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
Health care settings *
Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse in 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.
Imipenem–Cilastatin and Imipenem–Relebactam
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 imipenem-resistant Enterobacteriaceae have also been identified. Metallo-beta-lactamase-producing E. coli, E. cloacae, E. aerogenes, S. marcescens, C. freundii, P. vulgaris, K. oxytoca, and M. morganii have now been isolated in many countries (Queenan and Bush, 2007). The New Delhi metallo-beta-lactamase (NDM) type carbapenemase has its epicenter in the Indian subcontinent but has now been found in numerous other areas. KPC-type class A carbapenemase-producing E. coli, K. oxytoca, E. cloacae, E. aerogenes, and C. freundii have been identified most frequently in the USA, Israel, and Europe (Munoz-Price et al., 2013). Even KPC-2 carbapenemase-producing Salmonella enterica and IMP-3 metallo-beta-lactamase-producing Shigella flexneri have been detected. (Iyobe et al., 2000; Miriagou et al., 2003). Carbapenem-resistant Enterobacteriaceae have spread to communities, similar to MRSA and ESBL-producing Entero-bacteriaceae, although it is still typically associated with healthcare or nursing home facilities (Schwaber and Carmeli, 2008).
Emergence of VIM-2-producing Citrobacter freundii in Japan
Published in Infectious Diseases, 2018
Sayaka Ando, Ryuichi Nakano, Tomokazu Kuchibiro, Katsutoshi Yamasaki, Yuki Suzuki, Akiyo Nakano, Tomoki Mizuno, Kei Kasahara, Hisakazu Yano
Carbapenemase-producing Enterobacteriaceae show multi-antibiotic resistance; thus, infections with these bacteria are difficult to treat, representing a growing problem worldwide. Carbapenemase is often encoded by a plasmid that spreads via conjugal transfer. In the present journal, a recent report from Zhejiang Province, China payed attention to the increasing emergence of carbapenem resistance in gram-negative bacteria [1]. In 70.4% (59/71) isolates of carbapenem-resistant Enterobacteriaceae, two carbapenemase-encoding genes were detected, namely blaKPC-2 and blaIMP-4/blaIMP-8. Among class B metallo-β-lactamases, blaVIM were detected in Pseudomonas aeruginosa but occurred in none of not 71 isolates of carbapenem-resistant strains of Enterobacteriaceae. Aiming to add information to the present increasing emergence of carbapenemase-producing gram-negatives, we here report our detection of VIM-2-producing Citrobacter freundii in Japan.
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.
Identification of an NDM-1-producing Klebsiella pneumoniae from diabetic foot ulcer in China
Published in Infectious Diseases, 2018
Shuai Ye, Li Ni, Sihu Wang, Wu Dai
To our knowledge, there was no report of NDM-1-producing K. pneumoniae isolates from community acquired infections with diabetic foot ulcers in China. In our study, we described a K. pneumoniae carrying NDM-1 isolated from diabetic foot ulcers. Furthermore, the blaNDM-1 gene was carried by IncL/M plasmid and was associated with blaCTX-M-14, armA, ISEcp1 and IntI1. Because of this characteristic, K. pneumoniae KP0617 was also resistant to aminoglycoside, such as gentamicin and amikacin. Although many reports have identified NDM-1-producing isolates worldwide, clear identification of NDM-1 producers as a source of community-acquired infection is scarce. The present data and earlier reports indicate the need to control the dissemination of carbapenemase producing Enterobacteriaceae in the hospital setting, as well as in the community. This control will require the development of rapid, cheap and easy-to handle diagnostic techniques for the identification of carbapenemase producers.
Related Knowledge Centers
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