Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece)

Maltezou, Helena C.; Giakkoupi, Panagiota; Maragos, Antonios; Bolikas, M.; Raftopoulos, Vasilios; Papahatzaki, H.; Vrouhos, G.; Liakou, V; Vatopoulos, Alkiviadis

doi:10.1016/j.jinf.2009.01.010

Cited by 122 publications

(101 citation statements)

References 29 publications

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“…Twenty studies met the inclusion criteria (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The detailed search process and study selection are depicted in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-one studies were excluded because they did not present the clinical outcomes according to the antibiotic treatment administered. Among the included studies, 18 provided data on mortality, including for 651 patients who received definitive antibiotic treatment (9-13, 15-19, 21-28), while two other studies provided data on treatment failure, including for 41 patients who received definitive antibiotic treatment (14,20). The characteristics and outcomes of the included studies according to the studied outcomes are presented in Table 1 and Table 2.…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae: Systematic Evaluation of the Available Evidence

Falagas

Lourida

Poulikakos

et al. 2014

Antimicrob Agents Chemother

322

216

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We sought to evaluate the effectiveness of the antibiotic treatment administered for infections caused by carbapenemase-producing Enterobacteriaceae. The PubMed and Scopus databases were systematically searched. Articles reporting the clinical outcomes of patients infected with carbapenemase-producing Enterobacteriaceae according to the antibiotic treatment administered were eligible. Twenty nonrandomized studies comprising 692 patients who received definitive treatment were included. Almost all studies reported on Klebsiella spp. In 8 studies, the majority of infections were bacteremia, while pneumonia and urinary tract infections were the most common infections in 12 studies. In 10 studies, the majority of patients were critically ill. There are methodological issues, including clinical heterogeneity, that preclude the synthesis of the available evidence using statistical analyses, including meta-analysis. From the descriptive point of view, among patients who received combination treatment, mortality was up to 50% for the tigecycline-gentamicin combination, up to 64% for tigecycline-colistin, and up to 67% for carbapenem-colistin. Among the monotherapy-treated patients, mortality was up to 57% for colistin and up to 80% for tigecycline. Certain regimens were administered to a small number of patients in certain studies. Three studies reporting on 194 critically ill patients with bacteremia showed individually significantly lower mortality in the combination arm than in the monotherapy arm. In the other studies, no significant difference in mortality was recorded between the compared groups. Combination antibiotic treatment may be considered the optimal option for severely ill patients with severe infections. However, well-designed randomized studies of specific patient populations are needed to further clarify this issue.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae: Systematic Evaluation of the Available Evidence

Falagas

Lourida

Poulikakos

et al. 2014

Antimicrob Agents Chemother

322

216

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“…Ambler class B (VIM and IMP), class A (KPC), and class D (OXA-48) carbapenemase-producing isolates have been involved in nosocomial outbreaks (2,5,7,10). In addition carbapenemase producers are usually multidrug resistant.…”

mentioning

confidence: 99%

Use of ChromID Extended-Spectrum β-Lactamase Medium for Detecting Carbapenemase-Producing Enterobacteriaceae

2010

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ChromID extended-spectrum ␤-lactamase (ESBL) culture medium is routinely used for screening ESBL producers. This medium was tested for detecting carbapenemase-producing Enterobacteriaceae isolates from a collection of reference strains and compared to the CHROMagar KPC culture medium previously evaluated for detecting KPC-producing isolates. Producers of IMP-, VIM-, and KPC-type carbapenemases with high levels of resistance to cephalosporins and to carbapenems were detected at 1 ؋ 10 1 CFU/ml. The OXA-48 producers were not detected on ChromID ESBL medium unless coexpressing ESBLs, whereas carbapenemase-producing isolates with MICs of <4 g/ml were not detected on CHROMagar KPC medium.

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“…18 In general, however, clinical data on the treatment of carbapenem-resistant Enterobacteriaceae infections are very limited and consist mainly of small case-series and brief reports. [18][19][20][21][22][23][24][25] Treatment options against infections due to MDR Gram-negative rods in leukemic and HSCT patients are summarized in Table 2.…”

Section: Resistant Gram-negative Rodsmentioning

confidence: 99%

“…with aminoglycosides and/or tigecycline for the treatment of infections due to Klebsiella pneumoniae with KPC carbapenemases). [22][23][24] Nephrotoxicity following combination with aminoglycosides is of concern, though, and renal function should be monitored; moreover, most Enterobacteriaceae with NDM (rather than KPC) carbapenemases are broadly resistant to aminoglycosides. 65 …”

Section: Polymyxinsmentioning

confidence: 99%

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

et al. 2013

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The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3organizing committee and experts were solicited to form the working group. The group reviewed the published English-language literature and prepared proposals on treatment options for infections due to resistant bacteria. Papers for review were sought using PubMed with the terms "linezolid", "daptomycin", "quinupristin/ dalfopristin", "colistin or polymyxin", "tigecycline", "fosfomycin", "telavancin", "ceftaroline" AND "stem cell transplantation or bone marrow transplant or leukemia or hematological malignancy or cancer". References cited in the articles identified were also considered. In respect of 'Duration of therapy', the main search terms used were "antibiotic therapy"; "stem cell transplantation or bone marrow transplantation or hematological malignancy or cancer"; "febrile neutropenia" and "duration therapy", "discontinuation antibiotics" and "microbiologically documented infection". Definitions of resistanceA bacterial isolate was considered non-susceptible if it was categorized resistant, intermediate or non-susceptible when using clinical breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), Clinical and Laboratory Standards Institute (CLSI) or the US Food and Drug Administration (FDA). Definitions of 'MDR' vary among authors and usually presume resistance to at least two antibiotics used in empiric therapy (3 rd 4 th -generation cephalosporins, carbapenems or piperacillin/tazobactam) or resistance to at least three of the following antibiotic classes: antipseudomonal penicillins, cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. [11][12][13][14][15] According to the recent definition of the European Centre for Disease Prevention and Control...

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Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece)

Cited by 122 publications

References 29 publications

Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae: Systematic Evaluation of the Available Evidence

Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae: Systematic Evaluation of the Available Evidence

Use of ChromID Extended-Spectrum β-Lactamase Medium for Detecting Carbapenemase-Producing Enterobacteriaceae

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

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