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Infection prevention and control
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Carbapenems are a group of β-lactam (penicillin-like) antibiotics that include meropenem and ertapenem that are usually reserved to treat the most serious infections. Some gram-negative bacteria are naturally resistant to carbapenems, while others can produce enzymes (carbapenemase) capable of destroying carbapenem antibiotics, the genes for which tend to be located on plasmids that can be transferred from one organism to another. In this way, carbapenem resistance can be acquired (PHE 2020b).
Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Monobactams such as Aztreonam are another class of beta-lactam. They generally have no cross reactivity to penicillins or cephalosporins and can therefore be given in patients who are allergic to these agents (Adkinson 1990). Carbapenems appear to have low if any cross reactivity to penicillins but are often used cautiously in a patient with a severe penicillin allergy.
Adverse Reactions to Antibiotics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Diane M. Parente, Cheston B. Cunha, Michael Lorenzo
A wide spectrum of neurological manifestations from delirium to seizures (e.g., non-convulsive status epilepticus) can be caused by penicillins, cephalosporins (cefepime), carbapenems (imipenem, not meropenem or ertapenem), and fluoroquinolones (ciprofloxacin, not levofloxacin or moxifloxacin) [102–105]. The average time to onset is 5 days and ranges from 1 to 10 days [103–105]. β-lactam-induced seizures are thought to result from inhibition of the neurotransmitter γ-aminobutyric acid [106]. Penicillins, particularly benzylpenicillin, and less so ampicillin and piperacillin, have been known to cause neurotoxic effects ranging from encephalopathy, behavioral alterations, and myoclonus to seizures. Patients on piperacillin who progress from altered mental status to seizures not alleviated by anticonvulsant medications may require high-flux hemodialysis for resolution of symptoms. Cefepime-related neurotoxicity (particularly non-convulsive status epilepticus) is increased when the dose is not appropriately adjusted in patients with reduced renal function. Dose adjustments are recommended when the creatinine clearance is less than 60 mL/min. Other cephalosporins with neurotoxic potential (e.g., encephalopathy, myoclonus, and seizures) include cefazolin and ceftazidime [107]. Of the carbapenem class, imipenem/cilstatin has a higher reported incidence of seizures (0.9%‒3%) compared with other carbapenems (<0.8%). Patients on carbapenems can experience encephalopathy, headache, myoclonus, or seizures.
A nationwide evaluation of antibiotics consumption in Swedish intensive care units
Published in Infectious Diseases, 2022
Fredrik Sjövall, Morgan Edström, Sten Walther, Håkan Hanberger
Carbapenems are often a last resort antibiotic for infections with multi-drug resistant bacteria and are therefore proposed to be spared when there are other alternatives. According to our results, the use of carbapenems varied widely between the different hospital categories as well as between individual hospitals within the same category. Some of the variations could be explained by higher disease severity as there was a moderate but significant correlation between mean ICU SAPS3 score and carbapenem use. However, this does not fully explain the differences. Multi-drug resistance in Swedish ICUs does not vary enough to explain the differences (https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistik-a-o/sjukdomsstatistik/extended-spectrum-beta-lactamase-esbl/?t=county#statistics-nav). Thus, local variations, traditions and risk factors of infections caused by extended-spectrum beta-lactamase-producing bacteria, even in a low resistance setting, are likely part of decisions to prescribe-, and whether to de-escalate, a carbapenem. We had no information regarding the consultation with infectious disease specialists and regarding local antimicrobial stewardship programs in the ICUs. Such measures may have influenced the antibiotic choice, dosing and duration [16].
Epidemiology and risk factors for healthcare-associated infections caused by Pseudomonas aeruginosa
Published in Journal of Chemotherapy, 2021
Marko M. Folic, Zorana Djordjevic, Nevena Folic, Marija Zivkovic Radojevic, Slobodan M. Jankovic
Previous exposure to antibiotics is an important risk factor for HAIs caused by PA, in general, or by various resistant phenotypes. The meta-analysis by Voor In ‘t Holt at associates14 found a strong association between previous use of carbapenems and infections with CRPA strains (OR = 7.09; 95% CI = 5.43–9.25;), while Raman at associates19 linked MDRPA-caused infections with ICU admission or use of fluoroquinolones, and MDRPA or XDRPA-caused infections with the use of quinolones, carbapenems, and prior hospital stay. This underlines the necessity of monitoring antibiotics prescribing to preserve their efficacy in the future since carbapenems are still a mainstay in the treatment of serious infections due to PA. A recent study confirmed that PA exposure to various concentrations of antimicrobial drugs resulted in a variety of selection pressure. Lower concentrations of carbapenems induce resistance by stimulating the production of AmpC enzymes.21 Prolonged exposure to antimicrobials can be an additional factor for promoting infection by drug-resistant pathogens because the normal microbiological flora is replaced with endemic bacterial strains from the hospital environment, which are often multi- or pan-resistant. The infection is preceded by colonization due to weakened defensive mechanisms of patients with multiple comorbidities.22 The choice of optimal antibiotic therapy is critical, and numerous studies demonstrated the association of inappropriate prescribing of antibiotics to increase in resistance density23 and treatment costs.24
A plethora of carbapenem resistance in Acinetobacter baumannii: no end to a long insidious genetic journey
Published in Journal of Chemotherapy, 2021
Abolfazl Vahhabi, Alka Hasani, Mohammad Ahangarzadeh Rezaee, Behzad Baradaran, Akbar Hasani, Hossein Samadi Kafil, Faeze Abbaszadeh, Leila Dehghani
Carbapenem resistance is an on-going concern as carbapenems, including imipenem and meropenem, had a potent activity against A. baumannii and were often used as the last resort for the treatment of infections caused by MDR A. baumannii. Carbapenems have a good bactericidal activity, are stable towards a range of β-lactamases, possess broad-spectrum activity and a good safety profile.20,21 The first carbapenem discovered was olivanic acid produced by Streptomyces olivaceus. This was followed by the discovery of thienamycin in 1976. Years later, a more stable thienamycin derivative known as imipenem was synthesized and approved for use in 1984. Other carbapenems for parenteral administration were discovered later and included biapenem, panipenem, lenapenem and ertapenem. Carbapenems are recommended for the empirical treatment of a variety of severe infections and they are generally well tolerated in the human body except certain treatable allergic reactions.21,22 In parallel with the increase in carbapenem use and increase in A. baumannii infections there has been an increase in the rise of not only carbapenem resistance, but also resistance towards majority of other antibiotics (except the polymyxins or tigecycline). Imipenem resistance was first described in 1985 and since then carbapenem resistance in A. baumannii became increasingly common.20–22