Extensive drug resistant Acinetobacter baumannii: a comparative study between non-colistin based combinations

Elsayed, Eman; Elarabi, Mohamed; Sherif, Dana A; Elmorshedi, Mohamed; El-Mashad, Noha

doi:10.1007/s11096-019-00940-1

Cited by 17 publications

(7 citation statements)

References 15 publications

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“…Others have shown a higher prevalence for CRAB reaching 90% [10,25,26], which suggests that Egypt is the topmost country in the region in CRAB prevalence [27]. CRAB treatment typically relies on other last-resort antibiotics such as colistin and tigecycline and sometimes antibiotic combinations [28]. This becomes more challenging when isolates also exhibit resistance to last-resort antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Co-Existence of Carbapenemase-Encoding Genes in Acinetobacter baumannii from Cancer Patients

et al. 2020

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Introduction Acinetobacter baumannii is an opportunistic pathogen, which can acquire new resistance genes. Infections by carbapenem-resistant A. baumannii (CRAB) in cancer patients cause high mortality. Methods CRAB isolates from cancer patients were screened for carbapenemase-encoding genes that belong to Ambler classes (A), (B), and (D), followed by genotypic characterization by enterobacterial-repetitive-Intergenic-consensus–polymerase chain reaction (ERIC–PCR) and multilocus-sequence-typing (MLST). Results A total of 94.1% of CRAB isolates co-harbored more than one carbapenemase-encoding gene. The genes bla NDM , bla OXA-23 -like, and bla KPC showed the highest prevalence, with rates of 23 (67.7%) , 19 (55.9%), and 17 (50%), respectively. ERIC-PCR revealed 19 patterns (grouped into 9 clusters) . MLST analysis identified different sequence types (STs) (ST-268, ST-195, ST-1114, and ST-1632) that belong to the highly resistant easily spreadable International clone II (IC II). Genotype diversity indicated the dissemination of carbapenem-hydrolyzing, β-lactamase-encoding genes among genetically unrelated isolates. We observed a high prevalence of metallo-β-lactamase (MBL)-encoding genes (including the highly-resistant bla NDM gene that is capable of horizontal gene transfer) and of isolates harboring multiple carbapenemase-encoding genes from different classes. Conclusion The findings are alarming and call for measures to prevent and control the spread of MBL-encoding genes among bacteria causing infections in cancer patients and other immunocompromised patient populations.

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Section: Discussionmentioning

confidence: 99%

Co-Existence of Carbapenemase-Encoding Genes in Acinetobacter baumannii from Cancer Patients

et al. 2020

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“…Tigecycline-based combinations are often used in clinical practice against PDRAB [ 124 , 133 ], probably because of MICs closer to the cut-off for susceptibility [ 12 ]. However, based on the limited available data, tigecycline-based (or other tetracyclines, including eravacycline and minocycline) combinations are seldomly synergistic against resistant A. baumannii strains at clinically achievable concentrations [ 12 , 53 , 63 , 71 , 77 , 89 , 96 , 103 , 104 , 117 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant Acinetobacter baumannii

et al. 2021

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Antimicrobial combinations are at the moment the only potential treatment option for pandrug-resistant A. baumannii. A systematic review was conducted in PubMed and Scopus for studies reporting the activity of antimicrobial combinations against A. baumannii resistant to all components of the combination. The clinical relevance of synergistic combinations was assessed based on concentrations achieving synergy and PK/PD models. Eighty-four studies were retrieved including 818 eligible isolates. A variety of combinations (n = 141 double, n = 9 triple) were tested, with a variety of methods. Polymyxin-based combinations were the most studied, either as double or triple combinations with cell-wall acting agents (including sulbactam, carbapenems, glycopeptides), rifamycins and fosfomycin. Non-polymyxin combinations were predominantly based on rifampicin, fosfomycin, sulbactam and avibactam. Several combinations were synergistic at clinically relevant concentrations, while triple combinations appeared more active than the double ones. However, no combination was consistently synergistic against all strains tested. Notably, several studies reported synergy but at concentrations unlikely to be clinically relevant, or the concentration that synergy was observed was unclear. Selecting the most appropriate combinations is likely strain-specific and should be guided by in vitro synergy evaluation. Furthermore, there is an urgent need for clinical studies on the efficacy and safety of such combinations.

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“…Tigecycline-based combinations have also been proposed, but have predominantly been studied against tigecycline-susceptible strains, or in combination with an in vitro active agent (predominantly colistin) [ 163 ]. Although data regarding tigecycline-based combinations against CAPT-resistant GNB are limited, such combinations are often used in clinical practice given the lack of other options [ 158 , 164 ]. Synergistic combinations with minocycline may also prove useful [ 144 ], but currently available data are very limited.…”

Section: Options For Capt-resistant a Baumanniimentioning

confidence: 99%

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

2020

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The management of carbapenem-resistant infections is often based on polymyxins, tigecycline, aminoglycosides and their combinations. However, in a recent systematic review, we found that Gram-negative bacteria (GNB) co-resistant to carbapanems, aminoglycosides, polymyxins and tigecycline (CAPT-resistant) are increasingly being reported worldwide. Clinical data to guide the treatment of CAPT-resistant GNB are scarce and based exclusively on few case reports and small case series, but seem to indicate that appropriate (in vitro active) antimicrobial regimens, including newer antibiotics and synergistic combinations, may be associated with lower mortality. In this review, we consolidate the available literature to inform clinicians dealing with CAPT-resistant GNB about treatment options by considering the mechanisms of resistance to carbapenems. In combination with rapid diagnostic methods that allow fast detection of carbapenemase production, the approach proposed in this review may guide a timely and targeted treatment of patients with infections by CAPT-resistant GNB. Specifically, we focus on the three most problematic species, namely Klebsiella pneumoniae , Pseudomonas aeruginosa and Acinetobacter baumannii . Several treatment options are currently available for CAPT-resistant K. pneumonia . Newer β-lactam-β-lactamase combinations, including the combination of ceftazidime/avibactam with aztreonam against metallo-β-lactamase-producing isolates, appear to be more effective compared to combinations of older agents. Options for P. aeruginosa (especially metallo-β-lactamase-producing strains) and A. baumannii remain limited. Synergistic combination of older agents (e.g., polymyxin- or fosfomycin-based synergistic combinations) may represent a last resort option, but their use against CAPT-resistant GNB requires further study.

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Extensive drug resistant Acinetobacter baumannii: a comparative study between non-colistin based combinations

Cited by 17 publications

References 15 publications

Co-Existence of Carbapenemase-Encoding Genes in Acinetobacter baumannii from Cancer Patients

Co-Existence of Carbapenemase-Encoding Genes in Acinetobacter baumannii from Cancer Patients

Systematic Review of Antimicrobial Combination Options for Pandrug-Resistant Acinetobacter baumannii

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

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