Sensitivity of Surveillance Testing for Multidrug-Resistant Gram-Negative Bacteria in the Intensive Care Unit

Ridgway, Jessica P; Peterson, Lance R.; Thomson, Richard B.; Miller, Becky A.; Wright, Marc‐Oliver; Schora, Donna; Robicsek, Ari

doi:10.1128/jcm.02369-14

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…On one side, we plan to perform metagenomic sequencing and resistome analysis to detect subclinical gut colonization. It has been documented a low sensitivity of culture-based methods aimed to surveillance of MRGNB carriers [ 19 ]. This could be more frequent at the beginning of colonization, when the proportion of multi-resistant bacteria in the microbiota is still a minority.…”

Section: Discussionmentioning

confidence: 99%

FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients—efficacy and microbiologic safety

Moreno,

Lavín-Alconero,

de Ugarriza

et al. 2023

Trials

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Background Multidrug-resistant Gram-negative bacterial (MRGNB) infections represent a major public health threat. Cancer patients and, among them, hematological patients are most vulnerable to these infections. Gut colonization by MRGNB is a common phenomenon occurring during hospitalization and chemotherapy exposure. In the neutropenic phase that occurs after chemotherapy, MRGNB translocation occurs increasing patient’s mortality. Fluoroquinolone prophylaxis with ciprofloxacin or levofloxacin efficacy is now being questioned due to the increase of incidence in MRGNB. Methods A phase III randomized, controlled, clinical trial, open-label parallel-group with a 1:1 ratio, aimed to demonstrate the non-inferiority of oral fosfomycin versus oral ciprofloxacin for febrile neutropenia prevention in patients with acute leukemia (AL) or hematopoietic cell transplant (HSC) receptors. Weekly surveillance cultures are planned to detect gut colonization. Changes in fecal microbiome at the beginning and end of prophylaxis will also be analyzed. Discussion This trial will provide evidence of the efficacy of an alternative drug to ciprofloxacin for febrile neutropenia prevention in high-risk hematological patients. The battery of planned microbiological studies will allow us to evaluate prospectively the microbiological safety of both pharmacological strategies in terms of the selection of MRGNB occurring in each arm. In addition, valuable information on the way in which each drug changes the fecal microbiome of the patients throughout the treatment will be generated. Trial registration Clinical trials NCT05311254, Registered on 5 April 2022, https://clinicaltrials.gov/ct2/show/NCT05311254?term=FOVOCIP&cntry=ES&draw=2&rank=1. Protocol version: 3.0, dated 20 May 2022.

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Section: Discussionmentioning

confidence: 99%

FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients—efficacy and microbiologic safety

Moreno,

Lavín-Alconero,

de Ugarriza

et al. 2023

Trials

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“…Surveillance culture-based methods have demonstrated to be effective for the early detection of colonized patients by ESBL- and/or carbapenemase-producing Enterobacterales and are routinely performed in many hospitals, mainly in intensive care units and hematology wards [ 7 , 8 , 9 ]. This screening allows taking infection control measures rapidly, but also to adjust proper empirical antimicrobial regimes, once the infection develops.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, both overtreatment in non-colonized patients and undertreatment in colonized patients can be avoided, situations which are generally associated with an increase of infectious mortality [ 9 ]. Despite its usefulness, some studies found that culture-based methods are not sensitive enough for the detection of all cases of colonization by MDR Gram-negative bacteria [ 7 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Shotgun Metagenomics Approach for Detection of ESBL- and/or Carbapenemase-Producing Enterobacterales in Culture Negative Patients Recovered from Acute Leukemia

et al. 2023

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Patients diagnosed with acute leukemia (AL) have a weakened immune system. Infections acquired by these patients are cause for concern and especially worrisome when Gram-negative multidrug-resistant (MDR) bacteria are involved, as they are difficult to treat, especially in the case of ESBL- and/or carbapenemase-producing Enterobacterales. Culture-based approaches have been relied on over the past decades as the method of choice for the early detection of gut colonization by MDR Gram-negative bacteria. However, various studies have indicated its limited sensitivity, underlining the need for new screening procedures in onco-hematological patients. Here, we evaluated a shotgun metagenomics approach to detect ESBL- and/or carbapenemase-producing Enterobacterales in the gut of 28 patients who had recovered from AL, which were previously colonized by these bacteria but cured at the time of sampling, as judged by culture-based methods. No ESBL or carbapenemase determinants were detected among the many resistance genes found by the metagenomics approach, supporting that patients were truly decolonized, with considerable consequences for their future clinical management. Due to the relatively low number of patients available for the present investigation, further studies should be conducted to support the utility and applicability of metagenomics for the routine screening of MDR bacteria in onco-hematological patients.

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Active Screening of Multi-Drug Resistant Bacteria Effectively Prevent and Control the Potential Infections

Ren

Peng

et al. 2014

Cell Biochem Biophys

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Our objective is to determine if actively screen the multi-drug resistant bacteria (MDRB) infection in intensive care unit (ICU) to prevent, control, and decrease the infection rate and transmission of MDRB. The patients admitted in ICU of one hospital in 2013 were analyzed. The throat swab, blood, defecation, and urine of patients were actively collected for bacteria cultures to screen Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii in patients. All patients received screening of MDRB infection and colonization within 2 days and after 2 days of admission, the results showed that there were 418 infectious bacterial strains in total and P. aeruginosa was the main bacterium. The asymptomatic infection rates of P. aeruginosa, K. pneumonia, E. coli, S. aureus, and A. baumannii were 39.02, 24.74, 44.00, 29.17, and 33.33 %, respectively; the symptomatic infection rates were 60.98, 75.26, 56.00, 70.83, and 66.67 %. 59.70 % patients received antibiotics treatment, 27.45 % patients received trachea cannula, 32.95 % patients received mechanism ventilation, 2.27 % patients received arterial cannula or venous cannula and 4.00 % patients received indwelling urinary catheters. The main MDRB in ICU is P. aeruginosa. The active screening of MDRB infection and colonization can provide the opportunity to take the life-saving measure against MDRB and treat patients. This can decrease the infection risk and the nosocomial transmission of MDRB.

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Sensitivity of Surveillance Testing for Multidrug-Resistant Gram-Negative Bacteria in the Intensive Care Unit

Cited by 4 publications

References 5 publications

FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients—efficacy and microbiologic safety

FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients—efficacy and microbiologic safety

Evaluation of a Shotgun Metagenomics Approach for Detection of ESBL- and/or Carbapenemase-Producing Enterobacterales in Culture Negative Patients Recovered from Acute Leukemia

Active Screening of Multi-Drug Resistant Bacteria Effectively Prevent and Control the Potential Infections

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