scholarly journals Evaluation of the Therapeutic Outcomes of Antibiotic Regimen Against Carbapenemase-Producing Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Clement Yaw Effah ◽  
Emmanuel Kwateng Drokow ◽  
Clement Agboyibor ◽  
Shaohua Liu ◽  
Emmanuel Nuamah ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Meta Analysis ◽  
Control Measures ◽  
Cochrane Library ◽  
Antibiotic Regimen ◽  
Success Rates ◽  
Infection Control Measures ◽  
Number Of Patients

Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP.Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model.Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95%CI = 26.23–38.87; I2 = 89%; p-value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95%CI = 58.35–75.64, I2 = 22%, p-value = 0.25, Number of patients = 171) and 74.9% (95%CI = 59.02–86.09, I2 = 53%, p-value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95%CI = 0.35–0.87, p-value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95%CI = 0.28–2.57, p-value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95%CI = 0.21–1.22, p-value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates.Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP.

scholarly journals Infant Case of Co-infection with SARS-CoV-2 and Citrobacter koseri Urinary Infection

2020 ◽  
Author(s):  
Hyppolite K Tchidjou ◽  
Bernard Romeo
Keyword(s):  
Mortality Rate ◽  
Infection Control ◽  
Disease Control ◽  
Urinary Infection ◽  
Severe Disease ◽  
Control Measures ◽  
University Hospital ◽  
Infection Control Measures ◽  
Control And Prevention ◽  
Infant Case

Abstract Since 2019 coronavirus disease (COVID-19) is highly contagious with a high mortality rate. France has taken strict infection control measures. According to the report by the Center for Disease Control and Prevention, children are less affected with COVID-19 and seem to have less severe disease than adults. We reported the first confirmed infant case of co-infection with SARS-CoV-2 and Citrobacter koseri urinary infection in 6-week-old child admitted on 25 March 2020 with mild symptoms in the Pediatric COVID Unit of Amiens University Hospital, France.

scholarly journals Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

2020 ◽  
Vol 9 (9) ◽  
pp. 2744 ◽  
Author(s):  
Beatrice Tiri ◽  
Emanuela Sensi ◽  
Viola Marsiliani ◽  
Mizar Cantarini ◽  
Giulia Priante ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Prone Position ◽  
Antimicrobial Stewardship ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Prolonged Contact

The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.

scholarly journals Infection Control Measures in Dental Clinics during Coronavirus Disease-19 Pandemic in Kingdom of Saudi Arabia: A Pilot Study

2021 ◽  
Vol 9 (D) ◽  
pp. 61-67
Author(s):  
Rawa Kamal Abdelrahim ◽  
Husham Abu Elgasim Abdoun ◽  
Pradeep Koppolu ◽  
Lingam Amara Swapna
Keyword(s):  
Saudi Arabia ◽  
Infection Control ◽  
Control Measures ◽  
Categorical Variables ◽  
Prevention Measures ◽  
Kingdom Of Saudi Arabia ◽  
Cross Sectional ◽  
Infection Control Measures ◽  
Dental Clinics ◽  
Number Of Patients

BACKGROUND: Coronavirus disease (COVID)-19 is an infectious respiratory disease causing different symptoms ranging from mild to more complicated cases. In dental clinics, there is a potential risk of cross-infection between dental health worker and patients. Therefore, new infection prevention measures have been recommended to minimize spread of COVID-19 in dental clinics. AIM: The aim of this study is to get an insight into the infection control measures followed by dentists and modification done in personal protective equipment (PPE) to combat spread of infection during COVID-19 in Kingdom of Saudi Arabia. METHODS: A cross-sectional data using online Google survey. The sample included dentists working in either private or government from different regions in Kingdom of Saudi Arabia. Chi-square test was used to investigate the association between categorical variables (p < 0.05) RESULTS: Seventy dentists included in the study of which 40% are working in Riyadh. Dental clinics are undertaken respiratory triage and reduce number of patients in waiting area (91% and 98%, respectively). Increased usage of PPE (head cap, face shield, and N95 mask) during the pandemic was observed in the study sample (p = 0.001). Working hours and number of patients were reduced during COVID-19. CONCLUSION: Evidence shows that majority of dentists working in KSA are following recommended measures to minimize the spread of COVID-19. Some dentists modified their PPE during the pandemic. However, further research is required to investigate adherence to infection control measures by dentists.

scholarly journals Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010

2012 ◽  
Vol 17 (7) ◽  
Author(s):  
A Zagorianou ◽  
E Sianou ◽  
E Iosifidis ◽  
V Dimou ◽  
E Protonotariou ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Antibiotic Use ◽  
The United States ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Molecular Characteristics ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Infection Control Measures

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.

scholarly journals Infection Control Measures in Pakistani Dental Practices During COVID-19 Outbreak

2021 ◽  
Vol 30 (03) ◽  
pp. 152-156
Author(s):  
Yashfika Abdul Bari ◽  
◽  
Syeda Maliha Waqar ◽  
Saqif Nasir ◽  
Kamil Zafar ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Measures ◽  
Cross Sectional ◽  
Web Based ◽  
Infection Control Measures ◽  
Number Of Patients ◽  
Dental Practitioners ◽  
Dental Practices ◽  
Single Use ◽  
Study Participants

OBJECTIVE: The objective of this study is to assess infection control measures in dental practices during COVID-19 outbreak in Pakistan. METHODOLOGY: It was a cross-sectional web based survey conducted during COVID-19 outbreak from the period of June 2020 to August 2020. The study participants were the dental surgeons who were either working in hospital setup or running their own private practice or working in private dental setup. The survey consisted of sets of questions to assess whether dental practitioners have implemented strategies to combat novel corona virus infection in their practice. It also consists of questions that assess aerosol generating procedures are commencing with or without out any COVID-19 symptoms. RESULTS: About 39.1% participants reported that 75% of the number of patients in their clinic had been reduced and 52.2% of the participants reported that >50% of the patients came for endodontic procedures with pain. Eighty one percent of the participants were maintaining hand hygiene before touching all patients, 71.7% before any cleaning, 78.3% before any aseptic procedure, 81% after exposure to patient’s fluid and 80.4% after touching. There was low compliance regarding the use of personal protective equipment and almost 62.6% were using eye wear for all patients, 58.7% were disinfecting whole clinical room before new patient and 43.9% were using single use (disposable) examination set during COVID-19 outbreak. CONCLUSION: Majority of dentist in Pakistan were following the recommendations and guidelines of infection control practices related to COVID-19 pandemic. KEYWORDS: COVID-19, coronavirus, infection control measures, practices, dentistry

The emergence of multidrug-resistantKlebsiella pneumoniaeof international clones ST13, ST16, ST35, ST48 and ST101 in a teaching hospital in the Paris region

2012 ◽  
Vol 141 (8) ◽  
pp. 1705-1712 ◽  
Author(s):  
G. MARCADE ◽  
S. BRISSE ◽  
S. BIALEK ◽  
E. MARCON ◽  
V. LEFLON-GUIBOUT ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Teaching Hospital ◽  
Sequence Type ◽  
Control Measures ◽  
Incidence Density ◽  
Spatial Relationships ◽  
Cross Contamination ◽  
Infection Control Measures ◽  
Paris Region

SUMMARYDespite infection control measures, an important increase in the extended-spectrum β-lactamase (ESBL)-producingKlebsiella pneumoniaeincidence density occurred in our hospital from 2006 onwards. This study, focusing on the 2005–2007 period, was performed in an attempt to explain this increase. ESBLs were characterized, isolates were typed by ERIC2-PCR, and sequence type (ST) of clustered isolates was determined. Temporal-spatial relationships of patients were analysed to assess possible cross-contamination. Of the 74 ESBL-producing isolates, 30 (40%) were detected at admission, 53 (71·5%) produced CTX-M enzymes, 40 displayed unique ERIC2-PCR profiles and 34 were assigned into six clusters: ST16 (n = 21), ST101, ST48, ST35, ST13, and ST436. Relationships were identified in 22 of the 34 patients harbouring clustered isolates. This study highlights the complex epidemiology of ESBL-producingK. pneumoniaein the mid-2000s with potential cross-contamination for only 30% of the 74 patients in our hospital, and the emergence of clones that are currently spreading worldwide.

scholarly journals Molecular Analysis of Ciprofloxacin Resistance Mechanisms in Malaysian ESBL-ProducingKlebsiella pneumoniaeIsolates and Development of Mismatch Amplification Mutation Assays (MAMA) for Rapid Detection ofgyrAandparCMutations

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Farah Al-Marzooq ◽  
Mohd Yasim Mohd Yusof ◽  
Sun Tee Tay
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Molecular Analysis ◽  
Rapid Detection ◽  
Resistance Mechanisms ◽  
Control Measures ◽  
Quinolone Resistance ◽  
Infection Control Measures ◽  
High Prevalence ◽  
Ciprofloxacin Resistance

Ninety-three Malaysian extended-spectrumβ-lactamase (ESBL)-producingKlebsiella pneumoniaeisolates were investigated for ciprofloxacin resistance. Two mismatch amplification mutation (MAMA) assays were developed and used to facilitate rapid detection ofgyrAandparCmutations. The isolates were also screened for plasmid-mediated quinolone resistance (PMQR) genes includingaac(6′)-Ib-cr, qepA, andqnr. Ciprofloxacin resistance (MICs4–≥32 μg/mL) was noted in 34 (37%) isolates, of which 33 isolates had multiple mutations either ingyrAalone(n=1)or in bothgyrAandparCregions(n=32).aac(6′)-Ib-crwas the most common PMQR gene detected in this study(n=61), followed byqnrBandqnrS(n=55and 1, resp.). Low-level ciprofloxacin resistance (MICs 1-2 μg/mL) was noted in 40 (43%) isolates carryingqnrBaccompanied by eitheraac(6′)-Ib-cr(n=34)or a singlegyrA83 mutation(n=6). Ciprofloxacin resistance was significantly associated with the presence of multiple mutations ingyrAandparCregions. While the isolates harbouringgyrAand/orparCalteration were distributed into 11 PFGE clusters, no specific clusters were associated with isolates carrying PMQR genes. The high prevalence of ciprofloxacin resistance amongst the Malaysian ESBL-producingK. pneumoniaeisolates suggests the need for more effective infection control measures to limit the spread of these resistant organisms in the hospital.

Success of an Infection Control Program to Reduce the Spread of Carbapenem-Resistant Klebsiella pneumoniae

2009 ◽  
Vol 30 (5) ◽  
pp. 447-452 ◽  
Author(s):  
Sandeep Kochar ◽  
Timothy Sheard ◽  
Roopali Sharma ◽  
Alan Hui ◽  
Elaine Tolentino ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Infection Control ◽  
Control Program ◽  
Control Measures ◽  
Infection Control Program ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Number Of Patients ◽  
The Mean ◽  
Vancomycin Resistant

Objective.To assess the effect of enhanced infection control measures with screening for gastrointestinal colonization on limiting the spread of carbapenem-resistant Klebsiella pneumoniae in a New York City hospital endemic for this pathogen.Design.Retrospective observational study with pre- and postinterventional phases.Methods.Beginning in 2006, a comprehensive infection control program was instituted in a 10-bed medical and surgical intensive care unit at a university-based medical center. In addition to being placed in contact isolation, all patients colonized or infected with carbapenem-resistant gram-negative bacilli, vancomycin-resistant Enterococcus, or methicillin-resistant Staphylococcus aureus were cohorted to one end of the unit. Improved decontamination of hands and environmental surfaces was encouraged. In addition, routine rectal surveillance cultures were screened for the presence of carbapenem-resistant pathogens. The number of patients per quarter with clinical cultures positive for carbapenem-resistant K. pneumoniae was compared during the approximately 2-year periods before and after the intervention.Results.The mean number ( ± SD) of new patients per 1,000 patient-days per quarter with cultures yielding carbapenem-resistant K. pneumoniae decreased from 9.7 ± 2.2 before the intervention to 3.7 ± 1.6 after the intervention (P< .001 ). There was no change in the mean number of patient-days or the mean number of patients per quarter with cultures yielding methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, or carbapenem-resistant Acinetobacter baumannii or Pseudomonas aeruginosa after the intervention. There was no association between antibiotic usage patterns and carbapenem-resistant K. pneumoniae.Conclusions.The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbapenemase KPC were endemic.

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