Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria

Kofteridis, Diamantis P.; Andrianaki, Angeliki M.; Maraki, Sofia; Mathioudaki, Anna; Plataki, Marina; Alexopoulou, Christina; Ιωάννου, Πέτρος; Samonis, George; Valachis, Antonis

doi:10.1007/s10096-019-03784-9

Cited by 33 publications

(41 citation statements)

References 23 publications

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“…This high percentage of PDR isolates could be attributed to the antibiotic selective pressure in an area with endemic carbapenemase-producing K. pneumoniae infections [ 5 ], lack of newer antimicrobials, and the revision by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) of tigecycline’s breakpoints rendering most isolates that previously were considered susceptible or intermediate as being resistant to tigecycline [ 11 ]. The mortality in our cohort was high (39.1%), especially in patients with septic shock (54.9%), and it was higher than previously reported [ 6 , 7 , 8 , 9 , 10 ]. Most studies were based in cohorts with a limited number of patients infected by different pathogens.…”

Section: Discussioncontrasting

confidence: 64%

“…At the present time, no therapy is proven to be superior for patients with PDR-Kp infections [ 6 , 7 , 8 , 9 , 10 ]. Different combinations of antimicrobials have been previously used against PDR-Kp infections with moderate success [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…While isolation of PDR strains remained rare, nowadays they are prevalent worldwide [ 6 ]. They are mainly associated with critically ill patients previously exposed to many antimicrobials [ 6 , 7 , 8 , 9 , 10 ]. Mortality of infections caused by such bacteria is high, since no effective option is available [ 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…They are mainly associated with critically ill patients previously exposed to many antimicrobials [ 6 , 7 , 8 , 9 , 10 ]. Mortality of infections caused by such bacteria is high, since no effective option is available [ 6 , 7 , 8 , 9 , 10 ]. While treatment was based mainly on a combination of different antimicrobials, usually including colistin, no robust evidence exists supporting the superiority of a therapeutic regimen over another [ 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Papadimitriou-Olivgeris

Bartzavali

Georgakopoulou

et al. 2021

Antibiotics

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Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Papadimitriou-Olivgeris

Bartzavali

Georgakopoulou

et al. 2021

Antibiotics

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“…Tigecycline-based combinations have also been proposed, but have predominantly been studied against tigecycline-susceptible strains, or in combination with an in vitro active agent (predominantly colistin) [ 163 ]. Although data regarding tigecycline-based combinations against CAPT-resistant GNB are limited, such combinations are often used in clinical practice given the lack of other options [ 158 , 164 ]. Synergistic combinations with minocycline may also prove useful [ 144 ], but currently available data are very limited.…”

Section: Options For Capt-resistant a Baumanniimentioning

confidence: 99%

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

2020

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The management of carbapenem-resistant infections is often based on polymyxins, tigecycline, aminoglycosides and their combinations. However, in a recent systematic review, we found that Gram-negative bacteria (GNB) co-resistant to carbapanems, aminoglycosides, polymyxins and tigecycline (CAPT-resistant) are increasingly being reported worldwide. Clinical data to guide the treatment of CAPT-resistant GNB are scarce and based exclusively on few case reports and small case series, but seem to indicate that appropriate (in vitro active) antimicrobial regimens, including newer antibiotics and synergistic combinations, may be associated with lower mortality. In this review, we consolidate the available literature to inform clinicians dealing with CAPT-resistant GNB about treatment options by considering the mechanisms of resistance to carbapenems. In combination with rapid diagnostic methods that allow fast detection of carbapenemase production, the approach proposed in this review may guide a timely and targeted treatment of patients with infections by CAPT-resistant GNB. Specifically, we focus on the three most problematic species, namely Klebsiella pneumoniae , Pseudomonas aeruginosa and Acinetobacter baumannii . Several treatment options are currently available for CAPT-resistant K. pneumonia . Newer β-lactam-β-lactamase combinations, including the combination of ceftazidime/avibactam with aztreonam against metallo-β-lactamase-producing isolates, appear to be more effective compared to combinations of older agents. Options for P. aeruginosa (especially metallo-β-lactamase-producing strains) and A. baumannii remain limited. Synergistic combination of older agents (e.g., polymyxin- or fosfomycin-based synergistic combinations) may represent a last resort option, but their use against CAPT-resistant GNB requires further study.

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Olive oil nanoemulsion containing curcumin: antimicrobial agent against multidrug-resistant bacteria

Confessor,

Agreles,

Campos

et al. 2024

Appl Microbiol Biotechnol

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The present work aimed to develop, characterize, and evaluate the antibacterial and antibiofilm activity of two nanoemulsions (NEs) containing 500 µg/mL of curcumin from Curcuma longa (CUR). These NEs, produced with heating, contain olive oil (5%) and the surfactants tween 80 (5%) and span 80 (2.5%), water q.s. 100 mL, and were stable for 120 days. NE-2-CUR presented Ø of 165.40 ± 2.56 nm, PDI of 0.254, ζ of − 33.20 ± 1.35 mV, pH of 6.49, and Entrapment Drug Efficiency (EE) of 99%. The NE-4-CUR showed a Ø of 105.70 ± 4.13 nm, PDI of 0.459, ζ of − 32.10 ± 1.45 mV, pH of 6.40 and EE of 99.29%. Structural characterization was performed using DRX and FTIR, thermal characterization using DSC and TG, and morphological characterization using SEM, suggesting that there is no significant change in the CUR present in the NEs and that they remain stable. The MIC was performed by the broth microdilution method for nine gram-positive and gram-negative bacteria, as well as Klebsiella pneumoniae clinical isolates resistant to antibiotics and biofilm and efflux pump producers. The NEs mostly showed a bacteriostatic profile. The MIC varied between 125 and 250 µg/mL. The most sensitive bacteria were Staphylococcus aureus and Enterococcus faecalis, for which NE-2-CUR showed a MIC of 125 µg/mL. The NEs and ceftazidime (CAZ) interaction was also evaluated against the K. pneumoniae resistant clinical isolates using the Checkerboard method. NE-2-CUR and NE-4-CUR showed a synergistic or additive profile; there was a reduction in CAZ MICs between 256 times (K26-A2) and 2 times (K29-A2). Furthermore, the NEs inhibited these isolates biofilms formation. The NEs showed a MBIC ranging from 15.625 to 250 µg/mL. Thus, the NEs showed physicochemical characteristics suitable for future clinical trials, enhancing the CAZ antibacterial and antibiofilm activity, thus becoming a promising strategy for the treatment of bacterial infections caused by multidrug-resistant K. pneumoniae. Key points • The NEs showed physicochemical characteristics suitable for future clinical trials. • The NEs showed a synergistic/additive profile, when associated with ceftazidime. • The NEs inhibited biofilm formation of clinical isolates.

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Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria

Cited by 33 publications

References 23 publications

Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

Olive oil nanoemulsion containing curcumin: antimicrobial agent against multidrug-resistant bacteria

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