A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis

Rello, Jordi; Eshwara, Vandana Kalwaje; Lagunes, Leo; Alves, Joana; Wunderink, Richard G.; Morris, Andrew Conway; Rojas, Jose Nicolas; Alp, Emine; Zhang, Zhongheng

doi:10.1007/s10096-018-3428-y

Cited by 110 publications

(83 citation statements)

References 24 publications

(19 reference statements)

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“…Antimicrobials are the primary treatment strategy but options can be severely limited by AMR, particularly for thirdgeneration cephalosporin-and carbapenem-resistant strains causing invasive infections [2]. Concomitant with this are elevated mortality rates and treatment costs [3].…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

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Background: Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extendedspectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. Methods: We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. Results: K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 Kloci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae.Conclusions: K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.

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Section: Introductionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

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“…Despite the fact that there was a reduction in deaths from pneumonia of 36% between 2007 and 2017 in children under the age of five, the rate has risen by 34% among older adults (≥70 years) [1]. During the last few decades, the amount of pneumonia patients requiring intensive care management has increased overall, with the emergence of multidrug-resistant (MDR) pathogens making pneumonia management increasingly difficult for physicians [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Can Artificial Intelligence Improve the Management of Pneumonia

Chumbita

Cillóniz

Puerta‐Alcalde

et al. 2020

JCM

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The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia.

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“…cloacae has been reported as important opportunistic and multiresistant pathogen involved in outbreaks of hospital-acquired infections in Europe, particularly in France [44]. ESBL- S. marcescens has also been classified as one of the top ten priority pathogens causing infections in intensive care units [45]. The high prevalence of CR Enterobacteriaceae encountered in this study is really concerning, since wildlife is not directly exposed to any antimicrobial agents.…”

Section: Discussionmentioning

confidence: 87%

High prevalence and diversity of Extended-Spectrum β-Lactamase and emergence of Carbapenemase producingEnterobacteriaceaespp in wildlife in Catalonia

Darwich

Vidal

Seminati

et al. 2019

Preprint

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19In wildlife, most of the studies focused on antimicrobial resistance (AMR) describe 20 Escherichia coli as the principal indicator of the selective pressure. In the present study, 21 new species of Enterobacteriaceae with a large panel of cephalosporin resistant (CR) 22 genes have been isolated from wildlife in Catalonia. A total of 307 wild animals were 23 examined to determine CR enterobacteria prevalence, AMR phenotypes and common 24 carbapenem and CR gene expression. The overall prevalence of CR-phenotype was 25 13% (40/307): 17.3% in wild mammals (18/104) and 11.5% in wild birds (22/191) 26 (p<0.01)). Hedgehogs presented the largest prevalence with 13.5% (14/104) of the 27 mammal specimens, followed by raptors with 7.3% (14/191) of the total bird specimens. 28Although CR E. coli was obtained most frequently (45%), other CR- 29Enterobacteriaceae spp like Klebsiella pneumoniae (20%), Citrobacter freundii (15%), 30 Enterobacter cloacae (5%), Proteus mirabilis (5%), Providencia spp (5%) and Serratia 31 marcescens (2.5%) were isolated. A high diversity of CR genes was identified among 32 the isolates, with 50% yielding blaCMY-2, 23% blaSHV-12, 20% blaCMY-1 and 18% 33 blaCTX-M-15. Additionally, new CR-gene variants and resistance to carbapenems 34 associated to OXA-48 were found. Most of the CR isolates, principally K. pneumoniae 35 and C. freundii, were multiresistant with co-resistance to fluoroquinolones, tetracycline, 36 sulphonamides and aminoglycosides. This study describes for the first time in wildlife a 37 high prevalence of Enterobacteriaceae spp harbouring a large variety of carbapenem 38 and CR genes frequently associated to nosocomial human infections. Implementation of 39 control measures to reduce the impact of anthropogenic pressure in the environment is 40 urgently needed. 41 In the last decades, the prevalence of opportunistic and antimicrobial resistant (AMR) 44 bacteria associated with nosocomial infections has suffered an important increase in 45 hospital settings. The overuse of antibiotics in human and veterinary medicine have led 46 to the spread of AMR pathogens, becoming a global health problem [1]. 47 Extended-spectrum β-lactamases (ESBLs) and plasmid-mediated AmpC-type β-48 lactamases (pAmpC) are the most common enzymes that confer resistance to broad-49 spectrum cephalosporins among members of the family Enterobacteriaceae. These β-50 lactamases have extensively diversified in response to the clinical use of new generation 51 drugs: cephalosporins, carbapenems and monobactams [2]. These enzymes are mostly 52 encoded by genes located in plasmids that can be horizontally transferred to different 53 bacteria genera [1]. Carbapenems are last-line beta-lactam antibiotics with the broadest 54 spectrum of activity. Unfortunately, carbapenems nowadays are commonly used in 55 hospital settings for the treatment of life-threatening infections caused by cephalosporin 56 resistant (CR) Enterobacteriaceae. However, the emergence of resistance to 57 carbapenems mediated by the produ...

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A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis

Cited by 110 publications

References 24 publications

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Can Artificial Intelligence Improve the Management of Pneumonia

High prevalence and diversity of Extended-Spectrum β-Lactamase and emergence of Carbapenemase producingEnterobacteriaceaespp in wildlife in Catalonia

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