Effectiveness of Colistin in carbapenem resistant Acinetobacter baumannii – A systematic review

Treatment of carbapenem-resistant Acinetobacter baumannii (CRAb) infections has become a significant challenge for physicians due to its resistance to common antibiotics. Colistin, previously banned, has been reintroduced despite debates about its effectiveness and safety. We aimed to synthesize evidence on the effectiveness of Colistin in the CRAb infection management, based on current literature. We conducted a comprehensive search to identify relevant studies on the effectiveness of Colistin in treating CRAb infection in major databases such as Medline through PubMed, Embase, Web of Science, The Cochrane Library, and Scopus. We did not limit the search by age of participants, sex, region, or year of publication, but we only included randomized controlled trials (RCTs), quasi-experimental studies, cohort studies, case-control studies, and cross-sectional studies published in English, which had at least one comparison control group. Two independent authors screened articles, extracted data, and assessed the risk of bias in selected articles using the RoBANS tool. Our search retrieved 7907 articles, of which five were included after the sequential screening. All five studies were retrospective case-control studies from five different countries, with a total of 776 participants. Two studies showed a lower mortality rate in the intervention (Colistin) group as the primary outcome, whereas two studies showed the opposite mortality trend. One study reported a higher rate of infection remission in the intervention group, but the result was not statistically significant. Our systematic review could not find any robust evidence to support the effectiveness of Colistin over commonly used antibiotics. Due to the large discrepancy among the primary outcomes of the included studies, we recommend further randomized controlled trials with a larger number of participants to determine the suitability of Colistin for treating CRAb infections

Transmission of Infectious Vibrio cholerae Through Drinking Water among the Household Contacts of Cholera Patients (CHoBI7 Trial)

Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Of total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations with the highest incidence in households near the major rivers and polluted water bodies. The data presented on the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city

A prospective cohort study comparing household contact and water <i>Vibrio cholerae</i> isolates in households of cholera patients in rural Bangladesh

<div><p>Background</p><p>Household contacts of cholera patients are at a 100 times higher risk of developing cholera than the general population. The objective of this study was to examine the incidence of <i>V</i>. <i>cholerae</i> infections among household contacts of cholera patients in a rural setting in Bangladesh, to identify risk factors for <i>V</i>. <i>cholerae</i> infections among this population, and to investigate transmission pathways of <i>V</i>. <i>cholerae</i> using multilocus variable-number tandem-repeat analysis (MLVA).</p><p>Methodology/Principal findings</p><p>Stool from household contacts, source water and stored water samples were collected from cholera patient households on Day 1, 3, 5, and 7 after the presentation of the index patient at a health facility. Two hundred thirty clinical and water <i>V. cholerae</i> isolates were analyzed by MLVA. Thirty seven percent of households had at least one household contact with a <i>V</i>. <i>cholerae</i> infection. Thirteen percent of households had <i>V</i>. <i>cholerae</i> in their water source, and 27% had <i>V</i>. <i>cholerae</i> in stored household drinking water. Household contacts with <i>V</i>. <i>cholerae</i> in their water source had a significantly higher odds of symptomatic cholera (Odds Ratio (OR): 5.49, 95% Confidence Interval (CI): 1.07, 28.08). Contacts consuming street vended food had a significantly higher odds of a <i>V</i>. <i>cholerae</i> infection (OR: 9.45, 95% CI: 2.14, 41.72). Older age was significantly associated with a lower odds of a <i>V</i>. <i>cholerae</i> infection (OR: 0.96, 95% CI: 0.93, 0.99). Households with both water and clinical <i>V</i>. <i>cholerae</i>-positive samples all had isolates that were closely related by MLVA.</p><p>Conclusions/Significance</p><p>These findings emphasize the need for interventions targeting water treatment and food hygiene to reduce <i>V</i>. <i>cholerae</i> infections.</p></div

Household and individual level <i>V</i>. <i>cholerae</i> infection characteristics (visits 1–4), rural Bangladesh.

<p>Household and individual level <i>V</i>. <i>cholerae</i> infection characteristics (visits 1–4), rural Bangladesh.</p

Additional file 2: Table S2. of Genetic relatedness of Vibrio cholerae isolates within and between households during outbreaks in Dhaka, Bangladesh

SNP List of Chromosomes and Genes using reference 300,043. (XLSX 19 kb