|
1
|
Zamanian MH, Farhadian N, Sanaei S, Farhadian M. Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units: A Meta-Analysis. Microb Drug Resist 2025. [PMID: 40160131 DOI: 10.1089/mdr.2024.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025] Open
Abstract
Introduction: Infections due to carbapenem-resistant Enterobacteriaceae (CRE) in intensive care units (ICUs) pose a significant threat. Colonization with CRE is a prerequisite for bacterial translocation/infections. This work aimed to determine risk factors for CRE colonization in ICU patients. Methods: To find relevant works, PubMed, EMBASE, and references of eligible studies were systematically searched using appropriate keywords up to September 2023. Odds ratios (ORs) and 95% confidence intervals were used to compare risk factor between CRE colonized cases and CRE noncolonized controls. Results: Twelve studies were included. Previous hospitalization (OR: 2.26), previous ICU stay (OR: 10.33), higher acute physiology and chronic health evaluation (APACHE) II score (mean difference [MD]: 4.38), central venous catheter (OR: 4.07), long-term gastric tube (OR: 3.01), hemodialysis catheter (OR: 3.38), urinary catheter (OR: 2.59), mechanical ventilation (OR: 3.41), endoscopy (OR: 3.37), tracheostomy (OR: 3.46), and exposure to antibiotics such as glycopeptide (OR: 10.68), aminoglycosides (OR: 6.53), tigecycline (OR: 6.87), vancomycin (OR: 5.32), carbapenems (OR: 5.23), cephalosporins (OR: 4.96), metronidazole (OR: 4.82), penicillin (OR: 4.41), and β-lactams/β-lactamase inhibitor (OR: 4.28) are highly associated with CRE colonization. Conclusions: ICU-admitted patients with prior hospitalization, ICU stay, previous antibiotic use, and invasive devices/procedures exposures should be prioritized in the screening strategy for CRE colonization to prevent nosocomial infections.
Collapse
Affiliation(s)
- Mohammad Hossein Zamanian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Farhadian
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahar Sanaei
- Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
|
2
|
Nartey YA, Donkor AB, Siaw ADJ, Ekor OE, Jimah BB. Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infection in a Ghanaian Patient with Unilateral Diaphragmatic Eventration and HIV Type 1 Infection. Case Rep Infect Dis 2023; 2023:9930291. [PMID: 37867582 PMCID: PMC10586909 DOI: 10.1155/2023/9930291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii infection is a critically prioritized pathogen by the World Health Organization and a cause for growing concern due to increased mortality among hospitalised patients. Phrenic nerve palsy is a rare complication of herpes zoster infection of the C3, C4, and C5 nerve roots. We present a case of bloodstream carbapenem-resistant A. baumannii infection in a Ghanaian patient with HIV type 1 infection and multiple risk factors, including unilateral diaphragmatic eventration with compression atelectasis likely secondary to phrenic nerve palsy due to herpes zoster infection, consequently leading to recurrent hospital and ICU admission. In this case, we emphasize the need for clinicians in LMICs to be aware of CRAB, in order to advocate for the availability of evidence-based medicines in resource-limited settings for appropriate treatment. In addition, we illustrate the importance of a high index of suspicion for infection with carbapenem-resistant organisms such as A. baumannii and highlight a rare and severe complication of herpes zoster infection in the form of phrenic nerve palsy and consequent diaphragmatic eventration.
Collapse
Affiliation(s)
- Yvonne Ayerki Nartey
- Department of Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Oluwayemisi Esther Ekor
- Department of Anaesthesia and Pain Management, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Bashiru Babatunde Jimah
- Department of Medical Imaging, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
|
3
|
Nguyen M, Joshi SG. Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital-acquired infections: a scientific review. J Appl Microbiol 2021; 131:2715-2738. [PMID: 33971055 DOI: 10.1111/jam.15130] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
Carbapenem is an important therapy for serious hospital-acquired infections and for the care of patients affected by multidrug-resistant organisms, specifically Acinetobacter baumannii; however, with the global increase of carbapenem-resistant A. baumannii, this pathogen has significantly threatened public health. Thus, there is a pressing need to better understand this pathogen in order to develop novel treatments and control strategies for dealing with A. baumannii. In this review, we discuss an overview of carbapenem, including its discovery, development, classification and biological characteristics, and its importance in hospital medicine especially in critical care units. We also describe the peculiarity of bacterial pathogen, A. baumannii, including its commonly reported virulence factors, environmental persistence and carbapenem resistance mechanisms. In closing, we discuss various control strategies for overcoming carbapenem resistance in hospitals and for limiting outbreaks. With the appearance of strains that resist carbapenem, the aim of this review is to highlight the importance of understanding this increasingly problematic healthcare-associated pathogen that creates significant concern in the field of nosocomial infections and overall public health.
Collapse
Affiliation(s)
- M Nguyen
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA
| | - S G Joshi
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA.,Institute of Molecular Medicine and Infectious Diseases, Center for Surgical Infections, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
|
4
|
Infections due to carbapenemase-producing bacteria, clinical burden, and impact of screening strategies on outcome. Med Mal Infect 2020; 50:658-664. [PMID: 32035722 DOI: 10.1016/j.medmal.2019.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/27/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To characterize the risk factors, impact of screening, and clinical burden of colonization and/or infection by carbapenemase-producing bacteria (CPB) in hospitalized patients. METHOD Retrospective study in a tertiary care hospital between 2008 and 2016. RESULTS Among 88 included patients, 41% were colonized, 59% developed an infection, and 69% of all cases were hospital-acquired. Risk factors for CPB contamination included recent invasive medical device (94% of patients), antibiotic therapy (82%), travel abroad (17%), and hospitalization (>50%) with 80% of all patients with underlying chronic condition. Intestinal carriage represented 89% of all colonization cases and 50% of infections were located in the urinary tract. The recent use of mechanical ventilation devices was significantly more observed in infected patients than colonized patients. The most frequent CPB was Klebsiella pneumoniae and the most frequent carbapenemase was OXA-48. Overall mortality rate was 19%. Prevalence of CPB detection in intensive care units (ICU) based on systematical rectal screen swab upon admission remained <0.5%. The infected/colonized ratio (CPB colonization cases evolving into an infection) was 23%. The time between CPB infection diagnosis and start of appropriate antimicrobial therapy increased from 1 day in previously screened patients with positive CPB to 4 days in patients with previous negative or absent screening. CONCLUSION Our results emphasize the importance of CPB screening in all ICU patients and in at-risk patients hospitalized in other units, to allow earlier adequate antibiotic therapy in case of infection which occurred in 23% of the colonized patients.
Collapse
|
|
5
|
Vaze N, Pyrgiotakis G, McDevitt J, Mena L, Melo A, Bedugnis A, Kobzik L, Eleftheriadou M, Demokritou P. Inactivation of common hospital acquired pathogens on surfaces and in air utilizing engineered water nanostructures (EWNS) based nano-sanitizers. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2019; 18:234-242. [PMID: 30904585 PMCID: PMC6588479 DOI: 10.1016/j.nano.2019.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/15/2019] [Accepted: 03/06/2019] [Indexed: 01/22/2023]
Abstract
Infectious diseases represent a major public health challenge worldwide. There are various modes for the transmission of these diseases, with surface and airborne transmission being two of the most important ones. The inefficiencies of current intervention methods have resulted in the emergence of nosocomial infections. Here, we report the use of a nanotechnology based antimicrobial platform using Engineered Water Nanostructures (EWNS) generated using a combined electrospray and ionization of an aqueous suspension of various active ingredients (AIs). These EWNS based nano-sanitizers were tested in terms of their ability to efficiently deliver AI and inactivate Acinetobacter baumannii and influenza H1N1/PR/8 on both surfaces and air. Results indicate a significant reduction in the concertation of the pathogens, while the delivered to pathogen AI doses required for inactivation were miniscule (nanogram level), indicating the viability of such nano-carrier platform as an intervention technology against infectious microorganisms.
Collapse
Affiliation(s)
- Nachiket Vaze
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Georgios Pyrgiotakis
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - James McDevitt
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Lucas Mena
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Adler Melo
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Alice Bedugnis
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Lester Kobzik
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mary Eleftheriadou
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA; School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| |
Collapse
|
|
6
|
Sen B, Joshi S. Studies on Acinetobacter baumannii
involving multiple mechanisms of carbapenem resistance. J Appl Microbiol 2016; 120:619-29. [DOI: 10.1111/jam.13037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 01/26/2023]
Affiliation(s)
- B. Sen
- Department of Microbiology and Immunology; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
| | - S.G. Joshi
- Department of Microbiology and Immunology; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
- School of Biomedical Engineering, Science and Health Systems; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
| |
Collapse
|
|
7
|
Joshi SG, Litake GM. Acinetobacter baumannii: An emerging pathogenic threat to public health. World J Clin Infect Dis 2013; 3:25-36. [DOI: 10.5495/wjcid.v3.i3.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
Over the last three decades, Acinetobacter has gained importance as a leading nosocomial pathogen, partly due to its impressive genetic capabilities to acquire resistance and partly due to high selective pressure, especially in critical care units. This low-virulence organism has turned into a multidrug resistant pathogen and now alarming healthcare providers worldwide. Acinetobacter baumannii (A. baumannii) is a major species, contributing about 80% of all Acinetobacter hospital-acquired infections. It disseminates antibiotic resistance by virtue of its extraordinary ability to accept or donate resistance plasmids. The procedures for breaking the route of transmission are still proper hand washing and personal hygiene (both the patient and the healthcare professional), reducing patient’s biofilm burden from skin, and judicious use of antimicrobial agents. The increasing incidence of extended-spectrum beta-lactamases and carbapenemases in A. baumannii leaves almost no cure for these “bad bugs”. To control hospital outbreaks of multidrug resistant-Acinetobacter infection, we need to contain their dissemination or require new drugs or a rational combination therapy. The optimal treatment for multidrug-resistant A. baumannii infection has not been clearly established, and empirical therapy continues to require knowledge of susceptibility patterns of isolates from one’s own institution. This review mainly focused on general features and introduction to A. baumannii and its epidemiological status, potential sources of infection, risk factors, and strategies to control infection to minimize spread.
Collapse
|