Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection: a meta-analysis

Liu, Qianqian; Li, Xiaoqing; Li, Wenzhang; Du, Xinmiao; He, Jian‐Qing; Tao, Chuanmin; Feng, Yu

doi:10.1038/srep11715

Cited by 65 publications

(42 citation statements)

References 37 publications

(45 reference statements)

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“…This probably will present a particular challenge and could results in a major global problem since carbapenems are the final choice in the treatment of the difficult-to-treat pseudomonal infections and they are often the last resort for treating infections due to multidrug resistant isolates (Nordmann, 2010). The emerging carbapenem resistance will be very dangerous and of serious complications resulting in pan drug resistant strains leading to increased mortality rates (Hong et al, 2015;Liu et al, 2015).In the present study, the resistance rate to imipenem was relatively low and accounted for only 1%. Except for a single isolate which was found to be imipenem resistant with an MIC of 16 µg/ml, all isolates were sensitive to imipenem with MIC of 4 µg/ml, MIC 50 and MIC 90 were equal to 4 µg/ml.…”

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confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

Zowalaty

Gyetvai

2016

Polish Journal of Microbiology

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A b s t r a c tPseudomonas aeruginosa is a leading human pathogen that causes serious infections at various tissues and organs leading to life threatening health problems and possible deadly outcomes. Resistance patterns vary widely whether it is from hospitals or community acquired infections. Reporting resistance profiles to a certain antibiotics provide valuable information in a given setting, but may be extrapolated outside the sampling location. In the present study, P. aeruginosa isolates were screened to determine their susceptibilities against antipseudomonal antimicrobial agents and possible existing mechanisms of resistance were determined. Eighty-six isolates of P. aeruginosa were recovered. Isolates representing different resistance profiles were screened for the existence of three different resistance mechanisms including drug inactivation due to metallo-β-lactamases, drug impermeability by outer membrane proteins and drug efflux. All tested isolates showed uniform susceptibility (100%, n = 86/86) to piperacillin, meropenem, amikacin, and polymyxin B. A single isolate was found to be imipenem resistant (99%, n = 85/86). The possible mechanisms of resistance of P. aeruginosa to imipenem involve active drug efflux pumps, outer membrane impermeability as well as drug inactivating enzymes. These findings demonstrate the fundamental importance of the in vitro susceptibility testing of antibiotics prior to antipseudomonal therapy and highlight the need for a continuous antimicrobial resistance surveillance programs to monitor the changing resistance patterns so that clinicians and health care officials are updated as to the most effective therapeutic agents to combat the serious outcomes of P. aeruginosa infections. This copy is for personal use only -distribution prohibited.El Zowalaty M.E. and Gyetvai B.1 24 anti biotics (El Zowalaty et al., 2015). The literature is rich in surveillance studies from all over the world reporting varying resistance rates among P. aeruginosa against different antimicrobial agent. Recently, studies have focused on the decreased susceptibility of P. aeru ginosa to currently used antipseudomonal agents, including β-lactams, aminoglycosides, and fluoroquinolones (Al-Tawfiq, 2007) since resistance of P. aeru ginosa to carbapenems, piperacillin, and other highly active antibiotics has emerged and is increasing which makes treatment of P. aeruginosa infections troublesome (Strateva et al., 2007).Recently, resistance rates of P. aeruginosa clinical isolates recovered from patients admitted to Zagazig University hospitals in Egypt against different classes of antimicrobial agents were reported (El Zowalaty, 2012). The current study further examined the susceptibilities and possible resistance mechanisms of P. aeruginosa isolates collected from hospitalized patients against selected antipseudomonal agents that are available in the Egyptian pharmaceutical market and are frequently prescribed to patients. Experimental Materials and MethodsStudy site. The specimens were collected from ...

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confidence: 75%

Section: Discussionmentioning

confidence: 99%

Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

Zowalaty

Gyetvai

2016

Polish Journal of Microbiology

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“…Of note, carbapenem resistance in A. baumannii more than doubled between 2003/2005 and 2009/2012 (21.0% to 47.9%) [18]. The high rates of resistance in nonfermenters are of significant concern, as carbapenem resistance is associated with a more than 2-fold increase in mortality for both P. aeruginosa (adjusted OR, 2.38) [19] and Acinetobacter (adjusted OR, 2.49) [20]. …”

Section: Discussionmentioning

confidence: 99%

“…Pneumonia is a leading cause of death among hospital patients in the United States [21] and is a particular problem in the ICU. The mean hospital stay for P. aeruginosa pneumonia in US ICUs is 55.4 days per patient, and the mortality rate is >20% [22], a frequency that likely increases with carbapenem resistance [19]. These grim statistics highlight the clinical relevance of high Carb-NS rates in respiratory P. aeruginosa isolates and the vital need for more therapeutic options to treat carbapenem-resistant Gram-negative respiratory infections.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

McCann

Srinivasan

DeRyke

et al. 2018

Open Forum Infectious Diseases

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BackgroundInfections caused by Gram-negative pathogens resistant to carbapenems have limited treatment options and are associated with increased morbidity and mortality. We evaluated the rates, infection sources, and pathogen types associated with carbapenem-nonsusceptible (Carb-NS) Gram-negative isolates in intensive care unit (ICU) and non-ICU settings in a large US hospital database.MethodsWe conducted a retrospective cross-sectional analysis of carbapenem susceptibility of all nonduplicate isolates of Gram-negative pathogens collected from January 1, 2017, to December 31, 2017, at 358 US hospitals in the BD Insights Research Database. Carb-NS isolates included all pathogens reported at the institutional level as intermediate or resistant.ResultsOf 312 075 nonduplicate Gram-negative isolates, 10 698 (3.4%) were Carb-NS. Respiratory samples were the most frequent source of Carb-NS isolates (35.2%); skin/wound accounted for 23.6%. Pseudomonas aeruginosa was the most common Carb-NS pathogen (58.5% of isolates), and about 30% were Enterobacteriaceae. The highest rates of Carb-NS were found in Acinetobacter spp. (35.6%) and P. aeruginosa (14.6%). The rate of Carb-NS was significantly higher in ICU (5.4%) vs non-ICU settings (2.7%; P < .0001 in univariate analysis). This difference remained significant in multivariable analysis after adjusting for infection and hospital characteristics (odds ratio, 1.35; 95% confidence interval, 1.17–1.56; P < .0001).ConclusionsInfections caused by Carb-NS isolates pose a significant clinical problem across different sources of infection, species of pathogen, and hospital settings. Widespread infection prevention and antimicrobial stewardship initiatives, in combination with new treatment options, may be required to reduce the burden of carbapenem resistance in health care settings.

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“…This is consistent with a report published in 2002 in Mangalore, India 23 . The emergence of carbapenem resistance is a serious concern 24 . In various studies across the world, varying rates of resistance from 4-60% have been reported for imipenem and meropenem 25 .…”

Section: Figure 4: Distribution Of P Aeruginosa Isolates According Tmentioning

confidence: 99%

Prevalence of Pseudomonas Aeruginosa (P. Aeruginosa) and Antimicrobial Susceptibility Patterns at a Private Hospital in Sana'a, Yemen

2018

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Objective: Pseudomonas aeruginosa is clinically significant and opportunistic pathogen that causes infections in hospitalized patients. Antibiotic resistance is a major concern in clinical practice. The ongoing emergence of resistant strains that cause nosocomial infections contributes substantially to the morbidity and mortality of hospitalized patients. Objective of present study was to estimate the prevalence of Pseudomonas aeruginosa and the antimicrobial resistance patterns of P. aeruginosa isolates from hospitalized patients. Methods: The study was performed at microbiology department of a local hospital in Sana'a, Yemen. All the patients' samples of hospital departments from January, 2017 to December, 2017 were included. A Total of 2079 samples were collected during the study period. Among them, 193 strains of Pseudomonas spp. were isolated. One hundred ninety three isolates of P. aeruginosa were isolated from different clinical specimens and fully characterized by standard bacteriological procedures. Antimicrobial susceptibility pattern of each isolates was carried out by the Kirby-Bauer disk diffusion method as per CLSI guidelines. Majority of P. aeruginosa were isolated from Sputum, followed by urine specimens. Results: The isolate pathogen showed the highest sensitive to Meropenem (85.5%), followed by Amikacin (80.5%), Imipenem (80.0%), and Piperacillin/tazobactam (77.2). The highest frequency of resistance (96.2%) was observed with amoxicillin /clavulinic Acid followed by cefuroxime 94.6%, ampicillin/ sulbactam 94.5%, Co-Trimoxzole 80.5%, and norfloxacin 54%. Conclusion: The result confirmed the occurrence of drug resistance strains of P. aeruginosa. Meropenem, imipenem, and amikacin, were found to be the most effective antimicrobial drugs. It therefore calls for a very judicious, appropriate treatment regimens selection by the physicians to limit the further spread of antimicrobial resistance P. aeruginosa.

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Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection: a meta-analysis

Cited by 65 publications

References 37 publications

Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

Prevalence of Pseudomonas Aeruginosa (P. Aeruginosa) and Antimicrobial Susceptibility Patterns at a Private Hospital in Sana'a, Yemen

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