Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria?

Exner, Martin; Bhattacharya, Sanjay; Christiansen, Bärbel; Gebel, Jürgen; Goroncy‐Bermes, Peter; Hartemann, Philippe; Heeg, Peter; Ilschner, Carola; Krämer, Axel; Larson, Elaine; Merkens, Wolfgang; Mielke, Martin; Oltmanns, Peter; Ross, Birgit; Rotter, M.; Schmithausen, Ricarda Maria; Sonntag, Hans‐Günther; Trautmann, Matthias

doi:10.3205/dgkh000290

Cited by 189 publications

(82 citation statements)

References 156 publications

(167 reference statements)

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“…Acinetobacter species and Pseudomonas aeruginosa have long been recognized as major causes of nosocomial infections over the world, with a wide range of antibiotic resistance, which makes them a hazard in the hospital setting, as seen by periodic outbreaks, and has posed considerable issues for healthcare management around the world. 20 , 44 In the present study, Acinetobacter species and Pseudomonas aeruginosa isolates revealed high levels of resistance to Piperacillin tazobactam 50 (66.7%), and Aztreonam 26 (56.5%). This might be due to the wide availability and the blind prescription of these antibiotics in the areas.…”

Section: Discussionsupporting

confidence: 47%

Emergence of High Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase Producing Acinetobacter Species and Pseudomonas aeruginosa Among Hospitalized Patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia

Tilahun¹,

Gedefie²,

Bisetegn³

et al. 2022

IDR

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Background The emergence of extended spectrum beta lactamase and carbapenemase production of Acinetobacter and Pseudomonas aeruginosa is a great concern and major cause of nosocomial infections due to its ability to production of extended spectrum beta lactamase and carbapenemase enzymes. Objective To assess Emergence of high prevalence of extended-spectrum beta-lactamase and Carbapenemase producing Acinetobacter species and Pseudomonas aeruginosa among hospitalized patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted from February–August 2021 at Dessie Referral Hospital in the North eastern Ethiopia. A total of 423 clinical samples taken from admitted patients. Clinical specimens were collected aseptically and inoculated on blood agar and MacConkey agar media. Antimicrobial susceptibility test, ESBL and carbapenemase production were performed as CLSI guideline. The data were entered into the Epi-data and imported to Statistical Package for Social Science version 25. P value of <0.05 with odds ratio and 95% confidence interval was considered as statistically significant. Results Out of 423 clinical specimens 17.7% (75/423) were culture positive nosocomial infection. The proportions of nosocomial infection were higher in blood stream followed by wound infection which accounted 24.6%, 20.8%, respectively. Overall, 32/75 (42.7%) and 19/75 (25.3%) patients had infection with ESBL and CP producing bacterial infection. P. aeruginosa was the most predominant isolated bacteria 46/75 (52.9%). The overall multidrug resistance rate of the isolated bacteria was 88% (66/75). The majority of highest resistance rate was Piperacillin tazobactam 50 (66.7%) and Aztreonam 26 (56.5%), respectively, while least resistance rate was Amikacin 27 (36%). Conclusion The incidence rates of ESBL, carbapenemase production and antimicrobial resistant Acinetobacter species and P. aeruginosa infections are high. Therefore, treatment should be based on culture and antimicrobial test result and minimize the use of antibiotics empirically.

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Section: Discussionsupporting

confidence: 47%

Emergence of High Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase Producing Acinetobacter Species and Pseudomonas aeruginosa Among Hospitalized Patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia

Tilahun¹,

Gedefie²,

Bisetegn³

et al. 2022

IDR

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“…Antibiotic resistance is a global public health and clinical challenge [ 1 ]. Many expert reports and clinical guidelines have been published to highlight and address this concern [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Dose Optimization of Colistin: A Systematic Review

et al. 2021

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Colistin is considered a last treatment option for multi-drug and extensively resistant Gram-negative infections. We aimed to assess the available data on the dosing strategy of colistin. A systematic review was performed to identify all published studies on the dose optimization of colistin. Grey literature and electronic databases were searched. Data were collected in a specified form and the quality of the included articles was then assessed using the Newcastle-Ottawa scale for cohort studies, the Cochrane bias tool for randomized clinical trials (RCT), and the Joanna Briggs Institute (JBI) critical checklist for case reports. A total of 19 studies were included, of which 16 were cohort studies, one was a RCT, and two were case reports. A total of 18 studies proposed a dosing regimen for adults, while only one study proposed a dosing schedule for pediatric populations. As per the available evidence, a loading dose of 9 million international units (MIU) of colistin followed by a maintenance dose of 4.5 MIU every 12 h was considered the most appropriate dosing strategy to optimize the safety and efficacy of treatment and improve clinical outcomes. This review supports the administration of a loading dose followed by a maintenance dose of colistin in severe and life-threatening multi-drug Gram-negative bacterial infections.

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“…However, environmental heavy metal contamination may play a role in selection for plasmid-derived antibiotic resistance within the natural reservoirs for RGNB including water, soil, sewage, and the gut of animals, including humans. 51 …”

Section: Discussionmentioning

confidence: 99%