This document discusses antibiotic use and resistance. It notes that antibiotics are commonly misused, accounting for up to 50% of hospital drug expenditures. Up to 50% of antibiotics are used inappropriately, leading to resistant pathogens. New antibiotic development is difficult and discouraged due to lack of profitability and development of resistance. Antibiotic misuse can lead to treatment failure, increased costs and morbidity. Examples of misuse include using antibiotics for viral infections and continuing empirical treatment without culture results. Proper antibiotic use requires considering infection type, likely pathogens, local resistance patterns, prior therapy, and patient factors.
Challenges in the management of HAP-VAP include multidrug-resistant pathogens becoming more common. Combination antibiotic therapy is recommended for patients with risk factors for multidrug-resistant infections or septic shock. Newer beta-lactam/beta-lactamase inhibitor combinations such as ceftolozane-tazobactam and ceftazidime-avibactam show promise in treating resistant gram-negative bacteria including ESBL, AmpC, KPC, and OXA-48 producers.
This document outlines Patient Safety Goal 4 to tackle antimicrobial resistance as part of WHO's 3rd Global Patient Safety Challenge. It describes 3 indicators to monitor the incidence of MRSA, ESBL-Klebsiella Pneumoniae, and ESBL-E.coli infections. Data on newly identified multidrug resistant organism cases will be collected and the infection rates calculated monthly. Strategies like implementing antibiotic guidelines, stewardship programs, and national campaigns aim to optimize antibiotic use and contain the spread of antimicrobial resistance.
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
This document summarizes antimicrobial resistance surveillance in hospitals and communities. It discusses the increasing issues of antibiotic resistance over time, with predictions from 1966 that bacterial diseases would be eliminated by 2000 proving inaccurate. The document outlines various multidrug resistant organisms of concern, including MRSA, and the need to track resistance patterns and transmission. It presents a case study describing the identification of the ST-239 strain of MRSA in a surveillance program, which was previously uncommon in the US. Overall it emphasizes the growing challenges of antimicrobial resistance for treatment of infections.
This document summarizes a study on multidrug resistant organisms and their antibiotic resistance patterns among intensive care unit patients in Surat City, India. The study found that Pseudomonas aeruginosa and Klebsiella species were the most common causes of healthcare-associated infections. It also found high resistance of these organisms to cephalosporins but that amikacin and imipenem were the most effective antibiotics. Regular monitoring of resistance patterns was deemed important for guiding empirical treatment of infections in ICU patients.
IBacterial Pathogens Causing Urinary Tract Infections and Their Antimicrobial...Dr. Aisha M Elbareg
This document summarizes a study on urinary tract infections conducted in Libya. Urine samples were collected from 250 patients and cultured to isolate bacterial pathogens. Only 25.2% of samples showed significant bacterial growth. The most common isolates were gram-negative bacilli like E. coli, Klebsiella, Proteus, and Pseudomonas. E. coli was the predominant pathogen. Antibiotic susceptibility testing found that isolates were generally sensitive to aminoglycosides like amikacin and gentamicin but less sensitive to cephalosporins and highly resistant to ampicillin. The study concludes that gram-negative bacteria are the main urinary pathogens and regular monitoring of antibiotic susceptibility is needed to guide effective
The document discusses treatment of invasive fungal infections. It begins by defining invasive fungal infections and describing the epidemiology. Common fungi that cause invasive infections include Aspergillus and Candida. Risk factors include prolonged neutropenia from chemotherapy or hematopoietic stem cell transplants. Available antifungal drug classes are discussed along with their mechanisms of action including azoles, polyenes, and echinocandins. Treatment recommendations from clinical guidelines are summarized for conditions like candidemia and invasive aspergillosis.
This document discusses antibiotic use and resistance. It notes that antibiotics are commonly misused, accounting for up to 50% of hospital drug expenditures. Up to 50% of antibiotics are used inappropriately, leading to resistant pathogens. New antibiotic development is difficult and discouraged due to lack of profitability and development of resistance. Antibiotic misuse can lead to treatment failure, increased costs and morbidity. Examples of misuse include using antibiotics for viral infections and continuing empirical treatment without culture results. Proper antibiotic use requires considering infection type, likely pathogens, local resistance patterns, prior therapy, and patient factors.
Challenges in the management of HAP-VAP include multidrug-resistant pathogens becoming more common. Combination antibiotic therapy is recommended for patients with risk factors for multidrug-resistant infections or septic shock. Newer beta-lactam/beta-lactamase inhibitor combinations such as ceftolozane-tazobactam and ceftazidime-avibactam show promise in treating resistant gram-negative bacteria including ESBL, AmpC, KPC, and OXA-48 producers.
This document outlines Patient Safety Goal 4 to tackle antimicrobial resistance as part of WHO's 3rd Global Patient Safety Challenge. It describes 3 indicators to monitor the incidence of MRSA, ESBL-Klebsiella Pneumoniae, and ESBL-E.coli infections. Data on newly identified multidrug resistant organism cases will be collected and the infection rates calculated monthly. Strategies like implementing antibiotic guidelines, stewardship programs, and national campaigns aim to optimize antibiotic use and contain the spread of antimicrobial resistance.
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
This document summarizes antimicrobial resistance surveillance in hospitals and communities. It discusses the increasing issues of antibiotic resistance over time, with predictions from 1966 that bacterial diseases would be eliminated by 2000 proving inaccurate. The document outlines various multidrug resistant organisms of concern, including MRSA, and the need to track resistance patterns and transmission. It presents a case study describing the identification of the ST-239 strain of MRSA in a surveillance program, which was previously uncommon in the US. Overall it emphasizes the growing challenges of antimicrobial resistance for treatment of infections.
This document summarizes a study on multidrug resistant organisms and their antibiotic resistance patterns among intensive care unit patients in Surat City, India. The study found that Pseudomonas aeruginosa and Klebsiella species were the most common causes of healthcare-associated infections. It also found high resistance of these organisms to cephalosporins but that amikacin and imipenem were the most effective antibiotics. Regular monitoring of resistance patterns was deemed important for guiding empirical treatment of infections in ICU patients.
IBacterial Pathogens Causing Urinary Tract Infections and Their Antimicrobial...Dr. Aisha M Elbareg
This document summarizes a study on urinary tract infections conducted in Libya. Urine samples were collected from 250 patients and cultured to isolate bacterial pathogens. Only 25.2% of samples showed significant bacterial growth. The most common isolates were gram-negative bacilli like E. coli, Klebsiella, Proteus, and Pseudomonas. E. coli was the predominant pathogen. Antibiotic susceptibility testing found that isolates were generally sensitive to aminoglycosides like amikacin and gentamicin but less sensitive to cephalosporins and highly resistant to ampicillin. The study concludes that gram-negative bacteria are the main urinary pathogens and regular monitoring of antibiotic susceptibility is needed to guide effective
The document discusses treatment of invasive fungal infections. It begins by defining invasive fungal infections and describing the epidemiology. Common fungi that cause invasive infections include Aspergillus and Candida. Risk factors include prolonged neutropenia from chemotherapy or hematopoietic stem cell transplants. Available antifungal drug classes are discussed along with their mechanisms of action including azoles, polyenes, and echinocandins. Treatment recommendations from clinical guidelines are summarized for conditions like candidemia and invasive aspergillosis.
The document discusses principles of treating infectious illnesses in critical care, with a focus on antibiotic resistance and choice of antibiotics. It covers several topics: the impact of antibiotic use on resistance; choosing initial antibiotics and tailoring treatment based on culture results; applying pharmacology and pharmacodynamics to optimize bacterial killing; and reviewing guidelines for specific infections. It also provides an overview of antibiotic classes, mechanisms of action, considerations for dosing in renal impairment, and highlights specific agents like penicillins, cephalosporins, and vancomycin.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This document summarizes a study on enhancing the sensitivity of multidrug resistant E. coli isolated from urine samples to commonly used antibiotics. 15 E. coli strains were tested, and 11 were resistant to most antibiotics. Strain EC8 was selected for sensitivity enhancement testing using non-toxic concentrations of homodium bromide over time periods of 6, 12, 18, and 24 hours. EC8 showed increased sensitivity to gentamicin, nitrofurantoin, and streptomycin after treatment. Higher concentrations of 0.85 and 0.95 ug/ml homodium bromide produced the greatest sensitivity enhancements. The results suggest homodium bromide may be useful as an enhancer of bacterial permeability to increase the effectiveness of antibiotics.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This document summarizes a study that tested the ability of homodium bromide (HmBr) to enhance the antibiotic sensitivity of a multidrug resistant Escherichia coli isolate. The isolate was resistant to 8 of 11 antibiotics tested. Treatment with non-toxic concentrations of HmBr for various time periods increased the isolate's sensitivity to gentamicin, nitrofurantoin, and streptomycin in a time and concentration dependent manner, with higher concentrations and shorter incubation times producing greater enhancements. This suggests HmBr may be useful as an antibiotic sensitivity enhancer by increasing bacterial permeability.
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
This document discusses a study on the prevalence and characterization of beta-lactamases in multidrug resistant gram-negative bacteria isolated from intensive care units (ICUs) in a tertiary care hospital in central India. The study aims to identify gram-negative pathogens from ICU specimens, determine antimicrobial resistance patterns and prevalence of ESBLs, AmpC, and carbapenemases through phenotypic and genotypic methods. A literature review found increasing antimicrobial resistance in ICUs due to selective pressure from antibiotic overuse. ICUs have high rates of multidrug resistant infections. The study aims to detect resistance genes and their co-existence to guide optimal treatment and infection control in ICUs.
This document discusses the global threat of antimicrobial resistance (AMR) and the role that drug and therapeutics committees (DTCs) can play in containing AMR. It outlines the global spread of drug-resistant pathogens and infections. The overuse and misuse of antibiotics in both human and animal settings is a major cause of growing AMR. DTCs can help address this by developing antibiotic policies and formularies, educating on appropriate use, and monitoring antibiotic consumption and resistance patterns. Examples from Kenya and Thailand demonstrate how DTCs have successfully implemented strategies like antibiotic order forms to improve antibiotic use.
Threat of antibiotic resistant bacteria to humansRBKC
This document discusses antimicrobial resistance and provides an overview of several key topics:
1. It outlines various bacterial infections and classes of antibiotics used to treat them, as well as the history and classification of antibiotics.
2. It discusses the growing issue of antimicrobial resistance (AMR), costs and consequences associated with AMR, and examples of "superbugs" demonstrating resistance.
3. It covers interventions and strategies to address AMR, including improved stewardship, surveillance, research and development of new antibiotics, and prevention efforts.
Some Klebsiella and E. coli strains are collectively called “Carbapenem-resistant Enterobacteriaceae” (CRE) because they have developed resistance to a former last-resort antibiotic, carbapenem. They mainly occur in long-term care facilities. Nevertheless, the Center for Disease Control regards them as an urgent threat because of their insensitivity to multiple antibiotics, and because of concerns that they may spread into the community.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
Bacterial Profile and Antimicrobial Resistance Pattern of Pus Isolates in Ben...Ahmed Elberry
This study analyzed bacterial culture data from pus samples collected from 2008-2014 at Beni-Suef University Hospital in Egypt to identify the prevalent bacteria and their antibiotic resistance patterns. Pseudomonas spp. was the most commonly isolated bacteria (20.9%), followed by MSSA (14.3%). Gram-negative bacteria like Pseudomonas spp., E. coli, and Klebsiella spp. showed high resistance to many antibiotics but lower resistance to imipenem, amikacin, and meropenem. MSSA was resistant to penicillin and erythromycin but sensitive to vancomycin. The results provide guidance for empiric antibiotic treatment of wound infections in the
The document provides an overview of antimicrobial stewardship programs and antibiotic resistance. It discusses how antibiotic overuse has led to increased resistance [1]. Antimicrobial stewardship programs aim to optimize antibiotic use and slow resistance through coordinated actions [2]. The core elements of effective programs include leadership commitment, accountability, drug expertise, tracking antibiotic use and resistance, reporting on improvement efforts, and education [3]. Targeted strategies are needed given the unique challenges of prescribing antibiotics for neonatal intensive care patients. Bundles of evidence-based practices can help reduce healthcare-associated infections like CLABSIs in the NICU.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
Dr. Robert Tauxe - Public Health Concerns About Resistant Foodborne InfectionsJohn Blue
Public Health Concerns About Resistant Foodborne Infections - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Infections, Centers for Disease Control and Prevention, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health
Antibiogram of Bacteria Isolated from Wounds of Diabetic Patients on Admissio...Premier Publishers
A major challenge faced by diabetic patients is infected diabetic ulcers usually associated with substantial morbidity and mortality. Worse issues arise from antibiotic resistant microorganisms. This study was conducted to determine the antibiogram of bacteria isolated from wounds of diabetic patients on hospital admission. Nine wound swab samples were collected from nine diabetic in-patients with ulcers. These were processed using standard protocols. Multi antibiotic sensitivity discs (Gram negative and Gram positive) containing ten antibiotics respectively were used. Total of 91 bacterial isolates were obtained belonging to five species. Staphylococcus aureus was most predominant (34.07%) and Proteus mirabilis was the least isolated (7.69%). Pseudomonas aeruginosa showed highest (100%) resistance to the antibiotics used, followed by Proteus mirabilis (90%), Staphylococcus aureus (80%) and Escherichia coli (30%). Klebsiella pneumoniae was 100% susceptible. Streptomycin was the most efficacious antibiotic while Ciprofloxacin and Augmentin were the least. The level of resistance exhibited by these clinical isolates is worrisome and likely to impede treatment outcomes. Streptomycin showed broad spectrum activity and may be the best drug of choice for treating wounds in diabetic patients however, there is need for antibiotic susceptibility testing and consideration of patient’s physiologic disposition before introducing antibiotic regimen.
Epidemiology of antibacterial resistance in Eastern India: An analysisDiganta Dey
This study analyzed trends in antibiotic resistance in Eastern India over two time periods: July 2008-February 2009 and July 2015-September 2015. It found:
1) A marked increase in ESBL-producing bacteria, rising from 15% of E. coli and 21% of K. pneumoniae in 2008-2009 to 32% in community-acquired and 41% in hospital-acquired UTIs in 2015.
2) MRSA infections decreased from 52% in 2008-2009 to 25% in community settings and 37% in hospitals in 2015.
3) Alarmingly, resistance had risen for nearly all classes of antibiotics tested, with high rates of fluoroquinolone and carbapenem resistance observed even
This study investigated genotypic and phenotypic characteristics of Staphylococcus aureus isolates responsible for recurrent skin infections in Hilla City, Iraq. Of 150 clinical samples, 32 (21.3%) tested positive for S. aureus. Antibiotic susceptibility testing found high resistance to oxacillin (25%), cefoxitin, cefipime (100%), erythromycin (50%), tetracycline (56%), and doxycycline (53%). All isolates were susceptible to imipenem, meropenem, and vancomycin. Phenotypic detection found 23 of 32 isolates (71.9%) were biofilm producers. PCR detected the icaA and icaD genes in 23 isolates,
Antimicrobial resistance is a growing problem globally and in India. The overuse and misuse of antibiotics has contributed to resistance developing through various mechanisms in bacteria. In India in 2019, there were nearly 300,000 deaths attributable to antimicrobial resistance. Gram-negative bacteria are particularly problematic as they can develop resistance through various efflux pumps and enzymes. Carbapenem resistance is an emerging threat as it limits treatment options. Detection of resistance is important and can be done through various molecular techniques. Prevention requires a multi-pronged approach within healthcare systems including proper hand hygiene, infection control measures, and antimicrobial stewardship.
Antibiotic Resistance form food of animal origint- Debatable issueAsima Zehra
The document discusses antibiotic resistance arising from food of animal origin. It provides context on the global rise in antibiotic resistance and drivers such as extensive antibiotic use in livestock. Over 50% of antibiotics globally are used in livestock, primarily for growth promotion rather than treating disease. Several studies show foodborne pathogens from poultry and livestock harboring antibiotic resistance genes, which can transmit to humans. The document calls for regulating antibiotic use in livestock to curb the development and spread of resistant bacteria.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Carbapenem-resistant Gram-negative bacilli (GNB) such as Pseudomonas, Acinetobacter, and Enterobacteriaceae pose a serious threat due to limited treatment options. Resistance is mainly due to carbapenemase production or porin/efflux pump changes. Notable carbapenemases include KPC, NDM, and OXA-48. While still low in Canada, rates of carbapenem resistance are increasing globally. Strict infection control measures including active surveillance, contact precautions, and environmental cleaning are needed to control outbreaks.
The document discusses principles of treating infectious illnesses in critical care, with a focus on antibiotic resistance and choice of antibiotics. It covers several topics: the impact of antibiotic use on resistance; choosing initial antibiotics and tailoring treatment based on culture results; applying pharmacology and pharmacodynamics to optimize bacterial killing; and reviewing guidelines for specific infections. It also provides an overview of antibiotic classes, mechanisms of action, considerations for dosing in renal impairment, and highlights specific agents like penicillins, cephalosporins, and vancomycin.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This document summarizes a study on enhancing the sensitivity of multidrug resistant E. coli isolated from urine samples to commonly used antibiotics. 15 E. coli strains were tested, and 11 were resistant to most antibiotics. Strain EC8 was selected for sensitivity enhancement testing using non-toxic concentrations of homodium bromide over time periods of 6, 12, 18, and 24 hours. EC8 showed increased sensitivity to gentamicin, nitrofurantoin, and streptomycin after treatment. Higher concentrations of 0.85 and 0.95 ug/ml homodium bromide produced the greatest sensitivity enhancements. The results suggest homodium bromide may be useful as an enhancer of bacterial permeability to increase the effectiveness of antibiotics.
IOSRPHR(www.iosrphr.org) IOSR Journal of Pharmacyiosrphr_editor
This document summarizes a study that tested the ability of homodium bromide (HmBr) to enhance the antibiotic sensitivity of a multidrug resistant Escherichia coli isolate. The isolate was resistant to 8 of 11 antibiotics tested. Treatment with non-toxic concentrations of HmBr for various time periods increased the isolate's sensitivity to gentamicin, nitrofurantoin, and streptomycin in a time and concentration dependent manner, with higher concentrations and shorter incubation times producing greater enhancements. This suggests HmBr may be useful as an antibiotic sensitivity enhancer by increasing bacterial permeability.
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
This document discusses a study on the prevalence and characterization of beta-lactamases in multidrug resistant gram-negative bacteria isolated from intensive care units (ICUs) in a tertiary care hospital in central India. The study aims to identify gram-negative pathogens from ICU specimens, determine antimicrobial resistance patterns and prevalence of ESBLs, AmpC, and carbapenemases through phenotypic and genotypic methods. A literature review found increasing antimicrobial resistance in ICUs due to selective pressure from antibiotic overuse. ICUs have high rates of multidrug resistant infections. The study aims to detect resistance genes and their co-existence to guide optimal treatment and infection control in ICUs.
This document discusses the global threat of antimicrobial resistance (AMR) and the role that drug and therapeutics committees (DTCs) can play in containing AMR. It outlines the global spread of drug-resistant pathogens and infections. The overuse and misuse of antibiotics in both human and animal settings is a major cause of growing AMR. DTCs can help address this by developing antibiotic policies and formularies, educating on appropriate use, and monitoring antibiotic consumption and resistance patterns. Examples from Kenya and Thailand demonstrate how DTCs have successfully implemented strategies like antibiotic order forms to improve antibiotic use.
Threat of antibiotic resistant bacteria to humansRBKC
This document discusses antimicrobial resistance and provides an overview of several key topics:
1. It outlines various bacterial infections and classes of antibiotics used to treat them, as well as the history and classification of antibiotics.
2. It discusses the growing issue of antimicrobial resistance (AMR), costs and consequences associated with AMR, and examples of "superbugs" demonstrating resistance.
3. It covers interventions and strategies to address AMR, including improved stewardship, surveillance, research and development of new antibiotics, and prevention efforts.
Some Klebsiella and E. coli strains are collectively called “Carbapenem-resistant Enterobacteriaceae” (CRE) because they have developed resistance to a former last-resort antibiotic, carbapenem. They mainly occur in long-term care facilities. Nevertheless, the Center for Disease Control regards them as an urgent threat because of their insensitivity to multiple antibiotics, and because of concerns that they may spread into the community.
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
Bacterial Profile and Antimicrobial Resistance Pattern of Pus Isolates in Ben...Ahmed Elberry
This study analyzed bacterial culture data from pus samples collected from 2008-2014 at Beni-Suef University Hospital in Egypt to identify the prevalent bacteria and their antibiotic resistance patterns. Pseudomonas spp. was the most commonly isolated bacteria (20.9%), followed by MSSA (14.3%). Gram-negative bacteria like Pseudomonas spp., E. coli, and Klebsiella spp. showed high resistance to many antibiotics but lower resistance to imipenem, amikacin, and meropenem. MSSA was resistant to penicillin and erythromycin but sensitive to vancomycin. The results provide guidance for empiric antibiotic treatment of wound infections in the
The document provides an overview of antimicrobial stewardship programs and antibiotic resistance. It discusses how antibiotic overuse has led to increased resistance [1]. Antimicrobial stewardship programs aim to optimize antibiotic use and slow resistance through coordinated actions [2]. The core elements of effective programs include leadership commitment, accountability, drug expertise, tracking antibiotic use and resistance, reporting on improvement efforts, and education [3]. Targeted strategies are needed given the unique challenges of prescribing antibiotics for neonatal intensive care patients. Bundles of evidence-based practices can help reduce healthcare-associated infections like CLABSIs in the NICU.
This document provides an outline of José Ramón Paño-Pardo's track at the ICAAC 2015 conference. The conference focused on antimicrobial agents and chemotherapy. Key topics included antimicrobial stewardship, bloodstream infections, new antimicrobials, and clinical infectious disease syndromes. Sessions covered emerging resistance issues like carbapenemase-producing Enterobacteriaceae and rapid diagnostics for sepsis.
Dr. Robert Tauxe - Public Health Concerns About Resistant Foodborne InfectionsJohn Blue
Public Health Concerns About Resistant Foodborne Infections - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Infections, Centers for Disease Control and Prevention, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health
Antibiogram of Bacteria Isolated from Wounds of Diabetic Patients on Admissio...Premier Publishers
A major challenge faced by diabetic patients is infected diabetic ulcers usually associated with substantial morbidity and mortality. Worse issues arise from antibiotic resistant microorganisms. This study was conducted to determine the antibiogram of bacteria isolated from wounds of diabetic patients on hospital admission. Nine wound swab samples were collected from nine diabetic in-patients with ulcers. These were processed using standard protocols. Multi antibiotic sensitivity discs (Gram negative and Gram positive) containing ten antibiotics respectively were used. Total of 91 bacterial isolates were obtained belonging to five species. Staphylococcus aureus was most predominant (34.07%) and Proteus mirabilis was the least isolated (7.69%). Pseudomonas aeruginosa showed highest (100%) resistance to the antibiotics used, followed by Proteus mirabilis (90%), Staphylococcus aureus (80%) and Escherichia coli (30%). Klebsiella pneumoniae was 100% susceptible. Streptomycin was the most efficacious antibiotic while Ciprofloxacin and Augmentin were the least. The level of resistance exhibited by these clinical isolates is worrisome and likely to impede treatment outcomes. Streptomycin showed broad spectrum activity and may be the best drug of choice for treating wounds in diabetic patients however, there is need for antibiotic susceptibility testing and consideration of patient’s physiologic disposition before introducing antibiotic regimen.
Epidemiology of antibacterial resistance in Eastern India: An analysisDiganta Dey
This study analyzed trends in antibiotic resistance in Eastern India over two time periods: July 2008-February 2009 and July 2015-September 2015. It found:
1) A marked increase in ESBL-producing bacteria, rising from 15% of E. coli and 21% of K. pneumoniae in 2008-2009 to 32% in community-acquired and 41% in hospital-acquired UTIs in 2015.
2) MRSA infections decreased from 52% in 2008-2009 to 25% in community settings and 37% in hospitals in 2015.
3) Alarmingly, resistance had risen for nearly all classes of antibiotics tested, with high rates of fluoroquinolone and carbapenem resistance observed even
This study investigated genotypic and phenotypic characteristics of Staphylococcus aureus isolates responsible for recurrent skin infections in Hilla City, Iraq. Of 150 clinical samples, 32 (21.3%) tested positive for S. aureus. Antibiotic susceptibility testing found high resistance to oxacillin (25%), cefoxitin, cefipime (100%), erythromycin (50%), tetracycline (56%), and doxycycline (53%). All isolates were susceptible to imipenem, meropenem, and vancomycin. Phenotypic detection found 23 of 32 isolates (71.9%) were biofilm producers. PCR detected the icaA and icaD genes in 23 isolates,
Antimicrobial resistance is a growing problem globally and in India. The overuse and misuse of antibiotics has contributed to resistance developing through various mechanisms in bacteria. In India in 2019, there were nearly 300,000 deaths attributable to antimicrobial resistance. Gram-negative bacteria are particularly problematic as they can develop resistance through various efflux pumps and enzymes. Carbapenem resistance is an emerging threat as it limits treatment options. Detection of resistance is important and can be done through various molecular techniques. Prevention requires a multi-pronged approach within healthcare systems including proper hand hygiene, infection control measures, and antimicrobial stewardship.
Antibiotic Resistance form food of animal origint- Debatable issueAsima Zehra
The document discusses antibiotic resistance arising from food of animal origin. It provides context on the global rise in antibiotic resistance and drivers such as extensive antibiotic use in livestock. Over 50% of antibiotics globally are used in livestock, primarily for growth promotion rather than treating disease. Several studies show foodborne pathogens from poultry and livestock harboring antibiotic resistance genes, which can transmit to humans. The document calls for regulating antibiotic use in livestock to curb the development and spread of resistant bacteria.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Carbapenem-resistant Gram-negative bacilli (GNB) such as Pseudomonas, Acinetobacter, and Enterobacteriaceae pose a serious threat due to limited treatment options. Resistance is mainly due to carbapenemase production or porin/efflux pump changes. Notable carbapenemases include KPC, NDM, and OXA-48. While still low in Canada, rates of carbapenem resistance are increasing globally. Strict infection control measures including active surveillance, contact precautions, and environmental cleaning are needed to control outbreaks.
Similar to Global epidemiology of Carbapenem–resistant gram-negative bacterial infections: Global epidemiology, challenges and threats (20)
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Global epidemiology of Carbapenem–resistant gram-negative bacterial infections: Global epidemiology, challenges and threats
1. Carbapenem–resistant gram-negative
bacterial infections:
Global epidemiology, challenges and threats
Evangelos Kritsotakis
Lecturer in Epidemiology & Medical Statistics
School of Health & Related Research
University of Sheffield
e.kritsotakis@sheffield.ac.uk
May 2017
2. • Basic concepts/issues: HAIs, Antibiotics, AMR
• Global Epi: features and current situation in the spread of CR-GNB,
• Challenges and threats: the example of the VIM and KPC epidemics
in Greece and the KPC epidemic in Italy,
• Risk factors for of CR-GNB infections,
• Clinical impact of CR-GNB infections,
• Treatment options for CR-GNB infections.
Overview
Overview
4. Healthcare-associated infections (HAIs)
Healthcare-associated infections (HAIs)
• HAIs develop either as a direct result of healthcare interventions such as medical or surgical
treatment, or from being in contact with a healthcare setting.
• Point Prevalence, per 100 inpatients in acute-care hospitals:
USA 2011: 4% (95%CI: 3.7 – 4.4)
EU/EEA 2012: 6% (95%CI: 5.7 – 6.3)
Developing countries: 11% (95%CI: 8.1 – 13.9) , high quality studies: 13.5%
• Incidence, number of patients acquiring at least one HAI, per year:
USA : 648 000 (95%CI: 246 400 - 987 300)
EU/EEA: 3 200 021 (95%CI: 1 948 862 – 5 234 253)
ECDC PPS Surveillance Report 2013,
Magill S. et al NEJM 2014
Allegranzi et al Lancet 2011
5. Burden of HAIs on European population health
Burden of HAIs on European population health
DALYs = number of years lost due to ill-health, disability or early death.
PLOS Medicine 13(10): e1002150. https://doi.org/10.1371/journal.pmed.1002150
YLD = years lived with disability
YLL= years of life lost (to pre-mature mortality)
Total DALYs = 501 per 100,000 general population
6. Burden of HAIs in Europe (EU/EEA)
Burden of HAIs in Europe (EU/EEA)
DALYs = number of years lost due to ill-health, disability or early death.
Disease DALYs
per 100,000 population
HAIs (6 main types) 501
Influenza 71
TB 53
HIV infection 48
Sources:
ECDC study, 2011-2012 data, PLOS Medicine 13(10): e100215
ECDC/BCoDE study, 2009-2013 data, European Journal of Public Health 25(suppl 3); Oct 2015
9. Antimicrobial Resistance (AMR)
Antimicrobial Resistance (AMR)
• How does AMR emerge in bacteria?
- by naturally occurring pre-existing resistance mechanisms
- by de novo gene mutations (spontaneous and random)
- by horizontal transfer of mobile genetic elements.
• Protective mechanisms include:
- preventing entry of the antibiotic
- exporting the antibiotic
- producing enzymes that destroy or modify the antibiotic
- making changes to the antimicrobial target.
Holmes et al., Lancet 2016; 387: 176–87
Beaber et al., Nature 2004; 427: 72–74.
10. Antimicrobial Resistance (AMR)
Antimicrobial Resistance (AMR)
• How may antibiotics promote AMR ?
- by exerting selective pressure
- by facilitating transmission of resistant bacteria
- by facilitating transmission of antibiotic resistance genes
Holmes et al., Lancet 2016; 387: 176–87
Beaber et al., Nature 2004; 427: 72–74.
selective pressure
11. Nathan S. McClure, and Troy Day Proc. R. Soc. B
2014;281:20141861
Timeline of antibiotics against subsequent evolution of resistance
Timeline of antibiotics against subsequent evolution of resistance
12. Advanced Drug Delivery Reviews, Volume 78, 2014, 3–13
http://dx.doi.org/10.1016/j.addr.2014.08.003
Timeline of antibiotic discovery against the development of AMR
Timeline of antibiotic discovery against the development of AMR
14. Klebsiella pneumoniae
(and other enterobacteria, e.g. E.coli)
Pseudomonas aeruginosa
Acinetobacter spp.
Important Gram-negative nocomial
pathogens with carbapenem resistance issues
15. Microbiology of HAI
ECDC HAI PPS 2012
Source: ECDC PPS surveillance report, 2013
% isolation in healthcare-associated infections
ECDC Point Prevalence Study
231459 patients (15000 HAIs)
947 hospitals
33 countries
16. • Carbapenemases are enzymes that hydrolyse (destroy)
carbapenem antibiotics making the organism resistant
• Carbapenems: meropenem, imipenem, ertapenem,
doripenem (all IV)
• These antibiotics are the ‘last line of defence’ as they are the
broadest spectrum/most effective available
• Carbapenemase-producers are usually resistant to most other
antibiotics too.
Carbapenemases & Carbapenems
Carbapenemases & Carbapenems
17. Ambler Class B
Metallo-enzymes (MBL)
VIM (Pseudomonas, Klebsiella)
NDM (Klebsiella)
IMI, SPM, GIM, SIM
Ambler Class D
Oxacillinases
OXA-48 (Acinetobacter)
Not only genetic and biochemical classification, but also
Different epidemiology
Differences in profiles of resistance
Carbapenemases
Carbapenemases
Ambler Class A
Serine
KPC (Klebsiella)
IMI (Enterobacter)
GES (Pseudomonas)
SME (Serratia)
19. Global spread
Global spread
KPC is nowdays endemic in the USA, Greece, Italy, Israel,
China and Latin America
VIM was endemic in Greece (but KPC has taken over now)
and has substantial spread in Italy.
NDM primarily spread in the Indian subcontinent, but
sporadic cases have been reported everywhere in Europe
OXA have spread mainly around the eastern and southern
parts of the Mediterranean basin.
20. Munoz-Price LS et al. Lancet Infect Dis 2013; 13: 785–96
KPC Global spread
KPC Global spread
21. NDM Global spread
NDM Global spread
Front. Microbiol., 13 June 2016 |
https://doi.org/10.3389/fmicb.2016.00895
22. Carbapenem-NS isolates from the EARS-NET, 2015
K. pneumoniae
P. aeruginosa
Acinetobacter spp.
E. coli
Source: http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf
23. ECDC HAI PPS 2012
Antimicrobial resistance markers
for healthcare-associated infections
*Source: ECDC, 2012 (results as of 23/11/2012)
25. 2002:
VIM-1 in 17 K.pneumoniae isolates in 3 ICUs in Athens
“VIM-type genes have been spread via transferable plasmids in
the enterobacteria of the hospital flora in Greece”.
Giakkoupi P et al. JCM 2003; 41:3893-6
2001:
Isolation of E.coli with blaVIM-1 gene, hospital in Piraeus
Miriagou V et al. AAC 2003; 47:395-397.
Four sporadic VIM-1 E.coli isolates in Un. hospital, Crete
Scoulica E et al. DMID 2004; 48:167-172.
Class I integron with different structures suggesting a different evolution process
rather than a transfer and spread of the mobile element between the hospitals.
The Resistance spread
Inter-species resistance spread
Inter-species resistance spread
26. 2003: MBL production sporadically in E. cloacae in
Galani et al JAC 2005;55:634-8
2004-5: Outbreak of 7 MBL producing P. mirabilis in a
hospital in Thessaloniki, Vourli et al. CMI 2006; 12:691-4.
3 isolates, E.coli (2002), E. aerogenes (2003) & P. mirabilis (2004) producing
MBL VIM-1 encoded by same conjugative plasmid. Galani et al JAC 2007; 53 578-9
M. morganii (2005), Serratia liquefaciens, Klebsiella oxytoca (2006),
Providencia stuartii (2007) EID 2006:981–3, IJAA 2008:540-1, JAC 2007:183–4
Epidemic due to successful horizontal transfer of genetic material
between species.
May also facilitate their propagation into the community.
VIM-1 in Enterobacteriaceae
VIM-1 in Enterobacteriaceae
27. Spread of MBL-producers in the Community
Spread of MBL-producers in the Community
2005-8, Serres General Hospital:
45 patients with UTI or bacteremia
caused by VIM-2 P.aer, 40 reported
previous hospitalization 1mo-1y
before, 5 without link to health-
care facilities
2007-8, Serres General Hospital:
12 patients with UTI caused by VIM-
1 K.pn, 2-4 months after discharge.
Only 2 patients with known
colonization during recent
hospitalization
2005-7, Serres General Hospital:
9 outpatients with UTI cause by K.
oxytoca. All patients had been
hospitalized or exposed to health
care facilities during the preceding
year.
28. Eurosurveillance 2008; 13:1-3
CR K.pneumoniae (VIM-1) in
• 3 Hospitals in 2002
• 29/40 Hospitals in 2007
Establishment of endemicity
By 2007 VIM-1 MBL enzyme was responsible for the extremely high C- resistance
rates in K.pneumoniae in Greece: 75% in ICUs and 30% in med & surg wards
29. 2007–2008: Outbreaks of infection and/or colonization
due to KPC-2 producing K.pneumoniae identified in
hospitals in
• Crete (May 2007)
Maltezou et al. J Infect 2009; 58:213–9
• Athens (September 2007)
Souli et al. Clinical Infectious Diseases 2010; 50:364–73
• Thessaloniki (October 2007)
Pournaras et al. Antimicrob Chemother 2009; 64:348–52
The KPC spread
The KPC spread
31. Percentage (%) of IMIPENEM-R K.pneumoniae from all
specimens of Greek hospitals 1998-2012
www.mednet.gr/whonet
VIM
KPC
32. Bloodstream Infections due to
Carbapenem-R gram neg. pathogens
Procrustes Surveillance System 2013
Kontopidou F. Fighting AntiMicrobial Resistance Meeting, Rome, Dec. 2014
Mechanism of resistance among
Carbapenem-R Klebsiella isolates
33. Proportion
%
Year
EARS-NET database
Carbapenem-NS Klebsiella pneumoniae in Greece:
contemporary spread of two resistance mechanisms
Carbapenem-NS Klebsiella pneumoniae in Greece:
contemporary spread of two resistance mechanisms
VIM epidemic
polyclonal spread & transferable plasmids
Vatopoulos, Eurosurveillance 2008; 13(4)
Giakoupi et al Euro Surveillance 2009;14(21)
Giakkoupi et al. J Antimicrob Chemother 2011; 66: 1510–1513
0
10
20
30
40
50
60
70
80
2005 2006 2007 2008 2009 2010 2011
KPC-2 epidemic
spread mainly monoclonally
34. Intercontinental spread of KPCs
The first case of KPC outside the U.S. occurred in France,
KPC later spread in, Israel, Greece, China, and Colombia
KPC-3
KPC(+) K.pn NC, USA 1996
Until 2005, the geographical distribution of
KPC-2 & KPC-3 in K. Pneumoniae
was limited to the Eastern United States
KPC(+) K.pn
Tel Aviv, Israel 2006
Yigit et al. AAC 2003
Navon-Venezia et al. AAC 2009
KPC-2
35. 0
10
20
30
40
50
60
70
80
2005 2006 2007 2008 2009 2010 2011
Proportion
%
Year
Carbapenem-NS Klebsiella pneumoniae in Greece and Italy
Carbapenem-NS Klebsiella pneumoniae in Greece and Italy
Greece
Italy
KPC-2 epidemic
VIM epidemic
KPC-3 epidemic
EARS-NET database
36. Giani et al – JCM 2009
Fontana et al – BMC Res Notes 2010
Marchese et al – J Chemother 2010
Ambretti et al – New Microb 2010
Gaibani et al – Eurosurv 2011
Mezzatesta et al – CMI 2011
Agodi et al – JCM 2011
Richter et al – JCM 2011
Di Carlo et al – BMC Gastroenterol 2011
late 2008
late 2008
The first reported
cases of KPC-Kp
(ST258)
KPC-producing K. pneumoniae - Italy
KPC-producing K. pneumoniae - Italy
early 2011
early 2011
AMCLI – CoSA CRE network
Frasson et al – JCM 2012
ST258, ST512 (CC258) ST512
ST258
ST101
ST15
ST147-like
late 2012
late 2012
Source: Rossolini M., 2nd ARHAI Networks Meeting, Berlin 2012
38. Diversity of acquired b-lactamases amongst K.pneumoniae in Greek hospitals
Papagiannitsis et al IJAA 2012 39 178-80
256 KP isolates in 8 Hospitals,
July 2010
22 different β-lactamase
combinations
43% KPC-producers,
11% VIM-producers
Most prevalent combination :
KPC-2 + SHV-12, 33%
39. Report from New York City of 2
infections caused by "pan
resistant" K. pneumoniae
1 patient died
1 had continuing asymptomatic
bacteruria
CID 2009; 49: 271-274
40. PDR: resistant to all classes of antibiotics used for empirical treatment, but
not to Tigecycline (newly introduced at the time)
2 years surveillance, overall mortality 24%
Colistin reg.: mortality = 30%, discharge = 94 ± 62 days
Tigecycline: mortality = 0% , discharge = 35 ± 17 days
Conclusion:
Tigecycline appears to be effective for the successful
treatment of PDR infections, when active in vitro
41. Co-resistance in Carbapenem-R
A.baumannii, P.aeruginosa, K.pneumoniae
blood isolates in Greek hospitals
Procrustes Surveillance System 2013
Kontopidou F. Fighting AntiMicrobial Resistance Meeting, Rome, Dec. 2014
44. • Patient and healthcare- related
prolonged hospital stay,
poor functional status, severe illness, ICU stay,
presence of invasive devices, surgery
exposure to antibiotics
• Setting / environment -related
status of other patients / colonisation pressure
availability of isolation rooms
staff-to-patient ratio
hand-hygiene compliance
climate / temperature / moisture (?)
Temkin et al. Ann. N.Y. Acad. Sci. 2014; 1323: 22–42
Risk factors for hospital-acquired carriage or
infection with CRE
Risk factors for hospital-acquired carriage or
infection with CRE
45. • Sought to elucidate the role of various antibiotics as risk factors for
carbapenem-R ESBL-producing K. pneumoniae,
• Improving upon several methodological shortcomings:
– Appropriate control group (patients potentially at risk for CRKP)
– Case + case – control study
– Case groups with similar co-resistance profiles
– Examine several classes of antibiotics
– Account for duration of antibiotic use
– Allow for sufficiently long exposure period
– Examine potential interaction effects between antibiotics
– Adjustment for confounding factors
46. (1) Duration of exposure to β-lactam/β-
lactamase inhibitor combinations
showed a positive relationship with
ESBL-CRKP infection risk (adjusted
OR = 1.15 per day increase; 95%CI:
1.05-1.26, P = 0.001).
(2) Carbapenems and fluoroquinolones
presented a significant interaction
effect, such that increased exposure
to fluoroquinolones amplified the
effect of carbapenems on ESBL-CRKP
infection risk.
Multivariable analysis (accounting for effects of non-antibiotic exposures
and adjusting for other antibiotics) showed that :
50. Mortality attributable to CAR-Res. K.pneumoniae infections
Mortality attributable to CAR-Res. K.pneumoniae infections
Example Type of study Outcome Mortality
Patel, ICHE 2008,
USA
Matched case-control
CRKP vs CSKP
In-hospital death,
various infections
Crude mortality: 38%
Attributable mortality: 26%
Schwaber, AAC
2008, Israel
Case-case-control,
CRKP, CSKP, NoKP
In-hospital death,
various infections
Crude mortality: 44%
Attributable (vs CSKP): 31%
Attributable (vs S-KP): 42%
Borer, ICHE 2009,
Israel
Matched case-control
CRKP vs CSKP
In-hospital death,
following BSI
Crude mortality: 72%
Attributable mortality: 50%
Chang, JMII,
2011, Taiwan
Matched case-control
CRKP vs CSKP
In-hospital death,
following BSI
Crude mortality: 94%
Attributable mortality: 44%
Ben-David, CMI
2012, Israel
Nested case-control,
CRKP, ESBL-KP, S-kp
In-hospital death,
following BSI
Crude mortality: 69%
Attributable (vs ESBLKP): 30%
Attributable (vs S-KP): 45%
Excess mortality ranging 25% - 50% (CRKP – CSKP difference)
Crude mortality in CRKP infections: 38% - 94%
51. Mortality attributable to CRE infections
Mortality attributable to CRE infections
Falagas et al EID 2014; 20:1170–5
52. Advanced Age
Severity of illness, severe sepsis/shock
Severe comorbidities
Carbapenem Resistance
Inappropriate therapy (no active antibiotic)
Monotherapy (???)
Ben David D et al. Clin. Microbiol. Infect 2012
Zarkotou O et al. Clin. Microbiol. Infect 2011
Mouloudi E et al. Infect. Control Hosp. Epidemiol 2010
Qureshi ZA et al. Antimicrob Agents Chemother. 2012
Daikos GL et al. Antimicrob. Agents Chemother 2014
Predictors of death due to CRKP bacteremia
Predictors of death due to CRKP bacteremia
53. Epidemiological & clinical importance of CRE
Epidemiological & clinical importance of CRE
- Potential for rapid spread in health-care settings
- Resistance is highly transmissible and fast evolving
- Between patients
- Between bacteria - plasmids
- Potential of spread into the community
- Limited/suboptimal treatment options
- XDR/PDR phenotypes
- difficulties in laboratory detection
- could take decades for new effective antibiotics
- High morbidity and mortality burden
55. Treatment options for infections with CR-GNB
Treatment options for infections with CR-GNB
- Colistin (polymyxin E)
- Commonly used, as monotherapy or as the base of combination therapy (which is better?)
- Frequent adjuvants in combination therapy: carbapenems, aminoglycosides, tigecycline
(which is better?)
- Ideal dose for colistin is uncertain.
- Polymyxin B
- Limited clinical experience, a few small case series.
- Carbapenems
- Used succesfully as adjuvants in combination regimens (for relatively low MICs, 4-8 mg/L).
- Is there a potential additive or synergistic activity with col, tig or gentamycin?
- Are carbapenem-containing combinations the best option?
- Could double-carbapenem combinations be more effective (extend to higher MICS)?
56. - Tigecycline
- Used as an adjuvant in combination therapy
- Monotherapy is not recommended
- Could increasing the dose improve patient outcomes? BMC Anesthesiol 2013;13:1-8.
- Might a triple combination regimen colistin + meropenem + tigecycline be best?
- Fosfomycin
- Limited clinical experience.
- Not available in many countries, has been used succesfully in Greece mostly as an adjuvant.
- Could it be selected as salvage therapy?
- In development
- 3-4 new drugs are expexted to be available in the near future, but none active against the
entire spectrum of CR-GNB.
57. Clin Microbiol Infect 2010; 16: 102–111
“Limited clinical experience and several in vitro synergy studies seem to support
the view that antibiotic combinations should be preferred to monotherapies.”
But, in light of the data available to date, it is currently impossible to quantify the
real advantage of drug combinations in the treatment of these infections.
58. Tzouvelekis et al. Clin Microbiol Infect. 2014 Sep;20(9):862-72
Review of 20 clinical studies:
907 serious infections with KP producing KPC (75%), VIM(21%), OXA-48 (4%)
affecting mostly ICU patients (70%)
combination therapy with two or more in vitro active agents was superior to
monotherapy, providing a clear survival benefit (mortality rate, 27.4% vs.
38.7%; p <0.001).”
“The lowest mortality rate (18.8%) was observed in patients treated with
carbapenem-containing combinations”
59. Tzouvelekis et al. Clin Microbiol Infect. 2014 Sep;20(9):862-72
Regimen B vs. regimen A: p, not significant.
Regimens C, C1 and C2 vs. regimen B: p 0.001, p 0.034, and p <0.0001, respectively.
Numbers above columns indicate the number of patients
60. Limitations of (many of) these studies
Limitations of (many of) these studies
- Inclusion of Carbapenem-susceptible isolates
(bias in favour of combination therapy)
- Small sample size
forbids adjustment for (the many) other mortality risk factors
many different regimens involved more risk of chance findings
- Important confounders ignored
(appropriateness of empirical therapy and time to covering antibiotic treatment)
- Varying definitions of combination therapy
(any 2 drugs, at least one covering, two covering)
- Colistin loading doses not reported
(bias against colistin monotherapy)
- Single hospital studies
- Previous reviews lacked a rigorous meta-analysis
61.
62. Paul et al. J. Antimicrob. Chemother. 2014;
jac.dku168
All-cause mortality for colistin
monotherapy versus combination
therapy including colistin.
63.
64. VAP due to XDR Acinetobacter baumannii, ICU patients (n=93)
University Hospital of Heraklion, Greece (Oct.2012- Mar.2015)
65. Conclusions
Conclusions
CR-GNB present a major challenge for health-care systems worldwide
Can rapidly spread in health-care settings
Resistance is highly transmissible and fast evolving,
between patients and between bacteria
High potential of spread into the community
Lack of new treatment options, high mortality burden
There are weak evidence suggesting that combination therapy may be
considered the optimal therapy for CR-GNB infections, but:
Before adopting combination therapy as a standard of care, clinicians
should judiciously examine the available data and counterweight
against the increased risk of adverse effects, such as the development,
or promotion of resistance.