Bacterial infections after lung transplantation
Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell in LUNG Transplantation, 2016
Directed antimicrobial therapy depends on the pathogen causing the disease and review of the results of antimicrobial susceptibility testing. The emergence of MDR pathogens has made this choice particularly challenging, and susceptibility data should always guide therapeutic decisions. MRSA can be treated with vancomycin, linezolid, or daptomycin, although the use of daptomycin as therapy for MRSA lung infection should be avoided because pulmonary surfactant inactivates it. Vancomycin-resistant Enterococcus can be treated with daptomycin or linezolid. Gram-negative pathogens that produce extended-spectrum ß-lactamases or contain AmpC beta-lactamases (both of which confer resistance to many ß-lactam antibiotics) can be treated with carbapenem.76Acinetobacter isolates are frequently resistant to most antibiotics and are usually treated with carbapenems or colistimethate. Carbapenem-resistant Enterobacteriaceae have limited, nonstandardized treatment options. Polymyxins are commonly used against these isolates; however, they have poor pulmonary penetration when administered intravenously. Adjunctive therapy with aerosolized polymyxins is frequently used for such infection. Consultation with an infectious diseases specialist is recommended. Table 31.1 lists increasingly prevalent MDR pathogens and reasonable empiric antimicrobial coverage. As always, local susceptibility data, culture-specific susceptibility results, and infectious disease guidance should be used.76
Acinetobacter Species: Resistance Update and Treatment Options
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
Acinetobacter is a rapidly emerging pathogen in the healthcare setting, where it causes healthcare-associated infections including bacteremia, pneumonia, meningitis, urinary tract infections, and wound infections. Properties of A. baumannii, such as its ability to survive under a wide range of environmental conditions and to persist for extended periods of time on environmental surfaces, make it a frequent cause of outbreaks as well as an endemic pathogen in the healthcare setting (2). Risk factors for colonization or infection with A. baumannii include prolonged length of hospital stay, exposure to ICUs and mechanical ventilation, antimicrobial use, recent surgery, invasive procedures, and underlying severity of illness (Table 1) (2).
Beta-Lactamase Inhibitors
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 in Kucers’ The Use of Antibiotics, 2017
Other drug combinations have been studied in the management of Acinetobacter infections. In three studies, combination treatment was associated with a survival benefit. The combinations used were carbapenem with ampicillin–sulbactam (Kuo et al., 2007); carbapenem with colistin (Shields et al., 2012); and combinations of colistin with rifampin, sulbactam with aminoglycosides, tigecycline with colistin and rifampin, and tigecycline with rifampin and amikacin (Hernandez-Torres et al., 2012). This survival benefit has not been validated in other combination treatment studies.
Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases
Published in Journal of Chemotherapy, 2022
Uğur Önal, Deniz Akyol, Merve Mert, Dilşah Başkol, Seichan Chousein Memetali, Gamze Şanlıdağ, Buse Kenanoğlu, Ayşe Uyan-Önal, Günel Quliyeva, Cansu Bulut Avşar, Damla Akdağ, Melike Demir, Hüseyin Aytaç Erdem, Ümit Kahraman, Osman Bozbıyık, Erkin Özgiray, Devrim Bozkurt, Funda Karbek Akarca, Kubilay Demirağ, İlkin Çankayalı, Mehmet Uyar, Feriha Çilli, Bilgin Arda, Tansu Yamazhan, Hüsnü Pullukçu, Meltem Işıkgöz Taşbakan, Hilal Sipahi, Sercan Ulusoy, Oguz Resat Sipahi
The infecting pathogens were Acinetobacter spp. (49.2%, 59/120), Klebsiella spp. (45.8% 55/120), and Pseudomonas aeruginosa (13.3%, 16/120). All strains were MDR. The sources of the positive bacteriological culture results for CRGNP were urine cultures (39.1%, 47/120), peripheral or catheter blood cultures (36.7%, 44/120), and respiratory tract specimens’ cultures (34.2%, 41/120). Among the patients with positive peripheral or catheter blood cultures, the concomitant bacterial culture positivity rate was 36.4% (16/44) for urinary cultures, 22.7% (10/44) for respiratory tract cultures, and 15.9% (7/44) for other cultures. Further, Acinetobacter spp. culture positivity was found to be significantly higher in the respiratory tract specimens versus others (46%, 27/59 versus 23%, 14/61, P = 0.008).
Traumatic cervical posterior spondyloptosis: report of a rare case
Published in British Journal of Neurosurgery, 2023
Arash Fattahi, Alireza Tabibkhooei
After reduction, we performed an anterior cervical approach for C5 corpectomy followed by iliac autograft and plate fixation (Figure 1(d)). After two days, we found cerebrospinal fluid leakage from one of removed traction screw sites in the absence of any coexisting skull fracture, which was sutured under a sterile condition in the ICU but in the next few days she developed fulminate hospital-acquired meningitis which led to hydrocephalus. Bacteriologic studies revealed Acinetobacter as the causative organism. Using intravenous antibiotics and external ventricular drainage, the meningitis resolved with negative culture results and about two months later, a ventriculoperitoneal shunt was placed for final management of the hydrocephalus. Despite successful treatment of the meningitis, hospital-acquired pneumonia led to severe pleural effusion that was drained and ultimately to her death about three months after admission.
Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh
Published in Hospital Practice, 2020
Tanzina Nusrat, Nasima Akter, Nor Azlina A Rahman, Brian Godman, Diana Thecla D. Rozario, Mainul Haque
Phenotype MBL producing was 65.22% and Genotype (Multiplex PSR) was 45.65%. Approximately two-thirds of the 105 suspected VAP patients were males (n = 72, 68.6%). The mean age of the 105 patients was 47.8 years old (standard deviation = 21.17) with the minimum and maximum age of 16 and 92 years old, respectively. Ninety percent (n = 95) of the total clinically suspected VAP patients were found to be positive for the quantitative culture method. The distribution of positive and negative cultures according to the gender of the patients is shown in Table 1. Further testing performed showed that the identified organisms were Acinetobacter spp. (43.2%), Klebsiella spp. (20%), Pseudomonas spp. (18.9%), E.coli (8.9%), Coagulase Negative Staphylococcus spp. (2.2%), Staphylococcus aureus (2.2%) and mixed microbial growth (7.8%) (Table 2).
Related Knowledge Centers
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- Oxidase Test
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