The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit

Cornejo‐Juárez, Patricia; Pérez‐Jimenez, Carolina; Ñamendys‐Silva, Silvio A.; Sandoval-Hernández, Silvia; Volkow-Fernández, Patricia

doi:10.1016/j.ijid.2014.12.022

Cited by 159 publications

(130 citation statements)

References 24 publications

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“…5 A maior frequência neste estudo dos microrganismos Acinetobacter baumanni e Pseudomonas aeruginosa resistentes aos carbapenêmicos, e Staphylococcus aureus resistentes à oxacilina foi similar ao observado em estudos no Brasil e América Latina. 3,9,12 Na América Latina e Brasil, conforme os dados do SENTRY, os bastonetes Gram negativos (BGN) não fermentadores (Acinetobacter spp. e Pseudomonas aeruginosa) multirresistentes e as Enterobacteriaceae produtoras de betalactamases de espectro ampliado (ESBL) constituem o principal problema de farmacorressitência.…”

Section: Discussionunclassified

“…1,2 Nas instituições hospitalares, as Unidades de Terapia Intensiva (UTI) são consideradas o epicentro da resistência bacteriana devido à maior ocorrência de surtos por bactérias multirresistentes. [3][4][5] Nas UTIs as taxas de infecções são estimadas entre 18 e 54%, sendo responsável por 5 a 35% de todas as IRAS e por, aproximadamente, 90% de todos os surtos hospitalares. [6][7][8] Em tais unidades os pacientes colonizados e/ou infectados representam a principal fonte de patógenos pois, na colonização apesar de não haver sintomas clíni-cos e imunológicos de infecção, os microrganismos estão presentes nas superfícies cutâneas e mucosas do hospedeiro.…”

Section: Introductionunclassified

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Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

Oliveira

Paula²,

Iquiapaza

et al. 2017

Rev Epidemiol Control Infect

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Exceto onde especificado diferentemente, a matéria publicada neste periódico é licenciada sob forma de uma licença Creative Commons -Atribuição 4. //dx.doi.org/10.17058/reci.v7i2.8302 Páginas 01 de 06 não para fins de citação Justificativa e Objetivos: Nas instituições hospitalares, as unidades de terapia intensiva são consideradas o epicentro de resistência bacteriana em razão da maior ocorrência de surtos por bactérias multirresistentes. A monitorização do perfil microbiológico dos microrganismos associados a infecções é fundamental para apoiar o uso racional de antimicrobianos e as medidas de prevenção e controle de infecções. O objetivo desse estudo foi verificar o perfil de sensibilidade de microrganismos aos antimicrobianos associados à ocorrência de colonização e infecções em uma unidade de terapia intensiva. Métodos: Tratou-se de uma coorte com seguimento de 2.137 pacientes (2005 -2008) Background and Objectives:Intensive care units are considered the main focus of bacterial resistance in hospital settings because they are the place where most multiresistant bacterial outbreaks take place. Monitoring the microbiological profile of organisms that cause infections is fundamental to support the rational use of antimicrobial agents and implement infection prevention and control measures.The objective of the present study was to assess the profile of sensitivity of microorganisms associated with colonization and infection to antimicrobial agents in an intensive care unit. Methods: The investigation was a cohort study with 2,137 patients admitted to a teaching Os dados foram coletados por vigilância ativa dos registros dos pacientes, diariamente na unidade. Utilizou-se um instrumento com as variáveis: sexo, idade, procedência, tipo de paciente (clínico ou cirúrgico), tempo de permanência na unidade, diagnóstico de infecção comunitária, colonização/infecção por MR durante a internação, procedimentos invasivos, desenvolvimento de infecção hospitalar, e índice de gravidade clínica à admissão definida pela classificação específica, Average Severity Index Score (ASIS). Este índice é adotado para avaliar a condição clínica do paciente relacionando-a à ocorrência de IRAS, variando de A a E, de forma proporcional a gravidade observada (critério ASIS) a seguir descritos: 10 A: Pacientes em pós-operatório não requerendo cuidado médico ou de enfermagem intensivo com previsão de alta da unidade em até 48 horas; INTRODUÇÃOA resistência bacteriana tornou-se um desafio para o controle de Infecções Relacionadas à Assistência em Saúde (IRAS). Nas últimas décadas, se evidencia cada vez mais casos de colonização e infecção por microrganismos multirresistentes, para os quais o tratamento tem representado sérios dilemas terapêuticos. 1,2Nas instituições hospitalares, as Unidades de Terapia Intensiva (UTI) são consideradas o epicentro da resistência bacteriana devido à maior ocorrência de surtos por bactérias multirresistentes.3-5 Nas UTIs as taxas de infecções são estimadas entre 18 e 54%, sendo responsável por 5 a 35% de t...

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Section: Discussionunclassified

Section: Introductionunclassified

Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

Oliveira

Paula²,

Iquiapaza

et al. 2017

Rev Epidemiol Control Infect

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“…12 The hospital-acquired infections manifest in a wide gamut of severe clinical ramifications, such as bacteremia, septic shock, ventilator-related pneumonia and massive soft tissue necrosis, and rapidly progress to systemic infections that eventually culminate in multiorgan failure and death. 13 The control measures including implementation of hygiene, patient isolation and environmental decontamination have proved ineffective in keeping the infection at bay. Improper use of antibiotics has favored an upward trend in the development of resistance to almost all the available drugs, further compounding the clinical problem.…”

Section: Gravity Of the Problemmentioning

confidence: 99%

Nanomaterials for alternative antibacterial therapy

Hemeg

2017

IJN

441

262

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Despite an array of cogent antibiotics, bacterial infections, notably those produced by nosocomial pathogens, still remain a leading factor of morbidity and mortality around the globe. They target the severely ill, hospitalized and immunocompromised patients with incapacitated immune system, who are prone to infections. The choice of antimicrobial therapy is largely empirical and not devoid of toxicity, hypersensitivity, teratogenicity and/or mutagenicity. The emergence of multidrug-resistant bacteria further intensifies the clinical predicament as it directly impacts public health due to diminished potency of current antibiotics. In addition, there is an escalating concern with respect to biofilm-associated infections that are refractory to the presently available antimicrobial armory, leaving almost no therapeutic option. Hence, there is a dire need to develop alternate antibacterial agents. The past decade has witnessed a substantial upsurge in the global use of nanomedicines as innovative tools for combating the high rates of antimicrobial resistance. Antibacterial activity of metal and metal oxide nanoparticles (NPs) has been extensively reported. The microbes are eliminated either by microbicidal effects of the NPs, such as release of free metal ions culminating in cell membrane damage, DNA interactions or free radical generation, or by microbiostatic effects coupled with killing potentiated by the host’s immune system. This review encompasses the magnitude of multidrug resistance in nosocomial infections, bacterial evasion of the host immune system, mechanisms used by bacteria to develop drug resistance and the use of nanomaterials based on metals to overcome these challenges. The diverse annihilative effects of conventional and biogenic metal NPs for antibacterial activity are also discussed. The use of polymer-based nanomaterials and nanocomposites, alone or functionalized with ligands, antibodies or antibiotics, as alternative antimicrobial agents for treating severe bacterial infections is also discussed. Combinatorial therapy with metallic NPs, as adjunct to the existing antibiotics, may aid to restrain the mounting menace of bacterial resistance and nosocomial threat.

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“…However, depending on patient demographics and the strains present, the proportion of certain infections caused by A. baumannii can be much larger than 5 to 10%. For example, a retrospective study of ICU-acquired infections in the ICU of the National Cancer Institute of Mexico reported that A. baumannii was the causative agent of 6% of total hospital-acquired infections but disproportionately represented 60% of pneumonia and 25% of bloodstream infections (7). A. baumannii has rapidly evolved into a difficult-to-treat pathogen through acquisition, mostly via integrons and transposons, of multiple drug resistance genes that supplement the already high level of intrinsic drug resistance (8).…”

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confidence: 99%

Copper Resistance of the Emerging Pathogen Acinetobacter baumannii

Williams

Neu

Gilbreath

et al. 2016

Appl Environ Microbiol

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Acinetobacter baumannii is an important emerging pathogen that is capable of causing many types of severe infection, especially in immunocompromised hosts. Since A. baumannii can rapidly acquire antibiotic resistance genes, many infections are on the verge of being untreatable, and novel therapies are desperately needed. To investigate the potential utility of copper-based antibacterial strategies against Acinetobacter infections, we characterized copper resistance in a panel of recent clinical A. baumannii isolates. Exposure to increasing concentrations of copper in liquid culture and on solid surfaces resulted in dose-dependent and strain-dependent effects; levels of copper resistance varied broadly across isolates, possibly resulting from identified genotypic variation among strains. Examination of the growth-phase-dependent effect of copper on A. baumannii revealed that resistance to copper increased dramatically in stationary phase. Moreover, A. baumannii biofilms were more resistant to copper than planktonic cells but were still susceptible to copper toxicity. Exposure of bacteria to subinhibitory concentrations of copper allowed them to better adapt to and grow in high concentrations of copper; this copper tolerance response is likely achieved via increased expression of copper resistance mechanisms. Indeed, genomic analysis revealed numerous putative copper resistance proteins that share amino acid homology to known proteins in Escherichia coli and Pseudomonas aeruginosa. Transcriptional analysis revealed significant upregulation of these putative copper resistance genes following brief copper exposure. Future characterization of copper resistance mechanisms may aid in the search for novel antibiotics against Acinetobacter and other highly antibiotic-resistant pathogens. IMPORTANCEAcinetobacter baumannii causes many types of severe nosocomial infections; unfortunately, some isolates have acquired resistance to almost every available antibiotic, and treatment options are incredibly limited. Copper is an essential nutrient but becomes toxic at high concentrations. The inherent antimicrobial properties of copper give it potential for use in novel therapeutics against drug-resistant pathogens. We show that A. baumannii clinical isolates are sensitive to copper in vitro, both in liquid and on solid metal surfaces. Since bacterial resistance to copper is mediated though mechanisms of efflux and detoxification, we identified genes encoding putative copper-related proteins in A. baumannii and showed that expression of some of these genes is regulated by the copper concentration. We propose that the antimicrobial effects of copper may be beneficial in the development of future therapeutics that target multidrug-resistant bacteria.

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The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit

Abstract: The emergence of MDR bacteria poses a difficult task for physicians, who have limited therapeutic options. Critically ill cancer patients admitted to the ICU are at major risk of a bacterial MDR-HAI that will impact adversely on mortality.

Cited by 159 publications

References 24 publications

Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

Perfil dos microrganismos associados à colonização e infecção em Terapia Intensiva

Nanomaterials for alternative antibacterial therapy

Copper Resistance of the Emerging Pathogen Acinetobacter baumannii

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