A Review on Bacterial Resistance to Carbapenems: epidemiology, Detection and Treatment Options

Elshamy, Ann A; Aboshanab, Khaled M.

doi:10.2144/fsoa-2019-0098

Cited by 149 publications

(116 citation statements)

References 136 publications

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“…The increasing incidence of CRAB infections is becoming a pivotal concern for public health since the carbapenem drug group is considered the last resort for the treatment of severe infections caused by A. baumannii [10]. Notably, the World Health Organization (WHO) lists CRAB in the critical priority category according to the urgency of their need for new antimicrobial drugs [24].…”

Section: Discussionmentioning

confidence: 99%

“…Carbapenems have long been considered as a last resort to treat infections caused by MDR Gram-negative bacteria, but recently, carbapenem resistance has been increasingly common in A. baumannii [10]. Several resistance mechanisms of A. baumannii against carbapenems have been reported, including antimicrobial-inactivating enzymes, efflux pump, loss of the CarO outer membrane porin, and decreased target access [3,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

et al. 2020

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Carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical health concern for the treatment of infectious diseases. The aim of this study was to investigate the molecular epidemiology of CRAB emphasizing the presence of oxacillinase (OXA)-type β-lactamase-encoding genes, one of the most important carbapenem resistance mechanisms. In this study, a total of 183 non-repetitive CRAB isolates collected from 11 tertiary care hospitals across Thailand were investigated. As a result, the blaoxa-51-like gene, an intrinsic enzyme marker, was detected in all clinical isolates. The blaoxa-23-like gene was presented in the majority of isolates (68.31%). In contrast, the prevalence rates of blaoxa-40/24-like and blaoxa-58-like gene occurrences in CRAB isolates were only 4.92% and 1.09%, respectively. All isolates were resistant to carbapenems, with 100% resistance to imipenem, followed by meropenem (98.91%) and doripenem (94.54%). Most isolates showed high resistance rates to ciprofloxacin (97.81%), ceftazidime (96.72%), gentamicin (91.26%), and amikacin (80.87%). Interestingly, colistin was found to be a potential drug of choice due to the high susceptibility of the tested isolates to this antimicrobial (87.98%). Most CRAB isolates in Thailand were of ST2 lineage, but some belonged to ST25, ST98, ST129, ST164, ST215, ST338, and ST745. Further studies to monitor the spread of carbapenem-resistant OXA-type β-lactamase genes from A. baumannii in hospital settings are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

et al. 2020

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“…Carbapenems are antimicrobials used for the treatment of infections caused by multidrug-resistant gram-negative pathogens. However, some carbapenem resistance mechanisms are transferable to other bacterial species [15]. Hence, the monitoring of carbapenem resistance in C. difficile is justified.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Sholeh

Krutova

Forouzesh

et al. 2020

Antimicrob Resist Infect Control

106

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Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates.

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“…represent a major public health concern. 1,2 The most clinically relevant carbapenemases belong to Ambler class A, class B (metallo-b-lactamases [MBLs]), or class D (Oxacillinases; carbapenem hydrolyzing class D b-lactamases [CHDLs]). KPC-type enzymes are the most worldwide disseminated Ambler class A carbapenemases 3 ; NDM, VIM, and IMP-types are the most prevalent Class B carbapenemases (MBLs) 4,5 ; and OXA-48-like carbapenemases in Enterobacterales, 6 OXA-23, OXA-24/-40, OXA-58, OXA-143, the overexpressed chromosomally encoded OXA-51-like enzymes in Acinetobacter sp.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Novodiag CarbaR+, a Novel Integrated Sample to Result Platform for the Multiplex Qualitative Detection of Carbapenem and Colistin Resistance Markers

Girlich

Bogaerts

Bouchahrouf

et al. 2021

Microbial Drug Resistance

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Objectives: This study evaluated the performance of the Novodiag Ò CarbaR+ an automated qualitative nucleic acid-based diagnostic assay detecting the bla VIM , bla NDM , bla IMP , bla OXA-48 , bla KPC , bla OXA-23 , bla OXA-58 , bla OXA-24 , and ISAba1 associated bla OXA-51 carbapenemase genes and colistin resistance mcr-1 gene from clinical isolates or directly from rectal swabs. Materials and Methods: CarbaR+ was evaluated on 201 clinical isolates and on 100 rectal swabs (80 selected swabs from patients that were evaluated by culture method and/or Xpert Carba-R assay and 20 spiked samples). PCR-sequencing on colonies was considered as the gold standard. Results: The CarbaR+ detected all the variants of the targeted resistance genes (39 bla VIM-, 30 bla NDM-, 20 bla IMP-, 19 bla OXA-48-, 15 bla KPC-, 19 bla OXA-23-, 13 bla OXA-58-, 4 bla OXA-24-, 8 ISAba1-bla OXA-51-, and 3 mcr-1like genes) with sensitivity and specificity of 98.2% and 99.7%, respectively. On the 80 rectal swabs, 71 CarbaR+ results were fully concordant with the results on selective culture media (66 positive samples with 1 to 3 carbapenemases and 5 negative samples). In eight rectal swabs, CarbaR+ identified additional carbapenemase genes. One false negative result with an Escherichia coli producing-OXA-181 was observed and one CarbaR+ result for OXA-48 was in agreement with Xpert Carba-R assay, without growth on culture media. A concordance of 100% was observed on spiked samples. Conclusions: Novodiag CarbaR+ is a random-access fully automated system that achieves excellent performances for the detection of carbapenemase and/or colistin resistance determinants either from cultured clinical isolates or directly from rectal swabs in 80 minutes.

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A Review on Bacterial Resistance to Carbapenems: epidemiology, Detection and Treatment Options

Cited by 149 publications

References 136 publications

Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

Prevalence of OXA-Type β-Lactamase Genes among Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates in Thailand

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Evaluation of the Novodiag CarbaR+, a Novel Integrated Sample to Result Platform for the Multiplex Qualitative Detection of Carbapenem and Colistin Resistance Markers

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