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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
The Microbiology Laboratory
Published in Keith Struthers, Clinical Microbiology, 2017
The carbapenemase-producing Enterobacteriaceae (CPE) pose a critical challenge in clinical diagnosis, treatment and infection control. There are also two important laboratory diagnostic issues: Conventional culture and antibiotic susceptibility testing takes several days for the final result.Conventional susceptibility testing determines the phenotypic susceptibility profile of the organism. Isolates of Klebsiella can appear to be producing a carbapenemase, but on further examination are producing an ESBL and also have reduced susceptibility to carbapenems due to porin restriction, which gives the false carbapenemase-producing phenotype.
Health care settings *
Published in Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse, Routledge Handbook of Water and Health, 2015
Associated outbreaks in health care facilities are well described in the literature whereas sanitation system associated outbreaks are described only in a few publications. In the last few years, there have been well documented nosocomial outbreaks in which the sanitation system and its controls were identified as infection reservoirs, especially for Pseudomonas aeruginosa and antibiotic-resistant carbapenemase-producing Enterobacteriaceae.11,12, 13 Therefore it is of utmost importance to also take into account the sanitation system when there is an increase in those pathogens. Even today, official guidelines for prevention and control of health care associated infections to control carbapenemase-producing Enterobacteriaceae do not take into account water and sanitation systems as a reservoir. All that is proposed is the screening and training of health care workers in hand hygiene and isolating or grouping infected or colonized patients.
Safety considerations with new antibacterial approaches for chronic bacterial prostatitis
Published in Expert Opinion on Drug Safety, 2022
Gianpaolo Perletti, Alberto Trinchieri, Konstantinos Stamatiou, Vittorio Magri
2 – Reports describing therapy for CBP with some of the drugs reviewed in this article are scant in some cases. Whereas antibiotics like aminoglycosides and macrolides are recommended by international guidelines (e.g. the European Association of Urology Guidelines [22]), the evidence concerning other antibacterial agents is often anecdotal and restricted to case reports or small case series. Thus, readers should be warned of the limited published evidence concerning some of the drugs listed above. This also shows that the management of chronic prostatitis is a challenging task for clinicians, and antibiotic selection must be adapted as much as possible to current recommendations. Adequately powered comparative studies, preferably in a randomized setting, are urgently needed. In our opinion, priority should be given to studies focusing on CBP caused (i) by Gram-positive pathogens, whose prevalence is increasing in some geographic areas, and (ii) by multidrug-resistant/carbapenemase-producing Enterobacteriaceae. Unfortunately, the antibiotic pipeline is drying out due to the lack of interest of multinational pharmaceutical companies. Spontaneous research triggered by scientific interest and in the interest of patients will therefore be highly meritorious.
Incidence and risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care units: a matched case–control study
Published in Expert Review of Anti-infective Therapy, 2021
Fahad A S Aleidan, Hind Alkhelaifi, Aljouharah Alsenaid, Haya Alromaizan, Fajer Alsalham, Alhanouf Almutairi, Khalid Alsulaiman, Abdel Galil Abdel Gadir
Carbapenemase-producing Enterobacteriaceae (CPE) were unheard of until the 1990s, but recent years have witnessed an alarming global increase in CPE detection and spread, and it is encountered routinely in hospitals and other health-care facilities worldwide [19,20]. These bacteria, which are present in both clinical and non-clinical settings, including food, such as meat, seafood, and vegetables [21], are a deep source of worry in clinical practice, as they are difficult to treat, have an alarming potential to cause outbreaks, are associated with high morbidity and mortality, and have the potential to cause widespread transmission of resistance. Thus, it has become important that countries worldwide should undertake detailed studies of the local situation of CPE in their hospitals and health institutions. A recent (2018) European survey was undertaken by a group of experts from 37 European countries [22]. The alarming outcome of this survey indicates that CPE in health-care systems in Europe disseminated further between 2015 and 2018, despite the fact that these European countries maintain high standards of health-care delivery. This, and many other published European surveys, were whole country surveys, but such studies are lacking in developing countries. Thus, the few studies that have emerged were all single hospital/health institution surveys [8,9]. This current survey, which is larger than the other two, was undertaken in a one-hospital complex. Nonetheless, these studies give a glimpse of the local situation in single heath institutions in the capital city of Saudi Arabia, Riyadh.
Management of febrile neutropenia in the perspective of antimicrobial de-escalation and discontinuation
Published in Expert Review of Anti-infective Therapy, 2019
Martin Schmidt-Hieber, Daniel Teschner, Georg Maschmeyer, Enrico Schalk
An Italian multicenter trial has shown an advantage of tigecycline combined with piperacillin/tazobactam vs single-agent piperacillin/tazobactam in patients with high-risk FN [85]. Higher success rates were observed for both BSI and clinically documented infections. However, there was no significant difference in mortality rates between both patient groups in this study. A further retrospective study (INCREMENT) analyzed appropriate antibiotic therapy for BSI by carbapenemase-producing Enterobacteriaceae. In this study, combination therapy (e.g. tigecycline-based) was associated with improved survival only in patients with a high mortality score referring to different variables such as primary sepsis or shock, a Charlson Comorbidity Index score of ≥2 or a source of BSI other than urinary or biliary tract [86].