, current evidence asserts that one should err on the side of caution when prescribing antibiotics. The medical literature is accumulating studies on alarming consequences of inappropriate antibiotic use. Due to antibiotic overexposure, a North American “hypervirulant” strain of Clostridium difficile has emerged causing more severe gastrointestinal manifestations than previous strains. More recently, antibiotic overuse has been associated with obesity and diabetes mellitus. Unnecessary antibiotic use has led to increasing rates of bacterial resistance rendering more antibiotics ineffective. We are currently on the brink of an era which could reverse all the progress made with the introduction of antibiotics. The salient health consequences of inappropriate antibiotic prescriptions and the threat of a postantibiotic era command attention to practical initiatives that improve antibiotic prescribing patterns.

Download Full-text

Ventilator-Associated Pneumonia: The Effect of Bacterial Resistance

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i7.42 ◽

2019 ◽

Vol 7 (7) ◽

Author(s):

Yousry Elsaeed Risk ◽

Keyword(s):

Bacterial Resistance ◽

Ventilator Associated Pneumonia

Download Full-text

PSEUDOMONAS AERUGINOSA INFECTION: MODERN APPROACHES TO MANAGEMENT OF THE MOST SIGNIFICANT CLINICAL FORMS OF PATHOLOGY

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.20.1.205 ◽

2020 ◽

Vol 20 (1) ◽

pp. 205-211

Author(s):

O.A. Poda

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Therapy ◽

Treatment Options ◽

Medical Setting ◽

Ventilator Associated Pneumonia ◽

Modern Approach ◽

Clinical Forms ◽

Optimal Drug ◽

Definition Of ◽

Multiresistant Strains

Introduction. At present, antimicrobial therapy of ventilator-associated pneumonia and bacteremia caused by Pseudomonas aeruginosa is an urgent problem due to the high prevalence of microbial multiresistant strains and their ability to develop resistance to new antibacterial drugs. Materials and methods. The analysis and generalization of the results of scientific studies highlighted in fundamental medical journals related to the treatment of ventilator-associated pneumonia and bacteremia caused by Pseudomonas infection are carried out. Results. The main points in the modern approach to the effective treatment of ventilator-associated pneumonia and bacteremia caused by Pseudomonas aeruginosa include the correct empirical choice of the starting antibacterial agent in accordance with the local epidemiology of the medical setting, timely beginning of the treatment, options to combine drugs with a tendency to de-escalation to monotherapy. It is also important to choose the optimal drug in terms of its pharmacological parameters and a clear definition of the optimal therapeutic dosage. The article describes the main groups of drugs currently used in the treatment of the main clinical forms of Pseudomonas aeruginosa. Nowadays, it is recommended to combine therapy for pseudomonas ventilator-associated pneumonia and bacteremia with antipseudomonas penicillins or cephalosporins or carbapenems plus fluoroquinolones or aminoglycosides or colistin with phosphomycin. Conclusions. Despite the elaboration of the modern approaches to the antimicrobial therapy of infections caused by Pseudomonas aeruginosa, this issue is still debatable and requires further study.

Download Full-text