Treatment decisions in VRE bacteraemia: a survey of infectious diseases pharmacists

White, Bryan P.; Barber, Katie E.; Chastain, Daniel B

doi:10.1093/jacamr/dlad063

Cited by 5 publications

(1 citation statement)

References 32 publications

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“…In this work, we seek to understand these constraints on resistance evolution by investigating the evolutionary steps that lead to the successful transmission of resistant mutants. We study the nosocomial pathogen Enterococcus faecium and the evolution of resistance to the antibiotic daptomycin, which remains a preferred treatment for these infections ( 8 ). Daptomycin resistance was rare in E. faecium before the widespread use of daptomycin, but has increased concurrently with daptomycin usage ( 4 , 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen

Tracy,

McKaig,

Kinnear

et al. 2024

Preprint

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Bacterial pathogens that are successful in hospital environments must survive times of intense antibiotic exposure and times of no antibiotic exposure. When these organisms are closely associated with human hosts, they must also transmit from one patient to another for the resistance to spread. The resulting evolutionary dynamics have led to rising levels of resistance in hospitals. Here, we focus on an important but understudied aspect of this dynamic: the loss of resistance when resistant organisms evolve in an environment without antibiotic pressure. Based on prior data, we hypothesize that resistance arising in the context of strong selection may carry a high cost and revert to sensitivity quickly once the selective pressure is removed. Conversely, resistant isolates that persist through times of no antibiotic pressure should carry a lower cost and revert less quickly. To test this hypothesis, we utilize a genetically diverse set of patient-derived, daptomycin-resistantEnterococcus faeciumisolates that include cases of both de novo emergence of resistance within patients and putatively transmitted resistance. Bot these strains have survived periods of antibiotic exposure, but only putatively transmitted resistant strains have survived extended periods without antibiotic exposure. These strains were then allowed to evolve in antibiotic free laboratory conditions. We find that putatively transmitted resistant strains tended to have lower level resistance and that evolution in antibiotic-free conditions resulted in minimal loss of resistance. In contrast, resistance that arose de novo within patients was higher level but exhibited greater declines in resistance in vitro. Sequencing of the experimentally evolved isolates revealed that reversal of high level resistance resulted from evolutionary pathways that were frequently genetically associated with the unique resistance mutations of that strain. Further, these results suggest the rapid reversal of high-level resistance was associated with accessible evolutionary pathways where an increase in fitness is associated with decreased resistance. We describe how this rapid loss of resistance may limit the spread of resistance within the hospital and shape the diversity of resistance phenotypes across patients.

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Section: Introductionmentioning

confidence: 99%

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen

Tracy,

McKaig,

Kinnear

et al. 2024

Preprint

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Contemporary Management ofStaphylococcus aureusBacteremia—Controversies in Clinical Practice

Minter,

Appa,

Chambers

et al. 2023

Clinical Infectious Diseases

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Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication of the 2011 Infectious Diseases Society of America (IDSA) guidelines on management of methicillin-resistant Staphylococcus aureus infections, the field of SAB has evolved with the emergence of newer diagnostic strategies and therapeutic options. In this review, we seek to provide a comprehensive overview of the evaluation and management of SAB, with special focus on areas where the highest level of evidence is lacking to inform best practices.

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Impact of ESKAPE Pathogens on Bacteremia: A Three-Year Surveillance Study at a Major Hospital in Southern Italy

De Prisco,

Manente,

Santella

et al. 2024

Antibiotics

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Background/Objectives: ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pose a serious public health threat as they are resistant to multiple antimicrobial agents. Bloodstream infections (BSIs) caused by ESKAPE bacteria have high mortality rates due to the limited availability of effective antimicrobials. This study aimed to evaluate the prevalence and susceptibility of ESKAPE pathogens causing BSIs over three years in a large tertiary hospital in Salerno. Methods: Conducted at the Clinical Microbiology Laboratory of San Giovanni di Dio e ‘‘Ruggi D’Aragona’’ Hospital from January 2020 to December 2022, blood culture samples from different departments were incubated in the BD BACTEC™ system for 5 days. Species identification was performed using MALDI-TOF MS, and antimicrobial resistance patterns were determined by the VITEK2 system. Results: Out of 3197 species isolated from positive blood cultures, 38.7% were ESKAPE bacteria. Of these, 59.9% were found in blood culture samples taken from men, and the most affected age group was those aged >60 years. (70.6%). Staphylococcus aureus was the main BSI pathogen (26.3%), followed by Klebsiella pneumoniae (15.8%). Significant resistance rates were found, including 35% of Staphylococcus aureus being resistant to oxacillin and over 90% of Acinetobacter baumannii being resistant to carbapenems. Conclusions: These results highlight the urgent need for antimicrobial stewardship programs to prevent incurable infections.

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Treatment decisions in VRE bacteraemia: a survey of infectious diseases pharmacists

Cited by 5 publications

References 32 publications

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen

Contemporary Management ofStaphylococcus aureusBacteremia—Controversies in Clinical Practice

Impact of ESKAPE Pathogens on Bacteremia: A Three-Year Surveillance Study at a Major Hospital in Southern Italy

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