scholarly journals Characteristics, Influencing Factors, Predictive Scoring System, and Outcomes of the Patients with Nephrotoxicity Associated with Administration of Intravenous Colistin

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 2
Author(s):  
Pornpen Sangthawan ◽  
Alan Frederick Geater ◽  
Surarit Naorungroj ◽  
Piyarat Nikomrat ◽  
Ozioma Forstinus Nwabor ◽  
...  
Keyword(s):  
Prediction Model ◽  
Influencing Factors ◽  
Scoring System ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Global Public Health ◽  
Gram Negative ◽  
Overall Performance ◽  
The University

Multidrug-resistant Gram-negative infection is a major global public health threat. Currently, colistin is considered the last-resort treatment despite its nephrotoxicity. The purpose of this study was to estimate the incidence, characteristics, and influencing factors and to develop a prediction model for colistin-associated nephrotoxicity. A retrospective study was conducted in the university hospital in the South of Thailand from December 2015 to June 2019. A total of 381 patients (median age (IQR) of 64 (51–62) years) were analyzed. Overall, 282 (74%) had nephrotoxicity according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification. In-hospital, 30-day mortality rates and cost of hospital admission were significantly higher among those with nephrotoxicity. Age > 60 years, comorbidities, serum albumin less than 3.5 g/dL, and concomitant nephrotoxic use were significantly associated with colistin-associated nephrotoxicity with adjusted OR (95% CI) 2.01 (1.23–2.45), 1.85 (1.18–3.6), 1.68 (1.09–2.99), and 1.77 (1.10–2.97), respectively. The prediction model for high-risk colistin-associated nephrotoxicity was identified with good overall performance (specificity of 79.6% (95% CI 70.3–87.1) and positive predictive value of 92.1% (95% CI 88.0–95.1)). In conclusion, the incidence of colistin-associated nephrotoxicity was high and incurred significant morbidity, mortality, and economic burden. Our predictive scoring system is relatively simple and useful for optimizing colistin therapy.

scholarly journals Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015

2016 ◽  
Vol 21 (2) ◽  
Author(s):  
Claudia Reinheimer ◽  
Volkhard A. J. Kempf ◽  
Stephan Göttig ◽  
Michael Hogardt ◽  
Thomas A. Wichelhaus ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Multidrug Resistant ◽  
Control Measures ◽  
University Hospital ◽  
Healthcare Personnel ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Infection Control Measures ◽  
Multidrug Resistant Organisms ◽  
The University

Multidrug-resistant Gram-negative bacteria (MDR GNB) were found to colonise 60.8% (95% confidence interval: 52.3–68.9) of 143 refugee patients mainly from Syria (47), Afghanistan (29), and Somalia (14) admitted to the University Hospital Frankfurt, Germany, between June and December 2015. This percentage exceeds the prevalence of MDR GNB in resident patients four–fold. Healthcare personnel should be aware of this and the need to implement or adapt adequate infection control measures.

scholarly journals A novel chemical biology and computational approach to expedite the discovery of new-generation polymyxins against life-threatening Acinetobacter baumannii

2021 ◽  
Author(s):  
Xukai Jiang ◽  
Nitin A. Patil ◽  
Mohammad A. K. Azad ◽  
Hasini Wickremasinghe ◽  
Heidi Yu ◽  
...  
Keyword(s):  
Public Health ◽  
Chemical Biology ◽  
Multidrug Resistant ◽  
Computational Approach ◽  
Gram Negative Bacteria ◽  
Global Public Health ◽  
Gram Negative ◽  
Life Threatening ◽  
New Generation ◽  
Novel Antibiotics

Multidrug-resistant Gram-negative bacteria have been an urgent threat to global public health. Novel antibiotics are desperately needed to combat these 'superbugs'.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Diversified mcr-1 -Harbouring Plasmid Reservoirs Confer Resistance to Colistin in Human Gut Microbiota

mBio ◽  
2016 ◽  
Vol 7 (2) ◽  
Author(s):  
Huiyan Ye ◽  
Yihui Li ◽  
Zhencui Li ◽  
Rongsui Gao ◽  
Han Zhang ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Multidrug Resistant ◽  
Global Public Health ◽  
Colistin Resistance ◽  
Human Gut ◽  
Gram Negative ◽  
Sequence Mapping ◽  
Human Gut Microbiota ◽  
Functional Analyses ◽  
Conventional Idea

ABSTRACT Colistin is an ultimate line of refuge against multidrug-resistant Gram-negative pathogens. Very recently, the emergence of plasmid-mediated mcr-1 colistin resistance has become a great challenge to global public health, raising the possibility that dissemination of the mcr-1 gene is underestimated and diversified. Here, we report three cases of plasmid-carried MCR-1 colistin resistance in isolates from gut microbiota of diarrhea patients. Structural and functional analyses determined that the colistin resistance is conferred purely by the single mcr-1 gene. Genetic and sequence mapping revealed that mcr-1 -harbouring plasmid reservoirs are present in diversity. Together, the data represent the first evidence of diversity in mcr-1 -harbouring plasmid reservoirs of human gut microbiota. IMPORTANCE The plasmid-mediated mobile colistin resistance gene ( mcr-1 ) challenged greatly the conventional idea mentioned above that colistin is an ultimate line of refuge against lethal infections by multidrug-resistant Gram-negative pathogens. It is a possibility that diversified dissemination of the mcr-1 gene might be greatly underestimated. We report three cases of plasmid-carried MCR-1 colistin resistance in isolates from gut microbiota of diarrhea patients and functionally define the colistin resistance conferred purely by the single mcr-1 gene. Genetic and sequence mapping revealed unexpected diversity among the mcr-1 -harbouring plasmid reservoirs of human gut microbiota.

Reduction of Environmental Contamination With Multidrug-Resistant Bacteria by Copper-Alloy Coating of Surfaces in a Highly Endemic Setting

2017 ◽  
Vol 38 (7) ◽  
pp. 765-771 ◽  
Author(s):  
Maria Souli ◽  
Anastasia Antoniadou ◽  
Ioannis Katsarolis ◽  
Irini Mavrou ◽  
Elisabeth Paramythiotou ◽  
...  
Keyword(s):  
Phase 1 ◽  
Demographic Data ◽  
Alloy Coating ◽  
Multidrug Resistant ◽  
Copper Coating ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Gram Negative ◽  
Coated Surfaces

OBJECTIVETo evaluate the efficacy of copper-coating in reducing environmental colonization in an intensive-care unit (ICU) with multidrug-resistant-organism (MDRO) endemicityDESIGNInterventional, comparative crossover trialSETTINGThe general ICU of Attikon University hospital in Athens, GreecePATIENTSThose admitted to ICU compartments A and B during the study periodMETHODSBefore any intervention (phase 1), the optimum sampling method using 2 nylon swabs was validated. In phase 2, 6 copper-coated beds (ie, with coated upper, lower, and side rails) and accessories (ie, coated side table, intravenous [i.v.] pole stands, side-cart handles, and manual antiseptic dispenser cover) were introduced as follows: During phase 2a (September 2011 to February 2012), coated items were placed next to noncoated ones (controls) in both compartments A and B; during phase 2b (May 2012 to January 2013), all copper-coated items were placed in compartment A, and all noncoated ones (controls) in compartment B. Patients were randomly assigned to available beds. Environmental samples were cultured quantitatively for clinically important bacteria. Clinical and demographic data were collected from medical records.RESULTSCopper coating significantly reduced the percentage of colonized surfaces (55.6% vs 72.5%; P<.0001), the percentage of surfaces colonized by MDR gram-negative bacteria (13.8% vs 22.7%; P=.003) or by enterococci (4% vs 17%; P=.014), the total bioburden (2,858 vs 7,631 cfu/100 cm2; P=.008), and the bioburden of gram-negative isolates, specifically (261 vs 1,266 cfu/100 cm2; P=.049). This effect was more pronounced when the ratio of coated surfaces around the patient was increased (phase 2b).CONCLUSIONSCopper-coated items in an ICU setting with endemic high antimicrobial resistance reduced environmental colonization by MDROs.Infect Control Hosp Epidemiol 2017;38:765–771

Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission

2017 ◽  
Vol 38 (10) ◽  
pp. 1216-1225 ◽  
Author(s):  
Wen-Pin Tseng ◽  
Yee-Chun Chen ◽  
Bey-Jing Yang ◽  
Shang-Yu Chen ◽  
Jr-Jiun Lin ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Admission ◽  
Prediction Model ◽  
Bacterial Colonization ◽  
Care Facility ◽  
Improve Patient Care ◽  
Multidrug Resistant ◽  
Rank Test ◽  
Term Care ◽  
Gram Negative

OBJECTIVEIsolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.METHODSA 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.RESULTSA score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).CONCLUSIONA model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.Infect Control Hosp Epidemiol 2017;38:1216–1225

scholarly journals Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

2020 ◽  
Vol 17 (19) ◽  
pp. 6943
Author(s):  
Agnieszka Litwin ◽  
Olga Fedorowicz ◽  
Wieslawa Duszynska
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
Defined Daily Dose ◽  
Gram Negative Bacteria ◽  
Healthcare Associated Infections ◽  
Gram Negative ◽  
Enterococcus Spp ◽  
Healthcare Associated ◽  
The University

Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

scholarly journals Susceptibility of Urinary Tract Bacteria to Fosfomycin

2009 ◽  
Vol 53 (10) ◽  
pp. 4508-4510 ◽  
Author(s):  
Sofia Maraki ◽  
George Samonis ◽  
Petros I. Rafailidis ◽  
Evridiki K. Vouloumanou ◽  
Emmanuel Mavromanolakis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Vitro Activity ◽  
University Hospital ◽  
In Vitro Activity ◽  
Gram Negative ◽  
Susceptibility Data ◽  
The University ◽  
Urinary Isolates

ABSTRACT We evaluated the in vitro activity of fosfomycin against urinary isolates in a region in Greece that exhibits considerable antimicrobial resistance by evaluating retrospectively relevant susceptibility data retrieved from the microbiological library of the University Hospital of Heraklion, Crete, Greece. We examined 578 urinary isolates. In total, 516 (89.2%) were susceptible to fosfomycin; 415 isolates were gram negative, and 101 isolates were gram positive. Fosfomycin appears to exhibit good levels of in vitro activity against the examined urinary isolates.

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