scholarly journals Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Sarah Melissa Nørgaard ◽  
Camilla Skaarup Jensen ◽  
Josefine Aalestrup ◽  
Christina M. J. E. Vandenbroucke-Grauls ◽  
Mark G. J. de Boer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Antibiotic Treatment ◽  
Clinical Success ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Infection Site ◽  
Gram Negative ◽  
Group 2 ◽  
Group 1

Abstract Background Antimicrobial resistance is an increasingly serious threat to public health, and the increased occurrence of multidrug-resistant (MDR) bacteria is a concern in both high-income and low- and middle-income countries. The purpose of this systematic review was to identify and critically appraise current antimicrobial treatment options for infections with MDR Gram-negative bacteria. Methods A literature search for treatment of MDR extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa was conducted in MEDLINE in January 2019. Relevant studies published in English, German, and French that evaluated clinical success, microbiological success, and 30-day mortality outcomes were included. The population of interest was adult patients. Results Of 672 studies, 43 met the inclusion criteria. Carbapenems are the most common antibiotics used for the treatment of ESBL-producing Enterobacteriaceae. The clinical and microbiological success was similar for group 1 carbapenems (imipenem, meropenem, or doripenem), group 2 carbapenems (ertapenem), and non-carbapenem antibiotics. Mortality data were contradictory for group 1 carbapenems compared to group 2 carbapenems. The most common treatment option for A. baumannii and P. aeruginosa infections was intravenous colistin, regardless of infection site. Clinical success and mortality were similar in A. baumannii infections treated with colistin combination therapy vs. colistin monotherapy, whereas heterogeneous results were found with respect to microbiological success. Monotherapy and colistin combination therapy were used against P. aeruginosa with clinical and microbiological success (70–100%) depending on the infection site and severity, and the antibiotic used. Ceftazidime-avibactam therapy for ESBL-producing Enterobacteriaceae and P. aeruginosa showed good clinical success in one study. Conclusion We did not find robust evidence for antibiotic treatment of any infection with MDR Gram-negative bacteria, including ESBL-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa, that would lead to a firm recommendation for one specific antibiotic over another or for monotherapy over combination therapy. The choice of antibiotic treatment should be based on susceptibility testing balancing the expected clinical success rate against the risk of development of antibiotic resistance and the risk of severe side effects.

scholarly journals Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Adrian Schmid ◽  
Aline Wolfensberger ◽  
Johannes Nemeth ◽  
Peter W. Schreiber ◽  
Hugo Sax ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Case Control Studies ◽  
Gram Negative ◽  
Cure Rates

Abstract Infections caused by carbapenemase-producing, multidrug-resistant (MDR), or extensively drug-resistant (XDR) Gram-negative bacteria constitute a major therapeutic challenge. Whether combination antibiotic therapy is superior to monotherapy remains unknown. In this systematic review and meta-analysis OVID MEDLINE, EMBASE, PubMed, The Cochrane Library, and Scopus databases were searched for randomized controlled trials (RCTs) and observational studies published by December 2016 comparing mono- with combination antibiotic therapy for infections with carbapenemase-producing, MDR, or XDR Gram-negative bacteria. Mortality and clinical cure rates served as primary and secondary outcome measures, respectively. Of 8847 initially identified studies, 53 studies – covering pneumonia (n = 10 studies), blood stream (n = 15), osteoarticular (n = 1), and mixed infections (n = 27) - were included. 41% (n = 1848) of patients underwent monotherapy, and 59% (n = 2666) combination therapy. In case series/cohort studies (n = 45) mortality was lower with combination- vs. monotherapy (RR 0.83, CI 0.73–0.93, p = 0.002, I2 = 24%). Subgroup analysis revealed lower mortality with combination therapy with at least two in-vitro active antibiotics, in blood stream infections, and carbapenemase-producing Enterobacteriaceae. No mortality difference was seen in case-control studies (n = 6) and RCTs (n = 2). Cure rates did not differ regardless of study type. The two included RCTs had a high and unknown risk of bias, respectively. 16.7% (1/6) of case-control studies and 37.8% (17/45) of cases series/cohort studies were of good quality, whereas quality was poor in the remaining studies. In conclusion, combination antimicrobial therapy of multidrug-resistant Gram-negative bacteria appears to be superior to monotherapy with regard to mortality.

scholarly journals UPDATES IN ANTIBIOTIC THERAPY OF BILIARY TRACT INFECTIONS

2015 ◽  
Vol 18 (1) ◽  
pp. 34-38
Author(s):  
Cristian Balahura ◽  
◽  
Petre Iacob Calistru ◽  
Gabriel Constantinescu ◽  
◽  
...  
Keyword(s):  
Biliary Tract ◽  
Antimicrobial Agents ◽  
Empirical Therapy ◽  
Biliary Stent ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Group 2 ◽  
Tract Infections ◽  
A Prospective Study ◽  
Group 1

Introduction. The management of biliary tract infections involves systemic antibiotherapy and a biliary drainage procedure. Current guidelines provide recommendations for empirical antimicrobial therapy in cholangitis but development of multi-drug resistant organisms can make many of these antibiotics ineffective. This study aimed to analyze the microbiology of bile and the susceptibility profiles of organisms identified in patients with extrahepatic cholestatis, with or without a previously placed biliary stent. Materials and methods. We conducted a prospective study including 136 patients with biliary obstruction who were endoscopically drained between June 2014 and March 2015 in Emergency Hospital “Floreasca”, Bucharest. One hundred and four of these patients had no biliary stent in situ (group 1). Thirty-two procedures were performed in patients with at least one biliary stent in place (group 2). Microbiological examination of bile aspirates was performed and antibiotic susceptibilities were determined for the isolated bacteria. Results. One hundred eighteen of 136 analyzed cultures were positive (81% in group 1 vs. 100% in group 2; p<0.05). In both groups, the most frequent pathogens were Escherichia coli, Klebsiella spp. and Proteus spp. The most effective antimicrobial agents against Gram-negative bacteria in group 1 and group 2 were imipenem, cefoperazone/sulbactam and piperacillin/tazobactam. Susceptibilities to ceftazidime, cefotaxime, cefepime and fluoroquinolones were significantly lower in group 2. Conclusion. This survey shows that Gram-negative bacteria are the predominant bile pathogens found in patients with cholestatis. Cefoperazone/sulbactam, piperacillin/tazobactam or imipenem can be recommended in biliary infections. Cephalosporins and fluroquinolones should not be used as empirical therapy if a biliary stent is in place.

scholarly journals Evaluation of Intraventricular/Intrathecal Antimicrobial Therapy in the Treatment of Nosocomial Meningitis Caused by Multidrug-Resistant Gram-Negative Bacteria after Central Nervous System Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nagehan Didem Sari ◽  
Sevim Baltali ◽  
Istemi Serin ◽  
Veysel Antar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Success ◽  
Day Treatment ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Postoperative Meningitis

Introduction. Postoperative meningitis (POM) is an infection with high mortality and morbidity following central nervous system surgery due to trauma or tumor. Intrathecal/intraventricular (IT/IVT) antibiotic administrations have been considered as the last treatment options for multidrug-resistance (MDR) Gram-negative bacteria that do not respond to intravenous (IV) regimens. IT/IVT can bypass the blood-brain barrier, obtain a more effective antibiotic concentration in CSF, and reduce systemic side effects. We aimed to determine the characteristics of postoperative patients who were diagnosed with MDR POM during follow-up in our intensive care unit (ICU). Material and Methods. In this study, POM patients who were followed up in ICU after the central nervous system intervention between January 2016 and December 2019 and whose MDR Gram-negative bacteria were isolated from CSF were evaluated. As soon as the patients were diagnosed with POM, a catheter was inserted and treatment was started. Results. Microbiological eradication was achieved in 3 ± 0.8 days with 30 mg/day amikacin treatment in POM due to K. pneumoniae and 3.7 ± 1.95 days with colistin sodium 10 mg/day treatment in POM due to A. baumannii via IT/IVT catheter. IT/IVT treatment was utilized for a median of 10 days and continued until the defined cure criteria were achieved. While cure was achieved in 6 of 14 POM cases, 8 of them were exitus. Discussion and Conclusion. To avoid the severe consequences of postoperative meningitis, acting fast and adding IT/IVT methods to parenteral administration routes by considering the distribution of MDR microorganisms within the hospital while planning effective treatment will increase the clinical success.

scholarly journals Parallels of infections of diabetic foot syndrome at inpatient and outpatient stages of treatment

2021 ◽  
pp. 68-76
Author(s):  
A. B. Zemlianoi ◽  
T. A. Zelenina ◽  
V. V. Salukhov
Keyword(s):  
Diabetic Foot ◽  
Acute Infection ◽  
Multidrug Resistant ◽  
Diabetic Foot Syndrome ◽  
Gram Positive ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Infectious Process ◽  
Group 2 ◽  
Group 1

Introduction. Long-lasting ulcerative defects in patients with diabetic foot syndrome (DFS) are prone to reinfection, persistence of primary and hospital-acquired infection, and the infectious process is often caused by multidrug-resistant organisms (MDRO).Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.Materials and methods. We included 62 type 2 diabetic inpatients (group 1) with severe foot infection and 102 diabetic foot outpatients (group 2) with postoperative wounds, who had been operated on and discharged from the hospital, in to the study.Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.Results and discussion. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.Conclusion. The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gramnegative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment. The role of Enterobacterales increased with duration of infection. The prevalence of multidrug resistant Enterobacterales makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.

scholarly journals 475. High Rate of Extended-Spectrum β-Lactamase Producing Gram-Negative Infections and Associated Mortality in Ethiopia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S232-S232 ◽  
Author(s):  
Tafese B Tufa ◽  
Takele Beyene Tufa ◽  
Fuchs André ◽  
Feldt Torsten
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
High Rate ◽  
Clinical Samples ◽  
Published Data ◽  
Gram Negative Bacteria ◽  
Salmonella Spp ◽  
Gram Negative ◽  
Extended Spectrum

Abstract Background Extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. The rapid increase of ESBL-producing bacteria is associated with high mortality due to ineffective antibiotic treatment. To date, regular surveillance of multidrug-resistant (MDR) pathogens is lacking in Ethiopia. For this report, published data regarding ESBL-producing bacteria in different regions of Ethiopia were reviewed systematically. To our knowledge, this is the first systematic review from Ethiopia on ESBL-producing infections and associated mortality in the country. Methods A literature search was conducted in PubMed, PubMed Central, and Google Scholar from January 1, 1990 to April 28, 2019, using the following search terms: “ESBL producing Enterobacteriaceae,” “Gram-negative bacteria infection associated mortality,” and “Ethiopia.” Patient mortality associated with infections by ESBL-producing Gram-negative bacteria was recorded. Results Fourteen publications qualified for review. Totally, 1,782 Gram-negative bacteria isolated from 5,191 clinical samples were included. The phenotypic pooled rate of ESBL-producing Gram-negatives was estimated to be 52.9(95% CI: 50.5%–55.4%). Among different species, ESBL rates were 65. 7% (262/399) Klebsiella spp., 60.6% (20/33) for Enterobacter spp., 47.8% (22/46) for Citrobacter spp., 47.0% (383/815) for E. coli, 45.7% (85/186) for Salmonella spp., 27.8%(15/54) for Proteus spp., 16.7%(4/24) for P. aeruginosa, 14.3% (3/21) for Acinetobacter spps., and 40.5% (15/37) for others, respectively. ESBL genes were confirmed in three studies. blaCTX-M-1 and blaTEM were the predominately detected genes. Two studies reported mortality associated with Gram-negative infections and 86% (12/14) of the patients infected with ESBL-producing bacteria died. Conclusion In this meta-analysis, the pooled phenotypic prevalence of ESBL-producing pathogens is considerably high. Also, the mortality due to ESBL-producers is high but data are scarce. This highlights the need for establishing and upgrading of clinical microbiology laboratories in the country for routine antibiotic susceptibility testing. The capacity to detect ESBL genes is desirable for continuous surveillance of MDR. Disclosures All authors: No reported disclosures.

scholarly journals Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis

2017 ◽  
Vol 64 (suppl_2) ◽  
pp. S51-S60 ◽  
Author(s):  
Nattawat Teerawattanapong ◽  
Kirati Kengkla ◽  
Piyameth Dilokthornsakul ◽  
Surasak Saokaew ◽  
Anucha Apisarnthanarak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Prevention And Control ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
And Control
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