How do you solve a problem like multidrug-resistant Gram-negative bacteria?

Gray, J.; Mahida, Nikunj

doi:10.1016/j.jhin.2015.11.005

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…Worldwide, we are witnessing the emergence of MDR strains that may severely compromise the survival chances of patients. The key interventions against this phenomenon are appropriate infection control measures and the more considered use of antimicrobial agents [2]. To save the existing potential antibiotics, the government and physicians should limit the antibiotic prescription to prevent antibiotic resistance; for that reason, people should not easily get access to self-medicated antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Gram-Negative Bacilli: A Retrospective Study of Trends in a Tertiary Healthcare Unit

et al. 2018

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Background and objective: Bacterial multidrug resistance is particularly common in Gram-negative bacilli (GNB), with important clinical consequences regarding their spread and treatment options. The aim of this study was to investigate the trend of multidrug-resistant GNB (MDR-GNB) in high-risk hospital departments, between 2000–2015, in intervals of five years, with the intention of improving antibiotic therapy policies and optimising preventive and control practices. Materials and methods: This is an observational, retrospective study performed in three departments of the most important tertiary healthcare unit in the southwestern part of Romania: the Intensive Care Unit (ICU), the General Surgery Department (GSD), and the Nutrition and Metabolic Diseases Department (NMDD). MDR was defined as acquired resistance to at least one agent in three or more antimicrobial categories. Trends over time were determined by the Cochran–Armitage trend test and linear regression. Results: During the study period, a total of 2531 strains of MDR-GNB were isolated in 1999 patients: 9.20% in 2000, 18.61% in 2005, 37.02% in 2010, and 35.17% in 2015. The most significant increasing trend was recorded in the ICU (gradient = 7.63, R² = 0.842, p < 0.001). The most common MDR-GNB in the ICU was isolated from bronchoalveolar aspiration samples. Concerning the proportion of different species, most of the changes were recorded in the ICU, where a statistically significant increasing trend was observed for Proteus mirabilis (gradient = 2.62, R2 = 0.558, p < 0.001) and Acinetobacter baumannii (gradient = 2.25, R2 = 0.491, p < 0.001). Analysis of the incidence of the main resistance phenotypes proportion identified a statistically significant increase in carbapenem resistance in the ICU (Gradient = 8.27, R² = 0.866, p < 0.001), and an increased proportion of aminoglycoside-resistant strains in all three departments, but more importantly in the ICU and GSD. Conclusion: A statistically significant increasing trend was observed in all three departments; the most significant one was recorded in the ICU, where after 2010, carbapenem-resistant strains were isolated.

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Section: Discussionmentioning

confidence: 99%

“…Over recent years, infections caused by multidrug-resistant (MDR) bacteria have become endemic in many tertiary health care units and hospitals; acquired outbreaks involving such microorganisms are being reported worldwide [1,2,3].…”

Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Gram-Negative Bacilli: A Retrospective Study of Trends in a Tertiary Healthcare Unit

et al. 2018

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“…It is well reported that most nosocomial pathogens may remain on inanimate surfaces for months. In this context, the emergence of resistance to disinfectants is a fact, as well as cross-resistance to antimicrobials [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Is The Disinfection Procedure of The Intensive Care Unit Able To Reduce the Bacterial Resistance and Risk of Contamination?

Abreu

Guzmán

Mata

et al. 2021

Preprint

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Background: Healthcare-associated infections (HAIs) represent one of the main causes for the morbidity and mortality in the intensive care unit (ICU). In this study, we aimed to verify the presence, type, and antimicrobial susceptibility of bacteria in ICU settings, before and after disinfection procedures, and analyze the risk of contamination related to these bacteria in each area of the ICU.Methods: The study was conducted in the ICU of a medium-sized hospital in Brazil from February 2019 to February 2020. Samples were obtained from the surfaces of beds, bathrooms, pantries, sinks, pharmacies, administrative areas, and floors, before and after the disinfection process, with 1% benzalkonium chloride and biguanide mixture (BCB). The samples were processed and inoculated in different culture media for the selective isolation of strains of clinical interest. In addition, phenotypic identification and antimicrobial susceptibility tests were performed using the VITEK® 2 system. We grouped different environmental, temporal, and microbial factors and characteristics to calculate the risk of contamination before disinfection (Rbd) and after disinfection (Rad), as well as the total risk (Rtt) and real risk observed (Foldrisk) in the ICU.Results: Gram-positive cocci and rods, gram-negative rods of the Enterobacteriaceae family, and non-fermenting gram-negative rods were recovered after disinfection and were found to be widely distributed. Higher bacterial diversity and frequency of resistance were observed, mainly the resistance of gram-positive bacteria to cephalosporin (p < 0.05) and lincosamides (p < 0.0001), and gram-negative bacteria to quinolones (p < 0.0001) and aminoglycosides (p < 0.05). The pantry, pharmacy, and beds showed major risks of contamination after disinfection (Rad), ranging from intermediate to very high-risk levels. Foldrisk for the pantry and beds presented a significant increase in two and three risk levels, respectively, after the disinfection process.Conclusions: Our results demonstrate the presence of bacterial pathogens with multidrug-resistant profiles after disinfection with a higher risk of contamination, indicating that challenges still exist in the deployed disinfection protocols in the ICU settings, which are associated with the increased critical risk of HAIs after the disinfection procedure.

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“…Las bacterias Gram negativas extensamente resistentes a los antibióticos son una importante preocupación de salud pública en todo el mundo y representan un reto para la terapia antimicrobiana actual. La mayor incidencia de dichas bacterias ha surgido como uno de los graves problemas a los (9) que se enfrentan los médicos a nivel mundial . La actividad bactericida de esta clase de antibióticos se mantuvo inalterada desde su introducción a pesar de haber sido observada alguna resistencia y (10)(11)(12) existir relatos de asociación de antibióticos para potencializar su efecto bactericida .…”

Section: Entre Los Gérmenes Sensibles Destacan Los Bacilos Gram Negatunclassified

Prevalence of acute renal injury in patients treated with colistin

Gómez

Ortega

2018

Rev. virtual Soc. Parag. Med. Int

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Introducción: la colistina es un antibiótico eficaz para tratar infecciones causadas por bacterias Gram negativas multirresistentes pero tiende a producir injuria renal aguda. Objetivos: determinar la frecuencia de injuria renal aguda en pacientes adultos tratados con colistina e identificar la presencia de afecciones comórbidas asociadas. Metodología: estudio observacional retrospectivo de pacientes tratados con colistina en el Hospital Nacional, Paraguay, en 2016-2017. Resultados: se estudiaron 80 pacientes, siendo 64% del sexo masculino. La edad media fue 50±17 años. La prevalencia de injuria renal aguda fue 70%. Según los criterios RIFLE hubo lesión en 45% de los casos, riesgo de lesión en 25% y no riesgo/no lesión en 30%. Las afecciones comórbidas más frecuentes fueron la hipertensión arterial (61%) y diabetes mellitus (31%). El germen aislado con mayor frecuencia fue Acinetobacter baumannii (57%), Pseudomonas aeruginosa (24%) y Klebsiella pneumoniae (19%). Los antibióticos más utilizados en forma combinada con la colistina fueron la vancomicina (46%) y los carbapenémicos (43%). Conclusiones: la prevalencia de injuria renal aguda fue 70%. Según los criterios RIFLE predominó la lesión. Las afecciones comórbidas más frecuentes fueron la hipertensión arterial y la diabetes mellitus.

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How do you solve a problem like multidrug-resistant Gram-negative bacteria?

Cited by 12 publications

References 16 publications

Multidrug-Resistant Gram-Negative Bacilli: A Retrospective Study of Trends in a Tertiary Healthcare Unit

Multidrug-Resistant Gram-Negative Bacilli: A Retrospective Study of Trends in a Tertiary Healthcare Unit

Is The Disinfection Procedure of The Intensive Care Unit Able To Reduce the Bacterial Resistance and Risk of Contamination?

Prevalence of acute renal injury in patients treated with colistin

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