Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

Journal of Microbiology Immunology and Infection, Journal Year: 2023, Volume and Issue: 56(4), P. 653 - 671

Published: Feb. 18, 2023

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, microbiology, pharmacology, infection control, methodology experts jointly developed the present practice guidelines based on best available scientific evidence to address issues regarding laboratory testing, therapy, prevention infections. This focuses Enterobacteriales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA). Sixteen questions were proposed from perspective current translated into research using PICO (population, intervention, comparator, outcomes) format collect synthesize relevant inform corresponding recommendations. grading recommendations, assessment, evaluation (GRADE) approach was used evaluate quality evidence, benefit risk profile interventions formulate recommendations suggestions. Evidence extracted systematic reviews randomized controlled trials (RCTs) considered preferentially for treatment-related questions. Observational studies, non-controlled expert opinions as supplementary absence RCTs. strength classified strong conditional (weak). informing derives studies worldwide, while implementation suggestions combined Chinese experience. target audience this clinician related professionals involved management diseases.

Language: Английский

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Multidrug-resistant Gram-negative bacterial infections

The Lancet, Journal Year: 2025, Volume and Issue: 405(10474), P. 257 - 272

Published: Jan. 1, 2025

Language: Английский

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The Challenge of Overcoming Antibiotic Resistance in Carbapenem-Resistant Gram-Negative Bacteria: “Attack on Titan”

Microorganisms, Journal Year: 2023, Volume and Issue: 11(8), P. 1912 - 1912

Published: July 27, 2023

The global burden of bacterial resistance remains one the most serious public health concerns. Infections caused by multidrug-resistant (MDR) bacteria in critically ill patients require immediate empirical treatment, which may not only be ineffective due to MDR multiple classes antibiotics, but also contribute selection and spread antimicrobial resistance. Both WHO ECDC consider carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa (CRPA), Acinetobacter baumannii (CRAB) highest priority. ability form biofilm acquisition drug genes, particular carbapenems, have made these pathogens particularly difficult treat. They are a growing cause healthcare-associated infections significant threat health, associated with high mortality rate. Moreover, co-colonization was found predictor for in-hospital mortality. Importantly, they potential using mobile genetic elements. Given current situation, it is clear that finding new ways combat can no longer delayed. aim this review evaluate literature on how AMR. highlights importance rational use antibiotics need implement stewardship principles prevent transmission drug-resistant organisms healthcare settings. Finally, discusses advantages limitations alternative therapies treatment “titans” antibiotic

Language: Английский

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Polymyxin combination therapy for multidrug-resistant, extensively-drug resistant, and difficult-to-treat drug-resistant gram-negative infections: is it superior to polymyxin monotherapy?

Expert Review of Anti-infective Therapy, Journal Year: 2023, Volume and Issue: 21(4), P. 387 - 429

Published: Feb. 23, 2023

The increasing prevalence of infections with multidrug-resistant (MDR), extensively-drug resistant (XDR) or difficult-to-treat drug (DTR) Gram-negative bacilli (GNB), including Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter species, and Escherichia coli poses a severe challenge.The rapid growing multi-resistant GNB as well the considerable deceleration in development new anti-infective agents have made polymyxins (e.g. polymyxin B colistin) mainstay clinical practices either monotherapy combination therapy. However, whether polymyxin-based combinations lead to better outcomes remains unknown. This review mainly focuses on effect therapy versus treating GNB-related infections. We also provide several factors designing studies their impact optimizing combinations.An abundance recent vitro preclinical vivo data suggest benefit for polymyxin-drug therapies, especially colistin plus meropenem rifampicin, synergistic killing against MDR, XDR, DTR P. K. pneumoniae A. baumannii. beneficial effects + carbapenem carbapenem-resistant rifampin ceftolozan/tazobactam PDR-P. aeruginosa) often been shown setting by retrospective studies. high-certainty evidence from large randomized controlled trials is necessary. These should incorporate careful attention patient's sample size, characteristics groups, PK/PD relationships dosing, detection resistance, MIC determinations, therapeutic monitoring.

Language: Английский

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Rising role of 3D-printing in delivery of therapeutics for infectious disease

Journal of Controlled Release, Journal Year: 2024, Volume and Issue: 366, P. 349 - 365

Published: Jan. 8, 2024

Language: Английский

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Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

Antibiotics, Journal Year: 2024, Volume and Issue: 13(3), P. 238 - 238

Published: March 5, 2024

Intensive care units constitute a critical setting for the management of infections. The patients' fragilities and spread multidrug-resistant microorganisms lead to relevant difficulties in care. Recent epidemiological surveys documented Gram-negative bacteria supremacy among intensive unit (ICU) infection aetiologies, accounting numerous isolates. Regarding this specific setting, clinical microbiology support holds crucial role definition diagnostic algorithms. Eventually, complete patient evaluation requires integrating local knowledge into best practice standardization antimicrobial stewardship programs. Clinical laboratories usually receive respiratory tract blood samples from ICU patients, which express significant predisposition severe Therefore, conventional or rapid workflows should be modified depending on urgency preliminary colonization data. Additionally, it is essential each microbiological report with phenotypic minimum inhibitory concentration (MIC) values information about resistance markers. Microbiologists also help eventual integration ultimate genome analysis techniques complicated workflows. Herein, we want emphasize microbiologist decisional process management.

Language: Английский

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Navigating Antibiotic Resistance in Gram‐Negative Bacteria: Current Challenges and Emerging Therapeutic Strategies

ChemPhysChem, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 19, 2025

Abstract The rapid rise of antibiotic resistance poses a severe global health crisis, necessitating new approaches to counter this growing threat. problem is exacerbated in Gram‐negative bacterial pathogens as many antibiotics are unable enter these cells owing their unique additional outer membrane barrier. In review, we discuss the challenges targeting bacteria, including complexity membrane, well presence efflux pumps and β‐lactamases that contribute resistance. We also review solutions proposed facilitate entry accumulation bacteria. These involve using existing combination with other inhibitors attack cell synergistically. highlight target via novel modes action, providing strategies tackle

Language: Английский

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Clinical Characteristics of Patients Who Acquired Gram-Negative Bacteria During Ceftazidime-Avibactam Therapy

Infectious Diseases and Therapy, Journal Year: 2025, Volume and Issue: unknown

Published: April 2, 2025

Ceftazidime-avibactam (CZA) is recommended to treat infections caused by carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa with difficult-to-treat resistance. The selective pressure of CZA results in the isolation multidrug-resistant Gram-negative bacteria (MDR-GNB), causing superinfection or hospital-wide spread. We aimed study clinical characteristics patients who acquired GNB during treatment. Adult treated for ≥ 5 days proven suspected MDR-GNB were retrospectively enrolled at Taipei Veterans General Hospital between December 2019 June 2021. acquisition was defined as new species resulting infection colonization isolated period from after initiation until end Clinical features compared specimen those did not. Multivariable analysis used explore risk factors 28-day mortality GNB. Among 321 CZA, 68 identified 55 (17.1%). Elizabethkingia (n = 15) most common GNB, followed Acinetobacter 13) Burkholderia cenocepacia 11). presence diabetes mellitus, mechanical ventilation independent acquisition. There a statistically nonsignificant trend toward increased without (38.2% vs. 27.8%, P 0.105). Cerebrovascular disease associated species, B. major A observed Further studies on optimal treatments these warranted.

Language: Английский

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Geographic patterns of carbapenem-resistant, multi-drug-resistant and difficult-to-treat Acinetobacter baumannii in the Asia-Pacific region: results from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program, 2020

International Journal of Antimicrobial Agents, Journal Year: 2023, Volume and Issue: 61(2), P. 106707 - 106707

Published: Jan. 3, 2023

Language: Английский

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Synergy between Human Peptide LL-37 and Polymyxin B against Planktonic and Biofilm Cells of Escherichia coli and Pseudomonas aeruginosa

Antibiotics, Journal Year: 2023, Volume and Issue: 12(2), P. 389 - 389

Published: Feb. 15, 2023

The rise in antimicrobial resistant bacteria is limiting the number of effective treatments for bacterial infections. Escherichia coli and Pseudomonas aeruginosa are two pathogens with highest prevalence resistance, greatest need new agents. Combinations peptides (AMPs) antibiotics that display synergistic effects have been shown to be an strategy development novel therapeutic In this study, we investigated synergy between AMP LL-37 various classes against E. P. strains. Of six tested (ampicillin, tetracycline, ciprofloxacin, gentamicin, aztreonam, polymyxin B (PMB)), displayed strongest MG1655 PAO1 laboratory strains when combined PMB. Given strong synergy, PMB + combination was chosen further examination where it demonstrated multidrug-resistant clinical isolates. Synergy towards isolates varied showed synergistic, additive, or indifferent effects. treatment significant prevention biofilm formation as well eradication pre-grown biofilms. Using Galleria mellonella wax worm model, retained its antibacterial capacities vivo. Flow analyses were performed characterize mode action. results present study provide proof principle response give insights into a promising gram-negative planktonic cells.

Language: Английский

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