Search

Abstract Background Antipseudomonal antibiotics should be restricted to patients at risk of Pseudomonas aeruginosa infection. However, the indications in different guidelines on community-acquired pneumonia (CAP) are discordant. Our objectives were to assess the prevalence of antipseudomonal antibiotic prescriptions and to identify determinants of empirical antibiotic choices in the emergency department. Methods Observational, retrospective, one-year cohort study in hospitalized adults with pneumonia. Antibiotic choices and clinical and demographic data were recorded on a standardized form. Antibiotics with antipseudomonal activity were classified into two groups: a) β-lactam antipseudomonals (β-APS), including carbapenems, piperacillin / tazobactam or cefepime (in monotherapy or combination) and b) monotherapy with antipseudomonal quinolones. Results Data were recorded from 549 adults with pneumonia, with Pseudomonas aeruginosa being isolated in only nine (1.6%). Most (85%) prescriptions were compliant with SEPAR guidelines and 207 (37%) patients received antibiotics with antipseudomonal activity (14% β-APS and 23% levofloxacin). The use of β-APS was independently associated with ICU admission (OR 8.16 95% CI 3.69–18.06) and prior hospitalization (OR 6.76 95% CI 3.02–15.15), while levofloxacin was associated with negative pneumococcal urine antigen tests (OR 3.41 95% CI 1.70–6.85) but negatively associated with ICU admission (OR 0.26 95% CI 0.08–0.86). None of these factors were associated with P aeruginosa episodes. In univariate analysis, prior P aeruginosa infection/colonization (2/9 vs 6/372, p = 0.013), severe COPD (3/9 vs 26/372, p = 0.024), multilobar involvement (7/9 vs 119/372, p = 0.007) and prior antibiotic (6/9 vs 109/372, p = 0.025) were significantly associated with P aeruginosa episodes. Conclusions Antipseudomonal prescriptions were common, in spite of the very low incidence of Pseudomonas aeruginosa. The rationale for prescription was influenced by both severity-of-illness and pneumococcal urine antigen test (levofloxacin) and prior hospitalization and ICU admission (β-APS). However, these factors were not associated with P aeruginosa episodes. Only prior P aeruginosa infection/colonization and severe COPD seem to be reliable indicators in clinical practice.

Mohamed A El-Mokhtar, 1 Khaled M Hassanein, 1 Ahmed S Ahmed, 1 Gamal FM Gad, 2 Mohamed M Amin, 3 Osama FE Hassanein 4 1Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, Egypt; 3Department of Microbiology and Immunology, Faculty of Medicine, Aswan University, Aswan, Egypt; 4Drug Research Center, Assiut University, Assiut, EgyptCorrespondence: Mohamed A El-MokhtarDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, EgyptTel +20 122 111 53 13Email elmokhtarma@aun.edu.egAim: This study aimed to describe the inhibitory activity of cell-free supernatants (CFS) of lactobacilli against extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (K pneumoniae) and Pseudomonas aeruginosa (P aeruginosa).Material and Methods: Pathogenic clinical strains of K pneumoniae and P aeruginosa were isolated from urine samples and selected for investigation. Anti-bacterial activities of the CFS of lactobacilli were assessed by agar well diffusion, MTT assay, as well as time-kill tests. In addition, the antibiofilm characteristics were analyzed by the microplate method against fresh and 24 h-old biofilms. The ability of CFS to interfere with bacterial invasion was analyzed by flow cytometry.Results: Although all tested strains were ESBL producers and showed a multidrug-resistant phenotype, the CFS displayed a high anti-ESBL activity with inhibition zone diameters greater than 13 mm in the agar well diffusion assays against both pathogens. The growth kinetics of K pneumoniae and P aeruginosa were dramatically decreased in the presence of the CFS. The CFS not only inhibited the biofilm formation by these pathogens but also was able to remove the 24-h formed biofilms. The invasion abilities of FITC-labelled K pneumoniae decreased from 30.3%± 7 to 15.4%± 5 and invasion of FITC-labelled P aeruginosa was reduced from 36.9%± 7 to 25.2%± 5.Conclusion: CFS of lactobacilli exhibit anti-ESBL activities, which suggests its potential application for controlling or preventing colonization of infections caused by ESBL-producing bacteria.Keywords: lactobacilli, antibiofilm, ESBL, K pneumoniae, P aeruginosa

AbstractBackground and Aims: Bu çalışmada hastanemiz Yoğun Bakım Ünitelerinde (YBÜ) yatan hastalarda en sık rastlanan nonfermentatiflerden Pseudomonas ve Acinetobacter izolatlarında Çoklu ilaç dirençli (ÇİD) gelişimine sebep olan karbapenem direncinin genotipik analizlerle ortaya konulmasını amaçlanmıştır.Bu çalışmada hastanemiz Yoğun Bakım Ünitelerinde (YBÜ) yatan hastalarda en sık rastlanan nonfermentatiflerden Pseudomonas ve Acinetobacter izolatlarında Çoklu ilaç dirençli (ÇİD) gelişimine sebep olan karbapenem direncinin genotipik analizlerle ortaya konulmasını amaçlanmıştır. Çalışmada, Nisan 2014-Aralık 2014 tarihleri arasında Yüzüncü Yıl Üniversitesi Dursun Odabaş Tıp Merkezi YBÜ’deki hastalardan izole edilen 51 Acinetobacter baumannii ve 51 Pseudomonas aeruginosa karbapenem direnci araştırılmıştır.Methods: İzolatlarının antimikrobiyal duyarlılıkları, Kirby-Bauer disk difüzyon yöntemi ve BD Phoenix (Becton Dickinson, ABD) otomatize sistemi ile belirlenmiştir. Tüm izolatlarda karbapenem direncine yol açan IMP, VIM, GES, GIM, SPM, OXA-10, OXA-23 ve OXA-51 gen bölgeleri Polimeraz Zincir Reaksiyonu (PZR) ile belirlenmiştir. Ayrıca tüm izolatlarda pulse field gel electrophorez (PFGE) ile klonal ilişki ortaya konmuştur.Results: Toplam 102 izolatın hiç birinde IMP, VIM, GES, GIM gen bölgeleri tespit edilmemiştir. A. baumannii izolatlarının tamamında en az bir gen bölgesi pozitif olmak üzere %98’i OXA-51, %77’si OXA-23 ve %4’ünde SPM geni pozitif bulunmuştur. Bu izolatlarda; %77 oranında OXA-23 ile OXA-51 ve %4 oranında OXA-23, OXA-51 ile SPM birlikteliği saptanmıştır. P. aeruginosa izolatlarında ise OXA-51 %18 ve OXA-10 ise %14 oranında tespit edilmiştir. PFGE yöntemi ile klonal ilişki analizi sonuçlarına göre A. baumannii izolatlarının kümeleşme oranı % 80 olarak belirlenirken P. aeruginosa da bu oran % 53 olarak belirlenmiştir.Conclusions: Çalışmamızda A. baumannii suşlarının karbapenem direncinden SPM, OXA 23 ve OXA 51 ve P. aeroginosa suşlarının karbapenem direncinden OXA 10 ve OXA 51 tipi karbapenemaz sorumludur.

Bacteriophages are viruses that specifically target bacteria. They are considered to have a high potential in patients with prosthetic joint infection (PJI), as they have a synergistic anti-biofilm activity with antibiotics. We report here the case of an 88-year-old man (63 kg) with relapsing Pseudomonas aeruginosa prosthetic knee infection. The patient had severe alteration of the general status and was bedridden with congestive heart failure. As prosthesis explantation and/or exchange was not feasible, we proposed to this patient the use of phage therapy to try to control the disease in accordance with the local ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). Three phages, targeting P. aeruginosa, were selected based on their lytic activity on the patient's strain (phagogram). Hospital pharmacist mixed extemporaneously the active phages (initial concentration 1 ml of 1 × 1010 PFU/ml for each phage) to obtain a cocktail of phages in a suspension form (final dilution 1 × 109 PFU/ml for both phages). Conventional arthroscopy was performed and 30 cc of the magistral preparation was injected through the arthroscope (PhagoDAIR procedure). The patient received intravenous ceftazidime and then oral ciprofloxacin as suppressive antimicrobial therapy. Under this treatment, the patient rapidly improved with disappearance of signs of heart failure and pain of the left knee. During the follow-up of 1 year, the local status of the left knee was normal, and its motion and walking were unpainful. The present case suggests that the PhagoDAIR procedure by arthroscopy has the potential to be used as salvage therapy for patients with P. aeruginosa relapsing PJI, in combination with suppressive antimicrobial therapy. A Phase II clinical study deserves to be performed to confirm this hypothesis.

The article presents data on susceptibility to antiseptic preparations in antibiotic-resistant S. aureus and P. aeruginosa strains isolated from burn wounds, which were tested in single-species and double-species biofilms with varying degrees (24-hour and 48-hour) of maturity. The studies demonstrated susceptibility of S. aureus and P. aeruginosa in single- and double-species biofilms to “Prontosan”, “Betadine” and “Chlorophyllipt” and resistance to “Miramistin” and “Chlorhexidine”. The bactericidal effect was achieved at concentrations 1.64 times higher than bacteriostatic concentrations for all the antiseptics tested. A double increase in antiseptic resistance level was observed over biofilm maturation process.

Background: Antipseudomonal antibiotics should be restricted to patients at risk of Pseudomonas aeruginosa infection. However, the indications in different guidelines on community-acquired pneumonia (CAP) are discordant. Our objectives were to assess the prevalence of antipseudomonal antibiotic prescriptions and to identify determinants of empirical antibiotic choices in the emergency department.Methods: Observational, retrospective, one-year cohort study in hospitalized adults with pneumonia. Antibiotic choices and clinical and demographic data were recorded on a standardized form. Antibiotics with antipseudomonal activity were classified into two groups: a) β-lactam antipseudomonals (β-APS), including carbapenems, piperacillin / tazobactam or cefepime (in monotherapy or combination) and b) monotherapy with antipseudomonal quinolones.Results: Data were recorded from 549 adults with pneumonia, with Pseudomonas aeruginosa being isolated in only nine (1.6%). Most (85%) prescriptions were compliant with SEPAR guidelines and 207 (37%) patients received antibiotics with antipseudomonal activity (14% β-APS and 23% levofloxacin). The use of β-APS was independently associated with ICU admission (OR 8.16 95% CI 3.69-18.06) and prior hospitalization (OR 6.76 95% CI 3.02-15.15), while levofloxacin was associated with negative pneumococcal urine antigen tests (OR 3.41 95% CI 1.70-6.85) but negatively associated with ICU admission (OR 0.26 95% CI 0.08-0.86). None of these factors were associated with P aeruginosa episodes. In univariate analysis, prior P aeruginosa infection/colonization (2/9 vs 6/372, p = 0.013), severe COPD (3/9 vs 26/372, p = 0.024), multilobar involvement (7/9 vs 119/372, p = 0.007) and prior antibiotic (6/9 vs 109/372, p = 0.025) were significantly associated with P aeruginosa episodes.Conclusions: Antipseudomonal prescriptions were common, in spite of the very low incidence of Pseudomonas aeruginosa. The rationale for prescription was influenced by both severity-of-illness and pneumococcal urine antigen test (levofloxacin) and prior hospitalization and ICU admission (β-APS). However, these factors were not associated with P aeruginosa episodes. Only prior P aeruginosa infection/colonization and severe COPD seem to be reliable indicators in clinical practice. [ABSTRACT FROM AUTHOR]

Bronchiectasis is characterized by irreversible widening of the medium-sized airways (ectasia), with inflammation, chronic bacterial infection and destruction of the bronchial walls. This could be due to genetic constitusional state or episodic insidental state which not related to intrinsic imunity. The pathogenesis of bronchiectasis is a combination of repeated inflammation and parenchymal fibrotic, lead to bronchial wall weakening and bronchial irreversibly dilatation.“The vicious cycle” and P aeruginosa contributes on progression and severity of disease. The diagnosis of bronchiectasis is made on the basis of high-resolution computed tomography (HRCT) scan findings. Additional testmay be required in spesific clinical setting. Treatment strategies including antibiotic therapy in acute exacerbation and in controlling the microbial growth, therapy according to intrinsic conditional state, therapy to controll the excessive inflammation, promote bronchial hygiene, and consideration of surgery in some cases. In this review, we will describethe etiologies, pathogenesis, diagnostic investigation, and treatment strategies.

OBJETIVO: Describir un brote por Pseudomonas aeruginosa, en el área de atención ambulatoria de herida quirúrgica, en pacientes posmastectomizadas. MATERIAL Y MÉTODOS: Entre el 13 de marzo y el 18 de mayo de 2000 se definió como caso a las pacientes del Instituto Nacional de Cancerología de la Ciudad de México, mastectomizadas con infección quirúrgica por P aeruginosa resistente a ciprofloxacina y gentamicina. Se tomaron cultivos de los antisépticos, del material de curaciones, del agua y del personal de salud. Se efectuó un análisis de casos y controles. RESULTADOS: Se identificaron 13 infecciones tardías del sitio quirúrgico por P aeruginosa. La Pseudomona se aisló de las narinas de la enfermera y de las gasas que ella misma colocaba sobre la mesa de mayo, pero no de los paquetes de gasas cerrados del área de curaciones ambulatoria de tumores mamarios. El 14 de abril de 2000 se transfirió a la enfermera a otra área y se instauraron medidas estrictas para el control de infecciones. Después de esta fecha se diagnosticaron cuatro casos más. La radioterapia fue el único factor de riesgo asociado con la infección (RM=5.1, IC 95%=1.1-28.4). CONCLUSIONES: El brote probablemente estuvo causado en un inicio por una fuente común y se extendió por infección cruzada entre las pacientes. Las prácticas deficientes detectadas en el manejo de heridas y drenajes condujo a instaurar medidas preventivas específicas.OBJECTIVE: To describe an outbreak due to Pseudomonas aeruginosa in postmastectomy wounds. MATERIAL AND METHODS: Cases were patients with a surgical infection caused by P. aeruginosa resistant to ciprofloxacin and gentamycin seen between March 13, 2000 and May 18, 2000, at Instituto Nacional de Cancerologia in Mexico City. Specimens for culturing were taken from faucets, antiseptics, and tap water, as well as from healthcare workers. A case-control analysis was conducted. RESULTS: Thirteen late surgical infections were caused by a ciprofloxacin and gentamycin-resistant P. aeruginosa. The causative Pseudomonas was isolated from a nurse's nostrils and non-sterile gauzes left by her on the Mayo table at the Breast Tumor ambulatory clinic. None of the closed packages was positive to Pseudomonas. On April 14, 2000, the nurse was transferred to another ward and strict infection control practices were established. After this date, 4 additional cases were diagnosed. Radiation therapy was the only risk factor for infection (Or=5.1, 95% cI 1.1-28.4). CONCLUSIONS: This outbreak was probably caused by a common source initially, and later disseminated by cross-infection among patients. The poor compliance with infection control practices during wound cleaning and drainage led to implementing a series of specific preventive interventions.

The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties. [ABSTRACT FROM AUTHOR]

Objective: we investigated the effects of terbutaline, a ß2-adrenergic agonist, on lung permeability and alveolar fluid clearance (AFC) in acute lung injury (ALI). Methods: the study was conducted in vivo on a rat model of P aeruginosa ( Pa)-induced ALI. Rats were randomly divided into five groups: the control group (saline group), Pa and saline group, Pa and terbutaline treated group receiving intratracheal instillation of terbutaline at 10−4 M, Pa and terbutaline plus propranolol treated group (terbutaline++propranolol group) and Pa and propranolol treated group (propranolol group). Hemodynamics, airway pressures, arterial blood gases, extravascular lung water, lung permeability to protein evaluated by the extravascular accumulation of 125I-albumin (EPE), bacterial counts, and alveolar fluid clearance (AFC) were measured. Results: 4.5 hours after bacterial instillation, the lung wet-to-dry ratio and the EPE were significantly decreased in the terbutaline group compared to saline control group (respectively 4.31 ± 0.51 g/g versus 5.99 ± 0.5 g/g 4.18 ± 0.25 g/g and 148 ± 68 μL versus 349 ± 97 μL respectively p < 0.01). Treatment with terbutaline in the Pa-instilled group significantly increased basal AFC compared with the saline and Pa group, (respectively 22.3 ± 1.3%% versus 12.5 ± 4.7%%, p < 0.001). Intratracheal instillation of propranolol (10−4 M) inhibited the effects of terbutaline on lung fluid balance. Conclusion: Exogenous instillation of beta2-adrenergic have a beneficial effect on lung fluid balance following Pa pneumonia in rats, by reducing pulmonary endothelial permeability and increasing alveolar fluid clearance. These data suggest that exogenous beta-adrenergic therapy can protect against alveolar edema formation in acute P aeruginosa pneumonia. [ABSTRACT FROM AUTHOR]

Background P. aeruginosa is one of the most common causes of infection in burns and wounds and it is the major cause of death in burn patients. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant; complicating the choice of therapy. Thus, there is continuous need for enhancing the antibacterial efficacy of antibiotics against P aeroginosa. Objective This study was conducted to determine the MIC of antibiotics used in combination for resistant isolates of Pseudomonas aeruginosa and measure the effect of EDTA in increasing the inhibition effect of these antibiotics. Methods P. aeruginosa was identified microscopically and biochemically .The swap samples from burns and wounds were collected from patients of AL-YarmooK, Baghdad and Al-Kadhumia Teaching Hospitals. Minimum inhibitory concentration (MIC) was used to evaluate antibiotics effectiveness, while fractional inhibitory concentration (FIC) was used to evaluate the effect of antibiotics combination on pathogenic bacteria (P.aeruginosa). Disk diffusion assay were used to determine the inhibition zone of antibiotic disk (with and without EDTA) against P. aeruginosa. Results Ten isolates were selected according to their pattern of resistance as those showing multi-drug resistance and tested to specify their minimum inhibitory concentration for (amikacin, gentamicin, ceftazidime, and ciprofloxacin). Amikacin had the lowest MIC compared with others. Among combinations, the combination of ß-lactam antibiotics with amikacin was found to be the most effective combination. Results showed that EDTA increases the effect of antibiotic against P. aeruginosa isolates especially when it was combined with aminoglycoside antibiotics. Conclusion Amikacin is the most effective agent against Pseudomonas aeruginosa especially when combined with ceftazidime, more over; EDTA increases the activity of antibiotic against pseudomonas aeruginosa especially when combined with aminoglycoside antibiotics. [ABSTRACT FROM AUTHOR]

Background: Treatment of infections caused by gram-negative bacilli is increasingly challenging because of emerging resistance. Current surveillance data are informative, but may not discern differences by infection site and clinical setting, and do not incorporate pharmacodynamic (PD) characteristics when determining susceptibility. Objectives: This study explored the differences in infection site and clinical setting and evaluated dose-optimization strategies using PD principles. The stud focused only on systemic isolates, and targeted a cohort of 40 hospitals in the United States with a nationwide geographic distribution. Methods: Nonduplicate, nonurine isolates of Escherichia coli (n = 937) and Pseudomonas aeruginosa (n = 1044) collected from adult patients at 40 US hospitals underwent MIC testing by broth microdilution to 15 agents. Results were analyzed by infection site and unit type (ward or intensive care unit [ICU]). PD modeling employing Monte Carlo simulation was used to predict the microbiologic success of varying dosing strategies. Results: E coli were highly susceptible except to fluoroquinolones; 6.8% were multidrug resistant (MDR) and were more likely in ICUs (risk ratio [RR], 2.5; 95% CI, 1.6–4.0). P aeruginosa displayed ≤86% susceptibility for all agents; MICs differed significantly by site of infection (P < 0.05). Isolates were 9.2%MDR (less likely in wound infections [RR, 0.5; 95% CI, 0.3–0.9]). PD simulations predicted results similar to breakpoint-derived susceptibilities for both species, with notable exceptions of piperacillin/tazobactam and fluoroquinolones, which underpredicted susceptibility by as much as 20%. Prolonged (3 hours) or continuous infusion regimens of β-lactams appeared to improve drug exposure. Conclusions: These data suggest that susceptibility of E coli to commonly used antibiotics remains high (>90% for most drug classes), with the important exception of the fluoroquinolones; however, susceptibility of P aeruginosa is low enough to warrant concern. Attention to the source of the organism and the patient''s location in an ICU or a ward—combined with knowledge of local epidemiology and PD principles-—should prove valuable in empiric agent selection. Additionally, reassessment of breakpoints employing PD principles is recommended, particularly for fluoroquinolones and piperacillin/tazobactam. [Copyright &y& Elsevier]

OBJETIVO: Describir un brote por Pseudomonas aeruginosa, en el área de atención ambulatoria de herida quirúrgica, en pacientes posmastectomizadas. MATERIAL Y MÉTODOS: Entre el 13 de marzo y el 18 de mayo de 2000 se definió como caso a las pacientes del Instituto Nacional de Cancerología de la Ciudad de México, mastectomizadas con infección quirúrgica por P aeruginosa resistente a ciprofloxacina y gentamicina. Se tomaron cultivos de los antisépticos, del material de curaciones, del agua y del personal de salud. Se efectuó un análisis de casos y controles. RESULTADOS: Se identificaron 13 infecciones tardías del sitio quirúrgico por P aeruginosa. La Pseudomona se aisló de las narinas de la enfermera y de las gasas que ella misma colocaba sobre la mesa de mayo, pero no de los paquetes de gasas cerrados del área de curaciones ambulatoria de tumores mamarios. El 14 de abril de 2000 se transfirió a la enfermera a otra área y se instauraron medidas estrictas para el control de infecciones. Después de esta fecha se diagnosticaron cuatro casos más. La radioterapia fue el único factor de riesgo asociado con la infección (RM=5.1, IC 95%=1.1-28.4). CONCLUSIONES: El brote probablemente estuvo causado en un inicio por una fuente común y se extendió por infección cruzada entre las pacientes. Las prácticas deficientes detectadas en el manejo de heridas y drenajes condujo a instaurar medidas preventivas específicas.

Delayed antimicrobial prescriptions and inappropriate treatment can lead to poor outcomes in pneumonia. In nosocomial infections, especially in countries reporting high rates of antimicrobial resistance, the presence of multidrug-resistant gram-negative and gam-positive bacteria can limit options for adequate antimicrobial treatment. New antibiotics, belonging to known classes of antimicrobials or characterized by novel mechanisms of actions, have recently been approved or are under development. Advantages of the new compounds include enhanced spectrum of activity against resistant bacteria, high lung penetration, good tolerability, and possibility for intravenous to oral sequential therapy. This article reviews characteristics of newly approved and investigational compounds., (Copyright © 2018 Elsevier Inc. All rights reserved.)