Microbial drug resistance : MDR : mechanisms, epidemiology, and disease
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Microb. Drug Resist. · Sep 2021
Impact of Checklist for Early Recognition and Treatment of Acute Illness on Treatment of Critically Ill Septic Patients in a Low-Resource Medical Intensive Care Unit.
Introduction: Treatment of sepsis and septic shock can be a challenge even for intensive care units (ICUs) in high income countries, but it is especially difficult for ICUs with limited resources. Aim: To evaluate the impact of CERTAIN on treatment of critically ill septic patients in low-resource medical ICU. Materials and Methods: In a before-and-after study design, we compared clinical outcomes, processes, and complications (hospital acquired infections) 1 year before and 2 years after (2016 and 2017) introduction of CERTAIN. ⋯ The duration of mechanical ventilation (5.3 ± 5.3 vs. 4.2 ± 3.6 vs. 3.7 ± 5.5), antibiotic treatment (8.2 ± 5.4 vs. 6.9 ± 4.1 vs. 5.8 ± 5.6), central venous catheter use (6.2 ± 5.7 vs. 5.7 ± 4.6 vs. 4.2 ± 6.1), ICU stay (8.4 ± 5.4 vs. 7.1 ± 4.1 vs. 5.8 ± 5.6), and the incidence of nosocomial infection (33.3% vs. 30% vs. 12.5%) decreased in the period after the onset of the intervention, but the results did not reach statistical significance. When adjusted for baseline characteristics, CERTAIN was not associated with hospital mortality (odds ratio 0.88, 0.38-2.04). Conclusion: CERTAIN was readily adopted in the ICU workflow and was associated with improvement in treatment of critically ill patients with sepsis.
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Microb. Drug Resist. · Mar 2021
ReviewCombination of Hydroxychloroquine Plus Azithromycin As Potential Treatment for COVID-19 Patients: Safety Profile, Drug Interactions, and Management of Toxicity.
The coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2, has recently emerged worldwide. In this context, there is an urgent need to identify safe and effective therapeutic strategies for treatment of such highly contagious disease. ⋯ Although ongoing clinical trials are challenging the efficacy of this combination, many clinicians claim the authorization to or have already begun to use it to treat COVID-19 patients worldwide. The aim of this article is to share pharmacology considerations contributing to the rationale of this combination, and to provide safety information to prevent toxicity and drug-drug interactions, based on available evidence.
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Microb. Drug Resist. · Jun 2020
ReviewPreserving the Dwindling β-lactams-Based Empiric Therapy Options for Gram-Negative Infections in Challenging Resistance Scenario: Lessons Learned and Way Forward.
Appropriate empiric therapy reduces mortality and morbidity associated with serious Gram-negative infections. β-lactams (BLs) owing to their safety, efficacy, and coverage spectrum are the most preferred agents for empiric use. Inappropriate use of older penicillins and cephalosporins led to selection and spread of resistant clones. As a result, these valuable agents have lost their reliability compelling clinicians to often use erstwhile last-line therapies such as carbapenems. ⋯ This review elaborates the past trends in empirical use of BLs and ensuing patterns of resistance emergence in Gram-negatives. Furthermore, a critical appraisal of newer BL-BLIs has been presented to identify the appropriate clinical situations for their use to ensure clinical efficacy coupled with minimal resistance selection. These learning have been derived from past trends of clinical usage of older empiric therapies so that the therapeutic utility of newer agents is preserved for long in light of dwindling global antibiotics pipeline.
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Microb. Drug Resist. · Mar 2020
Evaluation of the Presence and Characterization of Vancomycin-Intermediate and Heterogeneous Vancomycin-Intermediate Level Resistance Among Bloodstream Isolates of Methicillin-Resistant Staphylococcus aureus.
Aims: Heterogeneous vancomycin-intermediate Staphylococcus aureus(hVISA) could be misinterpreted as "susceptible" with routine susceptibility testing procedures, and the subpopulations with reduced susceptibility to glycopeptides can lead to therapeutic failure. The aim of this study was to evaluate the presence of VISA and hVISA strains among stocked bloodstream methicillin-resistant S. aureus (MRSA) isolates of 14 years. Materials and Methods: A total of 127 nonduplicate MRSA strains isolated from blood cultures between 2001 and 2014 were investigated. Glycopeptide minimum inhibitory concentration values were detected by microbroth dilution method. ⋯ All isolates carried type-III SCCmec, sea was the most prevalent (96.9%) enterotoxin gene and agr group I locus was predominant (93.7%). PFGE analysis revealed four main and four unique patterns. Conclusion: No hVISA or VISA were detected. The resistance rate to ceftaroline seems remarkable due to its recent entry into the market in Turkey.
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Microb. Drug Resist. · Oct 2019
Clonal Diversity and Genetic Characteristics of Methicillin-Resistant Staphylococcus aureus Isolates from a Tertiary Care Hospital in Japan.
Molecular epidemiological characteristics were investigated for 1,041 isolates of methicillin-resistant Staphylococcus aureus (MRSA) collected in a tertiary care hospital in northern Japan for a 4-year period (2011-2014). Genotypes (staphylococcal cassette chromosome mec [SCCmec], sequence type, spa, coa, etc.) and the presence of drug resistance/virulence factor genes in the isolates were analyzed by multiplex/uniplex PCR, and PCR-direct sequencing as needed. Among these MRSA, predominant SCCmec type was IIa (87.2%), followed by IV (10.1%) and V (1.2%). ⋯ Uncommon MRSA clones in Japan, ST72-SCCmec IV (South Korean clone), ST398 livestock-associated clone, and ST20 bovine-associated MRSA, were identified. Furthermore, we isolated PVL-negative ST8-SCCmec I/coa-IIIa and ST81-SCCmec V/coa-VIIa MRSA, which were considered presumptive novel clones. The present study revealed the genetic diversity of HA-MRSA, including potentially emerging clones of putative different origins.