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Infection prevention and control
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Enterobacterales are a large family of gram-negative bacteria which includes Escherichia coli, Klebsiella spp. and Enterobacter spp., which usually live harmlessly in the gastrointestinal tract of humans; however, they are also some of the most common cause of urinary tract, abdominal and blood stream infections.
Cardiac Implantable Device Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Julian Anthony Rycroft, Simon Tiberi
Up to 90% of infections are caused by Gram-positive organisms—two-thirds of which are coagulase-negative staphylococci, with the majority of the remainder being Staphylococcus aureus. The most common Gram-negative organisms are Enterobacterales spp. and P. aeruginosa. Mycobacterial and fungal causes account for less than 1%. Infection is polymicrobial in around 11% of cases.
Differences in the distribution of pathogens and antimicrobial resistance in bloodstream infections in migrants compared with non-migrants in Denmark
Published in Infectious Diseases, 2023
Rikke Thoft Nielsen, Christian Østergaard Andersen, Henrik Carl Schønheyder, Jørgen Holm Petersen, Jenny Dahl Knudsen, Jens Otto Jarløv, Marie Norredam
In conclusion, we found that migrants had a higher proportion of community-acquired bloodstream infection with E. coli compared with non-migrants. Additionally, refugees had higher odds of resistant E. coli whereas family-reunified migrants only had higher odds of E. coli and other Enterobacterales resistant to ciprofloxacin, with these differences mainly present in the community-acquired bloodstream infections. These disparities in migrants compared with non-migrants are new and can be relevant for improving migrant health by focussing on preventing or treating infections with E. coli and Enterobacterales. More focus on timely and proper treatment of uncomplicated urinary tract infections in migrants could lead to fewer urinary tract infections and with lower risk of infection with resistant bacteria resulting in bloodstream infections. Further surveillance of antimicrobial resistance in migrants is needed as well as studies exploring the vulnerabilities in the different migrant groups.
New advances in management and treatment of multidrug-resistant Klebsiella pneumoniae
Published in Expert Review of Anti-infective Therapy, 2023
Alessandro Russo, Paolo Fusco, Helen Linda Morrone, Enrico Maria Trecarichi, Carlo Torti
Of importance, data from literature detected additional risk factors for the development of invasive infections due to MDR-KP. Solid organ transplant recipient status, steroid use, mechanical ventilation, high Charlson comorbidity index, previous hospitalization, use of medical device and antibiotic exposure were recognized as important risk factors [33–35]. Of interest, recent data evaluating the CD4 + T-cell response to Enterobacterales in healthy individuals compared to patients with K. pneumoniae infections showed that, in the blood of infected individuals, Enterobacterales-specific memory CD4 + T-cells were enriched into the Th1/Th17 helper subset, whereas this T-cell subset resulted severely reduced in septic patients who also selectively lacked circulating K. pneumoniae-reactive T-cells. Importantly, the major component of the memory T-cell repertoire is considered a broadly cross-reactive against different Enterobacterales, that was selectively expanded in the blood of exposed healthy individuals. These broadly cross-reactive T-cells were also found in the naïve T-cell repertoire [36]. This data also provides a better understanding of the human immune responses against infection, especially caused by Enterobacterales, giving insights for the development of new strategies for prevention of severe infections.
Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents
Published in Postgraduate Medicine, 2020
Mazen S. Bader, Mark Loeb, Daniela Leto, Annie A. Brooks
In a multinational, randomized, double-blind, non-inferiority phase III study, 609 patients with cUTIs, including acute pyelonephritis (40-44%), were randomized in to receive intravenous plazomicin (15 mg per kilogram of body weight once daily) or meropenem (1 g every 8 h) for a total of 7 to 10 days of therapy [103]. Among the 382 patients with Enterobacteriales in the microbiologic modified intention-to-treat population, 28.0%, 30.1%, and 26.4% had uropathogens with an ESBLs phenotype, multidrug-resistant uropathogens, and uropathogens that were not susceptible to other aminoglycosides, respectively. The primary end point (composite clinical cure and microbiologic eradication) at test of cure for plazomicin vs. meropenem was 81.7% vs. 70.1% (difference 11.6%, 95%CI 2.7–20.3%). Plazomicin achieved higher microbiological eradication than meropenem (89.5% vs. 74.6%, difference 14.9%, 95% CI 7.0–22.7%) including eradication of Enterobacteriales that were not susceptible to aminoglycosides (78.8% vs. 68.6%) and ESBLs-Enterobacterales (82.4% vs. 75.0%). It was not associated with increased risk of nephrotoxicity or vestibular toxicity [104].