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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).
Chapter 8 Antibiotics: help or hindrance?
Published in Paul Elliott, Julie Storr, Annette Jeanes, Barry Professor Cookson, Benedetta Professor Allegranzi, Marilyn ADJ Professor Cruickshank, Infection Prevention and Control, 2017
Carbapenem antibiotics, such as imipenem and meropenem, have a broad spectrum of activity and are used for the treatment of severe hospital-associated infections and polymicrobial infections.16 As such they are often used as last-line treatments for resistant infections. Worryingly, carbapenem resistance has begun to develop, resulting in bacteria that are resistant to all but a handful of antibiotics. A growing number of bacteria from the Enterobacteriaceae species, such as E. coli and Klebsiella, have been noted to produce carbapenemase enzymes.17 These enzymes destroy carbapenem antibiotics, and therefore bacteria producing them can cause multidrug-resistant infections.18 Resulting infections present a therapeutic challenge, as there are limited treatment options, such as colistin and tigecycline.19 This is has been a growing problem in recent years. The United States, India and parts of Europe are all reported to have high prevalence of healthcare-associated carbapenemase-producing Enterobacteriaceae.20
Cefoxitin, Cefotetan, and Other Cephamycins
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
The most common mechanism of resistance to penicillins is the chromosomally encoded class A/group 2e cephalosporinase (product of the cepA gene) (Rogers et al., 1993). This enzyme is active against penicillins and first-generation cephalosporins but not against cephamycin or carbapenem antibiotics. Resistance to cefoxitin is contributed by CfxA, a class A/group 2e cephalosporinase encoded by the cfxA gene, which has been shown to be distantly related to the B. fragilis endogenous cepA (Parker and Smith, 1993). This resistance gene is harbored in a mobilizable transposon (Tn4555) (Ferreira et al., 2007). The CfxA enzyme confers resistance to cephamycins and all other beta-lactam antibiotics, except the carbapenems (Parker and Smith, 1993). The B. fragilis group has been shown to rarely produce a class B metallo-beta-lactamase, encoded by the cfiA gene (also known as the ccrA gene), which causes resistance to all beta-lactam antibiotics, including cephamycins and carbapenems (Thompson and Malamy, 1990; Bandoh et al., 1991).
Amoxicillin-associated Stevens-Johnson syndrome or toxic epidermal necrolysis: systematic review
Published in Journal of Chemotherapy, 2023
Ana V. Pejcic, Milos N. Milosavljevic, Marko Folic, Diana Fernandes, João Bentes, Miralem Djesevic, Slobodan Jankovic
Almost all patients were treated in a hospital setting (n = 63; 98.4%). It was specified that 10 patients (15.6%) were managed in the intensive care units, while 11 patients (17.2%) were treated in specialized burn units. The specified total length of hospital stay ranged from 3 to 70 days (median: 16 days). The summary of treatment for each patient is given in Supplementary Table 1. Treatment with amoxicillin and amoxicillin/clavulanic acid was reported to be discontinued in 27 patients (42.2%) either after establishing diagnosis of the reaction or when the therapy course was completed. Use of some form of supportive and symptomatic care (e.g., local care, intravenous fluids, nutritional support, antihistamines, antiseptics, analgesics, mechanical ventilation…) was reported in 49 patients (76.6%). Systemic corticosteroids were reported to be administered in 29 (45.3%) patients and intravenous immunoglobulin (IVIG) in 11 (17.2%) patients (5 of these patients received both systemic corticosteroids and IVIG). Systemic cyclosporin use was reported in 2 patients (3.1%), while plasmapheresis was performed in 3 patients (4.7%). Systemic and topical antibiotics were administered in 17 (26.6%) and 13 (20.3%) patients, respectively. Adverse events related to treatment were reported only in one patient (1.6%): a single dose of carbapenem antibiotics administered due to postoperative infection triggered an anaphylactic shock.
Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections
Published in Expert Opinion on Pharmacotherapy, 2020
S.G. Kuiper, E. Leegwater, E.B. Wilms, C. van Nieuwkoop
Infections of the urinary tract are one of the most common bacterial infections. Health care-associated costs for this group of patients are substantial and increases after hospitalization [1]. The incidence of complicated urinary tract infection (UTI), including pyelonephritis and urosepsis, increases with age and women are more affected than men [2]. Most common causative bacteria are Gram-negative bacteria like Enterobacterales. Currently, multidrug resistance (MDR) is emerging and carbapenemase producing Gram-negative bacteria are of particular concern as this may result in untreatable and incurable complicated UTI (cUTI) and ultimately death. In order to prevent untreatable UTI, carbapenems are generally used as reserve antibiotics [3]. The World Health Organization deemed research into treatment of carbapenemase producing Enterobacterales, including the development of new antibiotics, as critical [4]. A treatment strategy to battle resistance in carbapenemase producing bacteria that’s currently being followed is the addition of a β-lactamase inhibitor to carbapenem antibiotics. One example is imipenem/cilastatin/relebactam (IMI/REL). This review discusses the use of imipenem/cilastatin/relebactam in patients with UTIs.
The use of polymyxins to treat carbapenem resistant infections in neonates and children
Published in Expert Opinion on Pharmacotherapy, 2019
Reenu Thomas, Sithembiso Velaphi, Sally Ellis, A. Sarah Walker, Joseph F. Standing, Paul Heath, Mike Sharland, Daniele Dona’
The most commonly used definition for multidrug resistance is non-susceptibility, intermediate sensitivity or resistance to at least one agent in 3 or more antimicrobial classes. The term extreme drug resistance (XDR) has been used to define MDR organisms that are resistant to at least one agent in all antimicrobial classes except 2 or fewer [6]. Resistance to carbapenem antibiotics poses a particular global health challenge, especially in LMIC, where therapeutic options are limited and mortality rates are reported to be as high as 50% [7,8]. A number of studies have reported a high prevalence of carbapenem resistant organisms (CRO) in neonatal units; however, most are from high-income countries [9–12] with very few from LMIC [7,13–15]. The common CRO are the carbapenem resistant Enterobacteriaceae (CRE), in particular Klebsiella species, and the non-lactose fermenters, namely the Acinetobacter and Pseudomonas species.