Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: A descriptive study

Irfan, Seema; Idrees, Faiza; Mehraj, Vikram; Habib, Faizah; Adil, Salman Naseem; Hasan, Rumina

doi:10.1186/1471-2334-8-80

Cited by 76 publications

(70 citation statements)

References 14 publications

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“…We report an overall mortality of 9.9%, which is lower than that reported (30%) from France (43) reported that the local prevalence and bacterial resistance patterns determine the choice of first-line empiric therapy (44). Hence, the varied susceptibility pattern reported in our study indicates the importance of appropriate selection of antibiotics based on the local prevalence of microorganisms for the treatment of pneumonia infections.…”

Section: Discussioncontrasting

confidence: 51%

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

Zhou

Zhao

2017

Jundishapur J Microbiol

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Background: Lung cancer is the most common cancer and the leading cause of cancer deaths. Streptococcus pneumoniae is the most common pathogen found among lung cancer patients that has shown increased resistance towards various antibiotics. Reports on bacterial colonization especially S. pneumoniae colonization in patients with lung cancer are scarce. Objectives: The study aimed to determine the prevalence and antibiotic resistance of S. pneumoniae isolated from lung cancer patients with pneumonia infection not undergoing any surgical procedure. Methods: Bronchoalveolar lavage (BAL) and blood samples for blood culture and PCR were collected from 152 lung cancer patients with pneumonia. Blood culture and BAL specimens were cultured to isolate S. pneumoniae and antibiotic resistance was determined by minimum inhibitory concentration assay. Results: Of the 152 blood samples, 85 (55.9%) samples from blood culture method and 97 (63.8%) samples from BAL specimens were positive for bacterial growth. Streptococcus pneumoniae was the predominant organism isolated from both blood culture (45.9%) and BAL (46.4%) specimens. Forty-seven (30.9%) samples were found to be positive for S. pneumoniae by PCR. The detection of S. pneumoniae in 60 patients by at least one of the 3 detection methods indicates that these patients harbored S. pneumoniae infection. Fifteen (9.9%) patients died due to the severity of pneumonia, rapid progression of lung cancer, multiple therapeutic failures, and unknown etiology. All our isolates were susceptible to penicillin; however, 48.7% and 60% of the isolates respectively from blood culture and BAL specimens were found to be resistant to erythromycin. Conclusions: Streptococcus pneumoniae was the predominant organism colonized in lung cancer patients diagnosed to have pneumonia and showed higher resistance towards erythromycin. Our results emphasize the need for a continuous monitoring of S. pneumoniae colonization and resistance patterns, which needs to be considered during treatment of lung cancer patients with pneumonia.

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Section: Discussioncontrasting

confidence: 51%

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

Zhou

Zhao

2017

Jundishapur J Microbiol

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“…Similarly, resistance to cefepime, piperacillin-tazobactam and fluoroquinolone was 53% v. 43%, 48% v. 42% and 46% v. 31%, respectively [28]. A study on bacteraemic isolates of febrile neutropenic patients in Pakistan [29] showed an increase in IPM resistance from 0% in 1999-2000 to 37% in 2001-2006 in the A large proportion of the CA-R isolates in our study were found to be MBL producers. In India, MBL-producing P. aeruginosa was first reported in 2002 [31].…”

Section: Resultsmentioning

confidence: 99%

Phenotypic characterization and colistin susceptibilities of carbapenem-resistant of Pseudomonas aeruginosa and Acinetobacter spp.

Mohanty

Maurya

Gaind

et al. 2013

J Infect Dev Ctries

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Introduction: Pseudomonas aeruginosa and Acinetobcter spp. are important nosocomial pathogens and carbapenem resistance is an emerging threat. Therapeutic options for infections with these isolates include colistin. This study was conducted to determine the prevalence of carbapenem resistance in P. aeruginosa and Acinetobacter spp. bloodstream isolates, phenotypically characterize the resistance mechanisms and evaluate the invitro activity of colistin. Methodology: Consecutive 145 (95 P.aeruginosa and 50 Acinetobacter spp.) non-repeat isolates were included. Antibiotic susceptibility testing was performed per CLSI guidelines. MIC for carbapenems and colistin was performed using Etest. Isolates showing reduced susceptibility or resistance to the carbapenems were tested for metallo-β-lactamase (MBL) production using imipenem-EDTA combined disk and MBL Etest. Results: Carbapenem resistance was observed in 40% P. aeruginosa and 66.0% Acinetobacter spp. Carbapenem-resistant (CA-R) isolates were significantly (p< 0.05) more frequently resistant to the other antibiotics than carbapenem-susceptible isolates. Approximately half of the CA-R strains were multidrug-resistant, and 3.1-5.5% were resistant to all antibiotics tested. MBL was found in 76.3% and 69.7% of the P. aeruginosa and Acinetobacter spp., respectively. Colistin resistance was observed in three (6.0%) Acinetobacter isolates and eight (8.4%) P. aeruginosa. MIC 50 for carbapenems were two to four times higher for MBL-positive compared to MBL-negative isolates, but no difference was seen in MIC for colistin. Conclusion: Carbapenem resistance was observed to be mediated by MBL in a considerable number of isolates. Colistin is an alternative for infections caused by CA-R isolates; however, MIC testing should be performed whenever clinical use of colistin is considered.

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“…also showed high prevalence of antimicrobial resistance in neutropenic patients. [25][26][27][28][29][30][31] Less common were CR Enterobacteriaceae, documented mainly from countries with high CR-Kp prevalence. 11,13,15 Only two studies in our review analysed molecular mechanisms of carbapenem resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Antimicrobial susceptibility testing was documented according to the CLSI in 16 studies 12,14,17,18,22,23,25,28,[31][32][33][35][36][37][38]40 and according to EUCAST or to Swedish Reference Group for Antibiotics (SRGA) breakpoints in two studies, 11,21 while for the others the testing method was not documented. Only two reports performed molecular characterization of CR strains.…”

Section: 39mentioning

confidence: 99%

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

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Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: A descriptive study

Abstract: Background: This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species.

Cited by 76 publications

References 14 publications

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

Phenotypic characterization and colistin susceptibilities of carbapenem-resistant of Pseudomonas aeruginosa and Acinetobacter spp.

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

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