Advances in Antibacterial Therapy Against Emerging Bacterial Pathogens

Pournaras, Spyros; Iosifidis, Εlias; Roilides, Emmanuel

doi:10.1053/j.seminhematol.2009.03.007

Cited by 19 publications

(13 citation statements)

References 109 publications

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“…Patients colonized and/or infected with such bacteria must typically undergo contact isolation, and strict infectious disease control protocols are recommended. [22][23][24][25] Antibiotic options for VRE are limited to linezolid, daptomycin, and quinupristin/dalfopristin. Patients with hematological malignancies are more susceptible to VRE than patients with other malignancies because of the routine use of broad-spectrum antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with hematological malignancies are more susceptible to VRE than patients with other malignancies because of the routine use of broad-spectrum antibiotics. 23,24 In the current study, all 5 patients with VRE bacteremia were receiving antibiotic prophylaxis. Furthermore, 8 of the 32 gram-negative bacteremia isolates obtained during consolidation phases demonstrated reduced sensitivity to first-line antibiotics, although no substantial morbidity or mortality was found to be associated with these bacteria.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

Inaba

Gaur

Cao

et al. 2014

Cancer

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BACKGROUND Intensive chemotherapy for pediatric acute myeloid leukemia (AML) incurs the risk of infectious complications, but the benefits of antibiotic prophylaxis remain unclear. METHODS In 103 children treated on the AML02 protocol between October 2002 and October 2008 at St. Jude Children’s Research Hospital, we retrospectively assessed the effect of antibiotic prophylaxis on the frequency of febrile neutropenia, clinically or microbiologically confirmed infections (including bacteremia), and antibiotic resistance, and on the results of nasal and rectal surveillance cultures. Initially, patients received no prophylaxis or oral cephalosporin (Group A). Then the protocol was amended to give intravenous cefepime alone or intravenous vancomycin plus either oral cephalosporin, oral ciprofloxacin, or intravenous cefepime (Group B). RESULTS There were 334 infectious episodes. Group A had a significantly greater frequency of documented infections and bacteremia (both P < .0001) (including gram-positive and gram-negative bacteremia, P = .0003 and .001, respectively) than Group B, especially viridans streptococcal bacteremia (P = .001). The incidence of febrile neutropenia without documented infection was not different between the two groups. Five cases of bacteremia with vancomycin-resistant enterococci (VRE) occurred in group B (vs. none in Group A), without related mortality. Two of these cases were preceded by positive VRE rectal surveillance cultures. CONCLUSIONS Outpatient intravenous antibiotic prophylaxis is feasible in children with AML and reduces the frequency of documented infection but not of febrile neutropenia. Despite emergence of VRE bacteremia, the benefits favor antibiotic prophylaxis. Creative approaches to shorten the duration of prophylaxis and thereby minimize resistance should be explored.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

Inaba

Gaur

Cao

et al. 2014

Cancer

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“…Emergence of vancomycin-resistant Enterococcus faecium (VRE), firstly reported in 1988, has become a significant challenge to clinicians with regard to limited antimicrobial therapeutic options. [1][2][3] Especially in immunocompromised patients VRE can cause treatment-refractory infections and lead to high mortality rates. [3][4][5][6] Outbreaks of VRE infections constitute the tip of the iceberg and develop in VRE-colonized patients.…”

mentioning

confidence: 99%

Polyclonal Outbreak of Vancomycin-resistant Enterococcus faecium in a Pediatric Oncology Department

Iosifidis

Karakoula

Protonotariou

et al. 2012

Journal of Pediatric Hematology/Oncology

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We present a polyclonal outbreak of vancomycin-resistant enterococci (VRE) colonization in a pediatric oncology department and the role of a bundle of actions. After the occurrence of VRE bloodstream infections in 2 patients, an active surveillance of VRE colonization was started. Enhanced infection control measures and closure of the department to new admissions for the first 3 months were implemented. Among 32 patients screened for VRE, 21 were found colonized. Daily prevalence of VRE colonization among hospitalized patients ranged from 40% to 75%, but no new VRE infections occurred. Monthly incidence of VRE colonization decreased from 2.5 to 0.6 cases per 100 occupied bed-days at the end of this outbreak by the implementation of the above-mentioned measures. All VRE isolates tested were Enterococcus faecium carrying VanA gene. Pulsed field gel electrophoresis showed a polyclonal outbreak. A case-control study did not show any particular risk factors for colonization. High use of glycopeptide was noted before study outbreak that was drastically decreased during the study but only temporarily. Control of VRE in pediatric oncology departments with high colonization rates is challenging and requires a multifaceted strategy. Polyclonal spread of VRE found in this study suggests a possible effect of prior antimicrobial overuse and the critical need for antimicrobial stewardship especially in the era of multidrug-resistant bacteria.

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“…The conventional views on the molecular pathways of septic shock originated from studies investigating Gram-negative endotoxic shock which was believed to be quantitatively of greater importance [18]. However, because of the widespread use of surgically implanted foreign material and changes in microbial resistance and virulence [19], Grampositive organisms are increasingly prevalent and mortality rates from them now may exceed those from Gram-negative organisms [20,21]. This expanding role of Grampositive pathogens in critically ill patients has been emphasised in several reviews [21,22].…”

Section: Differences In Gram-negative and Gram-positive Sepsismentioning

confidence: 99%

The difficulties of clinical trials evaluating therapeutic agents in patients with severe sepsis

et al. 2011

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The design of clinical trials on the septic patient remains a challenge. Methodology must be rigorous if seemingly positive clinical trials which are widely implemented are later discredited as a result of poor study design. Many lessons can be learnt from the study design of the PROWESS trial, however there remains room for improvement. This review serves as a stimulus and guide in motivating much needed high quality clinical trials in sepsis.

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Advances in Antibacterial Therapy Against Emerging Bacterial Pathogens

Cited by 19 publications

References 109 publications

Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

Polyclonal Outbreak of Vancomycin-resistant Enterococcus faecium in a Pediatric Oncology Department

The difficulties of clinical trials evaluating therapeutic agents in patients with severe sepsis

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