Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

Rhodes, Nathaniel J.; Cruce, Caroline; O’Donnell, John M.; Wunderink, Richard G.; Hauser, Alan R.

doi:10.1007/s11908-018-0609-x

Cited by 40 publications

(32 citation statements)

References 126 publications

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“…VAP is commonly caused by Pseudomonas aeruginosa , Klebsiella pneumonia , and Acinetobacter baumannii globally. It is important that the antimicrobial therapy be right in the first time in VAP patients, because the pathogens associated with inappropriate initial therapy are usually antibiotic-resistant strains of these pathogens, so patients at high risk of infection with these organisms initially needed to receive a combination of agents providing a very broad spectrum of coverage (Weiner et al, 2016; Rhodes et al, 2018). This review aims to summarize the available knowledge on drug prevention and control of VAP, taking profit from the recommendations of several health organization such as the American Thoracic Society with the Infectious Disease Society of America (Kalil et al, 2016), the Centers for Disease Control and Prevention (CDC) (Tablan et al, 2004), the European Task Force on VAP (Torres and Carlet, 2001), the Society for Healthcare Epidemiology of America, and the Institute for Healthcare Improvement (Klompas et al, 2014), as well as the recently major guidelines for the management of VAP (Kalil et al, 2016; Timsit et al, 2017a; Torres et al, 2017), and we hope that our clinicians know more about the initial therapies and treatment strategies of VAP, and we can investigate and focus on the management of the disease in future.…”

Section: Introductionmentioning

confidence: 99%

Drug Prevention and Control of Ventilator-Associated Pneumonia

et al. 2019

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Ventilator-associated pneumonia (VAP) is one of the most prevalent and serious complications of mechanical ventilation, which is considered a common nosocomial infection in critically ill patients. There are some great options for the prevention of VAP: (i) minimize ventilator exposure; (ii) intensive oral care; (iii) aspiration of subglottic secretions; (iv) maintain optimal positioning and encourage mobility; and (v) prophylactic probiotics. Furthermore, clinical management of VAP depends on appropriate antimicrobial therapy, which needs to be selected based on individual patient factors, such as previous antibacterial therapy, history of hospitalization or mechanical ventilation, and bacterial pathogens and antibiotic resistance patterns. In fact, antibiotic resistance has exponentially increased over the last decade, and the isolation of a multidrug-resistant (MDR) pathogen has been identified as an independent predictor of inadequate initial antibiotic therapy and which is significantly associated with increased mortality. Multiple attempts were used in the treatment of VAP, such as novel antibacterial agents, inhaled antibiotics and monoclonal antibodies. In this review, we summarize the current therapeutic options for the prevention and treatment of VAP, aiming to better management of VAP in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Drug Prevention and Control of Ventilator-Associated Pneumonia

et al. 2019

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“…It works well against MDR Pseudomonas aeruginosa and ESBL Klebsiella pneumoniae and has excellent lung and urinary penetration. A systematic review found that 90% of MDR strains of P. aeruginosa were susceptible, and a study of 5057 ESBL producing isolates of E. coli and K. pneumoniae found that 91.3% were susceptible [30,34,35]. With high levels of clinical efficacy and low levels of resistance, it is seemingly ideal for GNB infections.…”

Section: Fosfomycinmentioning

confidence: 99%

Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting

2020

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The increasing prevalence of antibiotic resistance is a threat to human health, particularly within vulnerable populations in the hospital and acute care settings. This leads to increasing healthcare costs, morbidity, and mortality. Bacteria rapidly evolve novel mechanisms of resistance and methods of antimicrobial evasion. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii have all been identified as pathogens with particularly high rates of resistance to antibiotics, resulting in a reducing pool of available treatments for these organisms. Effectively combating this issue requires both preventative and reactive measures. Reducing the spread of resistant pathogens, as well as reducing the rate of evolution of resistance is complex. Such a task requires a more judicious use of antibiotics through a better understanding of infection epidemiology, resistance patterns, and guidelines for treatment. These goals can best be achieved through the implementation of antimicrobial stewardship programs and the development and introduction of new drugs capable of eradicating multi-drug resistant Gram-negative pathogens (MDR GNB). The purpose of this article is to review current trends in MDR Gram-negative bacterial infections in the hospitalized setting, as well as current guidelines for management. Finally, new and emerging antimicrobials, as well as future considerations for combating antibiotic resistance on a global scale are discussed.

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“…A. baumannii has the propensity for biofilm formation, making it particularly difficult to eradicate in certain conditions (notably on blood and urinary catheters and endotracheal tubes) [23]. According to the National Healthcare Safety Network (NHSN), A. baumannii is the fifth most common VAP pathogen, accounting for 6.1% to 7.5% of all cases [24,25]. Despite only 2% of HAIs are caused by Acinetobacter spp., crude mortality in patients with A. baumannii infections can be as high as 75% [3,26].…”

Section: Epidemology Of Mdr and Xdr A Baumannii Infectionsmentioning

confidence: 99%

Developments for the Treatment of Invasive Infections Due to Multidrug-resistant Acinetobacter baumannii

David¹,

Drew²,

Wilson³

2019

JRI

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Acinetobacter baumannii is a significant pathogen in healthcare settings (specifically prominent in healthcare-and ventilator-associated pneumonia) due primarily to its virulence and resistance to a wide variety of antimicrobial drug classes, including carbapenems (CRAB). Existing therapies (notably polymyxins, minocycline, tigecycline, amikacin, and sulbactam) often result in suboptimal tissue concentrations, high rates of toxicity, and increasing rates of resistance. Although utilizing combinations of antibiotics (specifically those containing colistin) have been employed, results have been mixed, and control trials are lacking. Eravacycline is a novel tetracycline with an improved pharmacokinetic profile and more potent activity against A. baumannii relative to tigecycline. Cefiderocol has a unique mechanism of action that has performed well in vitro against multidrugresistant (MDR) and CRAB isolates. Limited clinical data exists with each of these agents. Other novel antimicrobials are still in early phase clinical trials (ETX2514/sulbactam, TP-271, TP-6076, VNRX-5133/cefepime, cefepime/zidebactam, AIC-499, GSK3342830, and SPR741) while further research is underway for non-antibiotic approaches, specifically monoclonal antibodies and bacteriophage therapies.

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Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

Cited by 40 publications

References 126 publications

Drug Prevention and Control of Ventilator-Associated Pneumonia

Drug Prevention and Control of Ventilator-Associated Pneumonia

Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting

Developments for the Treatment of Invasive Infections Due to Multidrug-resistant Acinetobacter baumannii

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