Significance of gram-resistant flora in etiology of nosocomial infections in determining rational antibiotic therapy

2021 ◽  
pp. 35-40
Author(s):  
A. E. Ermilin ◽  
N. V. Teplova ◽  
S. S. Postnikov ◽  
M. N. Kostyleva ◽  
A. N. Gratzhianskaya ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Nosocomial Infections ◽  
Resistance Mechanisms ◽  
Rapid Identification ◽  
Monitoring Data ◽  
Controlled Trials ◽  
Gram Negative ◽  
New Antibiotics ◽  
Multiresistant Strains

In recent years, the problem of resistance of gram-negative microorganisms to carbapenems, as well as the emergence of multiresistant strains is gaining urgency. This problem is of particular importance in neonatal practice due to the age limitations of the use of many antibiotics and the lack of specific recommendations. Local bacteriological monitoring data should be taken into account when selecting a starting antibiotic, and for this purpose, methods of rapid identification of the pathogen and its resistance mechanisms should be introduced. Pediatricians need controlled trials of new antibiotics to successfully treat MDR-Gram-infections.

scholarly journals Empedobacter brevis causing early onset sepsis and pneumonia in a neonate: case report and review of literature

2018 ◽  
Vol 5 (2) ◽  
pp. 654
Author(s):  
Laxman Basani ◽  
Roja Aepala
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Nosocomial Infections ◽  
Early Onset ◽  
Term Neonate ◽  
Review Of Literature ◽  
Gram Negative ◽  
Early Onset Sepsis ◽  
The Family ◽  
Compromised Patients

Empedobacter brevis, a gram negative non-motile bacillus that belongs to the family Flavobacteriaceae rarely causes infection in adults and is exceptionally rare in neonates. E. brevis is ubiquitous in the environment, causing nosocomial infections especially in debilitated and immuno-compromised patients with only one case being reported in a neonate. We report a case of early onset sepsis and pneumonia in a term neonate caused by E. brevis that was successfully treated in our unit. Awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy improves the outcome and prevents mortality. To the best of our knowledge, this is the second case of E. brevis sepsis reported in a neonate.

Preliminary Study of the Bacterial Flora and Indications for Antibiotic Therapy in Cancer Patients

1973 ◽  
Vol 59 (2) ◽  
pp. 151-162
Author(s):  
Emilio Bajetta ◽  
Silvio Monfardini ◽  
Marco Gasparini ◽  
Renzo Dettori
Keyword(s):  
Urinary Tract Infection ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Bacterial Flora ◽  
Retrospective Evaluation ◽  
Gram Positive ◽  
Gram Negative ◽  
New Antibiotics ◽  
Preliminary Study

A retrospective evaluation of infections that occurred at the National Cancer Institute of Milan during 1971 showed that the majority of them were still produced by gram-positive bacilli, even in myelosuppressed patients with leukemia and lymphoma. Only in patients with urinary tract infection and in febrile patients with bronchogenic carcinoma was the incidence of gram-negative higher than that of gram-positive infections. The persistence of the predominance of gram-positive versus gram-negative bacilli could be partly due to the fact some new antibiotics have been introduced into clinical practice later in Italy then in other countries. The incidence of fungi positive cultures was comparable to that reported in other centers. The importance of knowing the bacterial ecology in a given center or ward in order to choose the appropriate initial antibiotic therapy is discussed.

Persistent Apical Periodontitis: Bacterial Taxonomic Analysis and Treatment Through Intentional Replantation

2020 ◽  
Author(s):  
Fernando Eduardo Coria-Valdiosera
Keyword(s):  
Antibiotic Therapy ◽  
Root Canal ◽  
Resistance Mechanisms ◽  
Apical Periodontitis ◽  
Infectious Process ◽  
Identification Of Bacteria ◽  
The Right ◽  
Apical Lesions ◽  
Endodontic Retreatment

Introduction: The microorganisms own different resistance mechanisms that allow them to resist the chemo-mechanical cleanliness of root canal and antibiotic therapies causing the persistence of apical lesions. Methods: This clinical case describes a male patient diagnosed with pulp necrosis in the right lower central incisor due to trauma, which developed apical periodontitis manifesting itself extra orally. Root canal treatment along with antibiotic therapy was performed, but because the infectious process persisted, endodontic retreatment and a new antibiotic therapy were carried out, however, the clinical evolution was not favorable. For this reason, the intentional replantation was chosen as the outright treatment, performing apicectomy and curettage of the periapical lesion, from which the isolation and taxonomic study of microorganisms were carried out, with the respective antibiogram. Results: In the 10-day clinical follow-up, the extraoral infectious process disappeared almost completely and 6 months later, a complete repair of the bone tissue was observed on the tomography. Conclusion: A better understanding of the persistence of apical periodontitis was achieved by taxonomic identification of bacteria and the intentional replantation allowed to remove the apical biofilm gaining an excellent wound healing.

scholarly journals Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland

2021 ◽  
Vol 18 (5) ◽  
pp. 2785
Author(s):  
Agnieszka Chmielarczyk ◽  
Monika Pomorska-Wesołowska ◽  
Dorota Romaniszyn ◽  
Jadwiga Wójkowska-Mach
Keyword(s):  
Bloodstream Infections ◽  
Diagnostic Techniques ◽  
Resistance Mechanisms ◽  
Infection Prevention And Control ◽  
The South ◽  
Coagulase Negative Staphylococci ◽  
Aminoglycoside Resistance ◽  
Gram Negative ◽  
Maldi Tof ◽  
Carbapenem Resistant

Introduction: Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. Objectives: The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. Patients and methods: Data on 4218 LC-BSIs were collected between 2016–2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. Results: Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. Conclusions: The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.

scholarly journals 114. Implementation of an Empiric Organism Specific Guidelines for Gram-negative Bacteremia in conjunction with Rapid Diagnostic Testing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S71-S71
Author(s):  
Fidelia Bernice ◽  
Edina Avdic ◽  
Kathryn Dzintars ◽  
Aliyah Cruz
Keyword(s):  
Clinical Status ◽  
Compliance Rate ◽  
Diagnostic Testing ◽  
Specific Treatment ◽  
Resistance Mechanisms ◽  
Primary Objective ◽  
Blood Cultures ◽  
Common Reason ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative

Abstract Background The objective of this study was to confirm the validity of institution specific treatment recommendations targeting organisms identified by GenMark Dx® ePlex® blood cultures identification (BCID) Gram-negative panel prior to susceptibility results. Methods We developed and implemented institution specific guidelines for empiric antibiotic therapy for Gram-negative organisms targeted by GenMark Dx® ePlex® BCID. We utilized blood culture antibiograms, existing evidence for the most optimal agent for each pathogen, probable resistance mechanisms and patient clinical status to create these guidelines. From December 16, 2019 through May 31, 2020, infectious diseases pharmacists reviewed all positive blood cultures; assessed compliance with guidelines and intervened as needed. The primary objective was to determine how frequently guideline recommend agents would be ineffective against targeted pathogens based on susceptibilities. Secondary objectives were compliance with guidelines and frequency of therapy escalation or de-escalation. Results GenMark® testing was completed on 222 cultures positive for Gram-negative rods with target organisms identification in 195 (88%) blood cultures. Two hundred and five organisms were identified; most commonly E. coli (40%) and K. pneumoniae (21%).Resistance markers were detected in 30 aerobic blood cultures; 28 CTX-M, and 2 KPC. Our institutional guideline provided appropriate empiric coverage in 93% of bacteremia episodes. The most common reason for ineffective therapy was the presence of resistance mechanisms not detected by GenMark® test (e.g. non-CTX-M extended spectrum beta-lactamases). The compliance rate with the guidelines was 55%; the most common reason for non-compliance was the use of an anti-pseudmonal beta-lactams in neutropenic patients.. The system failed to identify panel organisms in only 5 (2%) of blood cultures. Conclusion The institution-specific guidelines providing empiric coverage for each organism identified by rapid diagnostic tests can aid antimicrobial stewardship efforts to de-escalate therapy while still providing effective coverage in >90% of cases. Disclosures All Authors: No reported disclosures.

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