Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms

Martín‐Loeches, Ignacio; Torres, Antoni; Rinaudo, Mariano; Terraneo, Silvia; Rosa, Francesca; Ramírez, Paula; Dı́az, Emili; Fernández-Barat, Laia; Bassi, G.; Ferrer, Miquel

doi:10.1016/j.jinf.2014.10.004

Cited by 130 publications

(92 citation statements)

References 25 publications

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“…The most important pathogens causing VAP today are gram-negative bacteria (mainly Klebsiella spp, Acinetobacter spp, Pseudomonas spp, Escherichia coli and other Enterobacteriaceae) and some gram-positive species such as Staphylococcus aureus and Enterococci, followed by a small amount of anaerobic species [1,6]. Furthermore, extensive antimicrobial resistance among bacteria isolated from critically ill patients with VAP represents a serious concern for the clinician, as it may lead to increased antibiotic drug usage, higher mortality rates and prolonged length of stay in the ICU [7,8]. Recent studies have shown an increasing spread of multidrug-resistant gram-negative and gram-positive bacteria in ICUs across Europe and the United States in the last few years, with carbapenem resistance usually found in almost 70 % of Acinetobacter spp and 40 % of Klebsiella spp and an extended-spectrum beta lactamase (ESBL) pattern expressed in up to 30 % of Enterobacteriaceae isolates globally [9].…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals

Rose

Pezzotti

Fortunato

et al. 2016

Eur J Clin Microbiol Infect Dis

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The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.

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Section: Introductionmentioning

confidence: 99%

Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals

Rose

Pezzotti

Fortunato

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…With this overview, we will highlight the important new findings with a focus on infectious disease and sepsis in critically ill patients.The concept of healthcare-associated pneumonia (HCAP) tried to highlight the increasing prevalence of multidrug-resistant pathogens [1]. The majority of the studies have been conducted outside Europe.…”

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confidence: 99%

“…The concept of healthcare-associated pneumonia (HCAP) tried to highlight the increasing prevalence of multidrug-resistant pathogens [1]. The majority of the studies have been conducted outside Europe.…”

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Focus on infection and sepsis in intensive care patients

Martín‐Loeches

Perner

2016

Intensive Care Med

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Over the last year, several papers have shed light on the management of severe infections and sepsis in intensive care units (ICU). With this overview, we will highlight the important new findings with a focus on infectious disease and sepsis in critically ill patients.The concept of healthcare-associated pneumonia (HCAP) tried to highlight the increasing prevalence of multidrug-resistant pathogens [1]. The majority of the studies have been conducted outside Europe. Vallés et al. conducted a prospective, multicentre study in Spain [2] in which the etiology of community-acquired pneumonia (CAP) and HCAP was comparable, as S. pneumoniae was the most frequently found pathogen. Therefore, based on this European study, empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP, at least in that population, and clearly differs from experiences in countries with higher rates of resistant pathogens.One important element over the last year in infectious diseases in critically ill patients has been the development of both less invasive and more sensitive diagnostic techniques in pneumonia [3]. A "What's new in intensive care" paper highlighted the innovative technologies that could result in a more timely recognition of respiratory infections [4] in critically ill patients through the detection of bacterial colonization (colorimetric endotracheal tubes) and the interaction between bacterial growth and host response (exhaled breath analysis) [5]. These technologies are still promising but not fully validated yet. Another promising area of research is the right use of biomarkers [6] in either decision-based algorithms like CHAID (Chi-squared Automatic Interaction Detection) [7] or biomarker combinations to increase diagnostic accuracy [8].An important "My paper 10 years later" described the trends in infective endocarditis in the ICU [9]. The authors pointed to sustained high mortality rates in patients with infective endocarditis, rates that may exceed 60 % mortality in ICU. They suggested a standardized approach to bacteriological testing including broad-range polymerase chain reaction (PCR) because of the high rates of culture-negative bacteraemia. SeptiFast is the first real-time PCR-based system and, to date, the most intensively investigated in clinical cohort studies. To this end, two papers have provided evidence regarding the new rapid diagnostic tests in bacteraemia. Warhurst et al.[10] conducted a phase III prospective multicentre diagnostic accuracy study of SeptiFast against microbiological culture in critical care settings. SeptiFast had a significantly greater specificity (0.86) than sensitivity (0.50) for bacteraemia. The most interesting finding was that despite the potential benefit of such a technique, there was a low prevalence of blood cultureproven pathogens (9.2 %), acknowledging the potential limitations of this technology in diagnosing bloodstream infection when compared with bloodstream infection at the species/genus level. An updated systematic review and ...

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“…12 In clinical practice, Intensive Care Unit (ICU) setting has been traditionally considered the tip of the iceberg of hospital MDRGN infections. [13][14][15] However, beside ICU setting, in recent years the spread of MDRGN pathogens has been increasingly described also in other settings, such as oncologic and hematologic wards 16,17 and long-term-care facilities. 18,19 A bedridden status, presence of indwelling devices, recent hospitalization or contact with health care facilities and recent antibiotic therapy may represent the most important risk factors for the development of emerging MDRGN infections (Table 3).…”

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Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

2016

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IntroductionIn the last decade, we have witnessed a dramatic increase worldwide in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Due to the resistance to the most common antibiotics prescribed as empiric regimens, MDRGN bugs have been associated with delays in an adequate treatment, leading to significant increases in morbidity and mortality.1 In addition, the spread of MDRGN pathogens resulted over last years in a vicious circle of an indiscriminate prescription of broad-spectrum antimicrobials and further resistance selection. 2The aim of this review is to describe the mechanism of resistance, epidemiology, risk factors, clinical issues, and therapeutic options of MDRGN pathogens. Mechanism of resistance of Gram-negative bacteriaMGRGN bacteria are defined as pathogens carrying resistance to one or more antimicrobials from at least three different classes. The most common mechanism of resistance is represented by intrinsic and acquired production of b-lactamases, which can be chromosomal or plasmid mediated. b-lactamases are hydrolytic enzymes able to disrupt the b-lactam ring, thus inactivating different classes of b-lactams.3,4 The most common enzymes in clinical practice are the extended-spectrum-b-lactamases (ESBLs), which are mostly expressed by Enterobacteriaceae. A novel type of class C b-lactamases also showing activity against cefepime and denominated extended spectrum AmpC b-lactamases has been described. 4 The consequent abuse of carbapenems, representing the first choice for ESBL infections, led to a progressive increase in carbapenem resistance, mainly due to the production of carbapenem-hydrolyzing b-lactamases, or carbapenemases, that usually confer clinical resistance to most b-lactams.5,6 K. pneumoniae carbapenemases (KPCs) are the most relevant enzymes among Enterobacteriaceae, and confer resistance to all the blactams, including b-lactam/b-lactamase inhibitors combinations. Class B enzymes, named metallo-b-lactamases are expressed by both enterics and P. aeruginosa and confer resistance to all b-lactams with the exception of aztreonam. Oxacillinases belong to the class D b-lactamases, and are mostly expressed in P. Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic optionsMatteo Bassetti, Davide Pecori, Maddalena Peghin Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy ABSTRACTIn the last decade, we have witnessed a dramatic increase in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, both in Italy and worldwide, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Inadequate empirical antimicrobial therapy of severe infections caused by MDR Enterobacteriacae has been associated with an increa...

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Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms

Cited by 130 publications

References 25 publications

Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals

Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals

Focus on infection and sepsis in intensive care patients

Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

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