Prevalence of Oxacillin-resistant Staphylococcus Strains in Clinical Specimens from Intensive Care Unit Patients

Data aproximada de realització del reportatg

Management of KPC-Producing Klebsiella pneumoniae Infections

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III

Νebulised colistin for ventilator-associated pneumonia prevention

We assessed if prophylactic nebulised colistin might reduce ventilator-associatedpneumonia (VAP) incidence in a setting, mixed medical-surgical ICU, where multidrug-resistant (MDR) bacteria were prevalent and endemic.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h.The two arms consisted of prophylaxis with 500000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%) versus 25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4 versus 25.6, respectively, p 48 ωρών. 168 ασθενείς έλαβαν μέρος στην παρούσα μη τυφλή, τυχαιοποιημένη μελέτη που έλαβε χώρα στη ΜΕΘ του Πανεπιστημιακού Νοσοκομείου Λάρισας, δύναμης 12 κλινών. Οι ασθενείς χωρίστηκαν σε δύο ομάδες: 84 έλαβαν 500000 μονάδες κολιμυκίνης και 84 φυσιολογικό ορό. Ως κύρια έκβαση ορίστηκε η επίπτωση της VAP στις 30 μέρες. Η επίπτωση της VAP δε διέφερε μεταξύ των ομάδων (14 (16.7%) στην ομάδα παρέμβασης έναντι 25 (29.8%) στην ομάδα ελέγχου (p=0.07). Ως προς τις δευτερεύουσες εκβάσεις, η VAP από πολυανθεκτικά μικρόβια και από Gram αρνητικά μικρόβια βρέθηκαν ελαττωμένες. Παράλληλα, δεν παρατηρήθηκε κατά τη διάρκεια της μελέτης ανάπτυξη μικροβιακής αντοχής, στην κολιμυκίνη ή περαιτέρω πολυαντοχή. Τα ευρήματά μας δε δείχνουν σημαντική ελάττωση της επίπτωσης της VAP από την προφυλακτική χορήγηση κολιστίνης

Community-Associated Staphylococcus aureus Infections: Pneumonia

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging health problem with distinct epidemiology. CA-MRSA colonization and infection is associated with risk factors different from healthcare-associated methicillin-resistant S. aureus infection. CA-MRSA strains pre­sent different characteristics to healthcare associated strains in terms of microbiology as well. Moreover, infection as a result of CA-MRSA may be associated with severe infections, in particular necrotizing pneumonia. CA-MRSA strains may produce Panton-Valentine leukocidin, a protein that available data suggest to be associated with the severity of the infection. Although the incidence of CA-MRSA pneumonia is relatively low, it affects mostly young, immunocompetent individuals, and in this respect constitutes a serious and potentially lethal form of community-acquired pneumonia. Current treatment suggested by international consensus guidelines includes linezolid or vancomycin often combined with clindamycin and/or rifampicin. However, clinical studies are required to clarify further therapeutic issues on timing, dosing, and choice of optimum treatment, and whether new therapeutic strategies such as vaccination and immunoglobulins could be useful. In the present review we discuss the microbiology, epidemiology, pathogenesis, and clinical aspects of community-acquired pneumonia as a result of CA-MRSA in respect of management and prevention

New perspectives in the antibiotic treatment of mechanically ventilated patients with infections from Gram-negatives

Introduction: Ventilator-associated pneumonia (VAP) is a common and potentially fatal complication of mechanical ventilation that is often caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB). Despite the repurposing of older treatments and the novel antimicrobials, many resistance mechanisms cannot be confronted, and novel therapies are needed. Areas covered: We searched the literature for keywords regarding the treatment of GNB infections in mechanically ventilated patients. This narrative review presents new data on antibiotics and non-antibiotic approaches focusing on Phase 3 trials against clinically significant GNB that cause VAP. Expert opinion: Ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam stand out as new options for infections by Klebsiella pneumoniae carbapenemase-producing bacteria, whereas ceftolozane-tazobactam adds therapeutic flexibility in Pseudomonas aeruginosa infections with multiple resistance mechanisms. Ceftazidime-avibactam and ceftolozane-tazobactam have relevant literature. Aztreonam-avibactam holds promise for the treatment of infections by metallo-β-lactamase (MBL)-producing organisms. Recently approved cefiderocol possesses an extended antibacterial spectrum, including KPC- and MBL-producers. However, recently published data have toned down optimism about treating VAP caused by carbapenem-resistant Acinetobacter baumannii. For the latter, eravacycline may provide additional hope, pending pertinent data. Non-antibiotic treatments currently being considered as adjunct therapeutic approaches are welcome. Nevertheless, they will hopefully substitute current antimicrobials in the future. © 2020 Informa UK Limited, trading as Taylor & Francis Group

Guidelines on the use of external ventricular drain and its associated complications: do we “AGREE II”?

Insertion of an external ventricular drain is a common procedure used in everyday practice by neurosurgeons all around the world. It consists of the placement of an external ventricular drain (EVD) into the ventricular system providing the ability to measure intracranial pressure, and also divert the flow of cerebrospinal fluid (CSF) in a variety of pathological conditions. The most common complication is infection, and it may result in devastating consequences and negatively affect the outcome of these patients. The Infectious Diseases Society of America (IDSA), the Neurocritical Care Society (NCS), and The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) have published recommendations for the management of EVD-Associated Ventriculitis. The objective of this study was to assess the methodological quality and reporting clarity of these recommendations using the AGREE-II tool. We found that the overall quality of the published clinical practice guidelines is acceptable. However, continuous updates and external validation should be implemented. © 2021 The Neurosurgical Foundation