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Antibiotic for MDR

Matteo Bassetti, Alessia Carnelutti, Maddalena Peghin
The isolation of multi-drug-resistant gram-negative (MDRGN) pathogens has progressively increased worldwide and has been associated with important delays in the prescription of an adequate antibiotic treatment, resulting in increased mortality rates. Patient's stratification for MDRGN infections to optimize the prescription of an adequate empiric antimicrobial regimen is crucial. Areas covered: This article covers MDRGN epidemiology, with a specific focus on risk factors for harbouring infections sustained by extended-spectrum-Beta-lactamase (ESBL), carbapenem resistant Enterobacteriacae (CRE), MDR Pseudomonas aeruginosa and MDR Acinetobacter baumanii...
October 21, 2016: Expert Review of Anti-infective Therapy
Weiwei Wang, Ting Jiang, Weihong Zhang, Chunyu Li, Jun Chen, Dandan Xiang, Kejiang Cao, Lian-Wen Qi, Ping Li, Wei Zhu, Wensen Chen, Yan Chen
The study was undertaken to describe the profile of patients and the characteristics of all multidrug-resistant gram-negative bacteria (MDR-GNB) and to assess mortality. We examined 138 patients with bloodstream infections (BSIs) caused by MDR-GNB. Clinical characteristics, antibiotic therapy, and in-hospital mortality were analyzed. Survivor and nonsurvivor subgroups were compared to identify predictors of mortality. The in-hospital mortality rate was 25.4%. Univariate analysis revealed that comorbidities and inadequate initial antimicrobial treatment could increase risk of death...
October 17, 2016: American Journal of Infection Control
Ahmed Abdel Megeed, M Ali Hayssam, Mohamed Z M Salem, Mohamed S El-Shikh, Ibrahim Ahmed Talea, Yahya A Alogaibi
Multidrug-resistant (MDR) Acinetobacter baumannii infections are a great public health concern and demand continuous surveillance and antibiotic stewardship. Virulence traits and the pathogenicity of Acinetobacter are less studied compared with the molecular epidemiological and antibiotic resistance profile of this organism. In our present study, we investigated the primary characteristics contributing to the virulence of MDR A. baumannii isolates and compared them with avirulent isolates. A total of 32 well-characterized MDR A...
October 19, 2016: Journal of AOAC International
Sandrine Alibert, Joannah N'Gompazza Diarra, Jessica Hernandez, Aurélien Stutzmann, Marwa Fouad, Gérard Boyer, Jean-Marie Pagès
Worrying levels of bacterial resistance have been reported worldwide involving the failure of many available antibiotic treatments. Multidrug resistance (MDR) in Gram-negative bacteria is often ascribed to the presence of multiple and different resistance mechanisms in the same strain. RND efflux pumps play a major role and are an attractive target to discover new antibacterial drugs. Areas covered: This review discusses the prevalence of efflux pumps, their overexpression in clinical scenarios, their polyselectivity, their effect on the intracellular concentrations of various antibiotics associated with the alteration of the membrane permeability and their involvement in pathogenicity are discussed...
October 20, 2016: Expert Opinion on Drug Metabolism & Toxicology
Athanasios Tselebonis, Evangelia Nena, Christos Nikolaidis, Theocharis Konstantinidis, Christos Kontogiorgis, Maria Panopoulou, Theodore C Constantinidis
OBJECTIVE: To monitor microbes, focusing on drug resistance, on the hands of the personnel of four departments of a tertiary hospital (ICU, neonatal unit, internal medicine ward and surgical ward) and explore differences between departments, professions and genders. MATERIALS AND METHODS: Hand sampling from 125 healthcare employees was conducted followed by isolation, identification and antibiotic resistance profiling of different microbial species. RESULTS: Staphylococcus spp was the most prevalent microbe (76/125, 60...
September 1, 2016: Folia Medica
Yancheng Yang, Zhen Hu, Weilong Shang, Qiwen Hu, Junmin Zhu, Jie Yang, Huagang Peng, Xiaopeng Zhang, Hui Liu, Yanguang Cong, Shu Li, Xiaomei Hu, Renjie Zhou, Xiancai Rao
Methicillin-susceptible Staphylococcus aureus (MSSA) accounts for ∼40% of staphylococcal infections in China. However, the molecular characterization of MSSA is not well described. In this study, 124 MSSA strains collected in 2013 from a comprehensive teaching hospital in Chongqing, Southwestern China, were subjected to antibiotics susceptibility testing and molecular typing, including multilocus sequence typing, staphylococcal protein A (spa) gene typing, accessory gene regulator (agr) typing, pulsed-field gel electrophoresis (PFGE) typing, Panton-Valentine leukocidin (pvl) gene detection, and antibiotic-resistant gene detection...
October 18, 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Krupa M Parmar, Zubeen J Hathi, Nishant A Dafale
The spread of multidrug-resistant (MDR) bacteria is an emerging threat to the environment and public wellness. Inappropriate use and indiscriminate release of antibiotics in the environment through un-metabolized form create a scenario for the emergence of virulent pathogens and MDR bugs in the surroundings. Mechanisms underlying the spread of resistance include horizontal and vertical gene transfers causing the transmittance of MDR genes packed in different host, which pass across different food webs. Several controlling agents have been used for combating pathogens; however, the use of lytic bacteriophages proves to be one of the most eco-friendly due to their specificity, killing only target bacteria without damaging the indigenous beneficial flora of the habitat...
October 8, 2016: Applied Biochemistry and Biotechnology
Mazen S Bader, Mark Loeb, Annie A Brooks
Urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited therapeutic options. Gram-negative bacteria, specifically Enterobacteriaceae, are common causes of both community-acquired and hospital acquired UTIs. These organisms can acquire genes that encode for multiple antibiotic resistance mechanisms, including extended-spectrum-lactamases (ESBLs), AmpC- β -lactamase, and carbapenemases. The assessment of suspected UTI includes identification of characteristic symptoms or signs, urinalysis, dipstick or microscopic tests, and urine culture if indicated...
October 7, 2016: Postgraduate Medicine
Ida Pam Ombura, Noel Onyango, Susan Odera, Florence Mutua, Joshua Nyagol
BACKGROUND: Although prevention and control of spread of multi-drug resistant tuberculosis strains is a global challenge, there is paucity of data on the prevalence of DR-TB in patients diagnosed with TB in referral hospitals in Kenya. The present study assessed patients' characteristics and prevalence of drug resistant TB in sputa smear positive TB patients presenting to Coast Provincial General Hospital (CPGH) in Mombasa, Kenya. METHODS: Drug resistance was evaluated in 258 randomly selected sputa smear TB positive cases between the periods of November 2011 to February 2012 at the CPGH-Mombasa...
2016: PloS One
Pascale Trepanier, Kim Mallard, Danièle Meunier, Rachel Pike, Derek Brown, Janet P Ashby, Hugo Donaldson, F Mustafa Awad-El-Kariem, Indran Balakrishnan, Marc Cubbon, Paul R Chadwick, Michael Doughton, Rachael Doughton, Fiona Hardiman, Graham Harvey, Carolyne Horner, John Lee, Jonathan Lewis, Anne Loughrey, Rohini Manuel, Helena Parsons, John D Perry, Gemma Vanstone, Graham White, Nandini Shetty, John Coia, Camilla Wiuff, Katie L Hopkins, Neil Woodford
OBJECTIVES: To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities. METHODS: A 6 month survey was undertaken in November 2013-April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project...
September 29, 2016: Journal of Antimicrobial Chemotherapy
Jordi Rello, Eleonora Bunsow, Antonio Perez
Bacterial resistance to antibiotics is increasing worldwide, due to the emergence of multidrug-resistant strains. With this panorama, there is a serious danger that we may be entering the 'post-antibiotic era'. Areas covered: We assess why so few new classes of antibiotics have been developed in the past years and discuss a variety of treatments that may be able to replace antimicrobials: monoclonal antibodies, bacteriophages, stem cells and anti-virulence agents such as liposomes. Expert commentary: There are a series of economic, scientific-research and regulatory reasons for the scarcity of new antimicrobials...
October 6, 2016: Expert Review of Clinical Pharmacology
Sutep Jaruratanasirikul, Wibul Wongpoowarak, Thitima Wattanavijitkul, Waroonrat Sukarnjanaset, Maseetoh Samaeng, Monchana Nawakitrangsan, Natnicha Ingviya
Sulbactam is being considered as an alternative concomitant medication with other effective antibiotics for the treatment of multidrug-resistant (MDR) Acinetobacter baumannii infections. Pathophysiological changes in critically ill patients with severe sepsis, resulting in altered pharmacokinetic (PK) patterns for antibiotics, are important factors in determining therapeutic success. The aims of this study were (i) to examine the population PK parameters, and (ii) to assess the probability of target attainment (PTA) for sulbactam in patients with severe sepsis caused by A...
September 26, 2016: Antimicrobial Agents and Chemotherapy
Sofia Maraki, Elpis Mantadakis, Viktoria Eirini Mavromanolaki, Diamantis P Kofteridis, George Samonis
BACKGROUND: Acinetobacter baumannii has emerged as a major cause of nosocomial outbreaks. It is particularly associated with nosocomial pneumonia and bloodstream infections in immunocompromised and debilitated patients with serious underlying pathologies. Over the last two decades, a remarkable rise in the rates of multidrug resistance to most antimicrobial agents that are active against A. baumannii has been noted worldwide. We evaluated the rates of antimicrobial resistance and changes in resistance over a 5-year period (2010-2014) in A...
September 2016: Infection & Chemotherapy
Polly Soo Xi Yap, Azanna Ahmad Kamar, Chun Wie Chong, Ivan Kok Seng Yap, Kwai Lin Thong, Yao Mun Choo, Mohd Yasim Md Yusof, Cindy Shuan Ju Teh
The prevalence and antibiotic susceptibility of intestinal carriage of Gram-negative bacteria among preterm infants admitted to the neonatal intensive care unit (NICU) in a tertiary teaching hospital in Malaysia were determined. A total of 34 stool specimens were obtained from preterm infants upon admission and once weekly up to two weeks during hospitalization. The presumptive colonies of Escherichia coli and Klebsiella pneumoniae were selected for identification, antibiotic susceptibility testing, and subtyping by using pulsed-field gel electrophoresis (PFGE)...
September 2016: Pathogens and Global Health
Jessica Z Kubicek-Sutherland, Hava Lofton, Martin Vestergaard, Karin Hjort, Hanne Ingmer, Dan I Andersson
BACKGROUND: The clinical development of antimicrobial peptides (AMPs) is currently under evaluation to combat the rapid increase in MDR bacterial pathogens. However, many AMPs closely resemble components of the human innate immune system and the ramifications of prolonged bacterial exposure to AMPs are not fully understood. OBJECTIVES: We show that in vitro serial passage of a clinical USA300 MRSA strain in a host-mimicking environment containing host-derived AMPs results in the selection of stable AMP resistance...
September 20, 2016: Journal of Antimicrobial Chemotherapy
Masoumeh Douraghi, Seyedesomaye Jasemi, Mansoor Kodori, Mohammad Rahbar, Mohammad Ali Boroumand
Recent studies have recognized the ATPase-encoding comM gene as a hot spot for the integration of Acinetobacter baumannii resistance islands (RIs). Despite the circulation of high numbers of multidrug-resistant A. baumannii (MDR-AB) isolates in Middle East countries, no information is available about the interruption of comM and subsequent transposition into comM in isolates belonging to the global clones (GC) GC1, GC2, or GC3. In this study 401 A. baumannii isolates from hospitals in Tehran, Iran, were included...
September 16, 2016: Journal of Molecular Microbiology and Biotechnology
Tony Velkov, Bo Yun, Elena K Schneider, Mohammad A K Azad, Olan Dolezal, Faye C Morris, Roger L Nation, Jiping Wang, Ke Chen, Heidi H Yu, Lv Wang, Philip E Thompson, Kade D Roberts, Jian Li
Polymyxins B and E (i.e., colistin) are a family of naturally occurring lipopeptide antibiotics that are our last line of defense against multidrug resistant (MDR) Gram-negative pathogens. Unfortunately, nephrotoxicity is a dose-limiting factor for polymyxins that limits their clinical utility. Our recent studies demonstrate that polymyxin-induced nephrotoxicity is a result of their extensive accumulation in renal tubular cells. The design and development of safer, novel polymyxin lipopeptides is hampered by our limited understanding of their complex structure-nephrotoxicity relationships...
May 13, 2016: ACS Infectious Diseases
A M Ammar, A M Attia, M I Abd El-Hamid, I M El-Shorbagy, S A Abd El-Kader
Antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) poses a serious problem for clinicians worldwide. The present study attempted to evaluate the susceptibility patterns of MRSA to various antimicrobials and the prevalence of inducible clindamycin resistance as well as the relevant antibiotic and antiseptic resistance genes among these isolates. Totally, 40 MRSA isolates were recovered from examined milk and meat product samples (18.60%). Multi-drug resistance (MDR) was remarkably observed among 85% of these isolates...
2016: Cellular and Molecular Biology
Matteo Bassetti, Maddalena Peghin, Davide Pecori
PURPOSE OF REVIEW: Multidrug-resistant (MDR) Enterobacteriaceae are often related to the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases. ESBL and carbapenemase-producing Enterobacteriaceae (CRE), in particular, represent an increasing global threat. Recommendations for the therapeutic management of MDR-related infections, however, are mainly derived from retrospective and nonrandomized prospective studies. The aim of this review is to discuss the challenges in the treatment of patients with infections because of MDR Enterobacteriaceae and provide an expert opinion while awaiting for more definitive data...
August 31, 2016: Current Opinion in Infectious Diseases
Roohollah Kheiri, Leili Akhtari
BACKGROUND: The human and animal intestinal tract harbors a complex community of microbes which enables bacteria to inherit antibiotic resistance genes. The aims of this study were to investigate clonality, antimicrobial resistance, prevalence and gene cassette arrays of class I and II integrons among commensal Escherichia coli from human and animals. METHODS: A total of 200 E. coli isolates from human, chicken, cattle, and sheep were isolated followed by phenotypic antibiotic susceptibility testing and detection of class I and II integrons gene cassettes arrays...
2016: Gut Pathogens
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