ANTIMICROBIAL SUSCEPTIBILITIES OF ENTEROBACTERIACEAE (EB) AND PSEUDOMONAS AERUGINOSA (PA) FROM INPATIENT INFECTIONS IN THE U.S.: 1999-2002 TRUST SURVEILLANCE
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SOCIETY OF CRITICAL CARE MEDICINE 32ND CRITICAL CARE CONGRESS SAN ANTONIO, TEXAS, USA JANUARY 28-FEBRUARY 2, 2003: ORAL/SANDWICH PRESENTATIONS: Poster Presentation: Clinical Science: Sepsis Pneumonia: PDF OnlyKeywords:
Antimicrobial Stewardship
We read with great interest the article by Bae et al.1 published in your journal recently. This study compared the clinical effectiveness of antimicrobial treatment for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) between short (7–11 days; median = 9 days) and prolonged (12–21 days; median = 15 days) courses. Their data suggested that short-course antimicrobial therapy is adequate for uncomplicated P. aeruginosa BSI, with a lower recurrence rate, all-cause mortality and emergence of antimicrobial-resistant organisms. In this age of emerging antimicrobial resistance,2 antimicrobial stewardship should be accelerated even in cases with potentially fatal diseases, such as P. aeruginosa BSI. Specifically, the emergence and spread of difficult-to-treat (DTR) P. aeruginosa poses limited availability of effective treatment to patients.3 Therefore, we appreciate their efforts in scheduling, conducting and summarizing the results in their current form. Despite its single-centre, retrospective and observational nature, the study was well-designed by incorporating...
Antimicrobial Stewardship
Bloodstream infection
Bacteremia
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Pseudomonas aeruginosa is among the most common pathogens that cause nosocomial infections and is responsible for about 10% of all hospital-acquired infections. In the present study, we investigated the potential development of tolerance of P. aeruginosa to antimicrobial blue light by carrying 10 successive cycles of sublethal blue light inactivation. The high-performance liquid chromatographic (HPLC) analysis was performed to identify endogenous porphyrins in P. aeruginosa cells. In addition, we tested the effectiveness of antimicrobial blue light in a mouse model of nonlethal skin abrasion infection by using a bioluminescent strain of P. aeruginosa. The results demonstrated that no tolerance was developed to antimicrobial blue light in P. aeruginosa after 10 cycles of sub-lethal inactivation. HPLC analysis showed that P. aeruginosa is capable of producing endogenous porphyrins in particularly, coproporphyrin III, which are assumed to be responsible for the photodynamic effects of blue light alone. P. aeruginosa infection was eradicated by antimicrobial blue light alone (48 J/cm(2) ) without any added photosensitizer molecules in the mouse model. In conclusion, endogenous photosensitization using blue light should gain considerable attention as an effective and safe alternative antimicrobial therapy for skin infections. Lasers Surg. Med. 48:562-568, 2016. © 2016 Wiley Periodicals, Inc.
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The judicious use of antimicrobials on farms is necessary to mitigate the development of antimicrobial-resistant pathogens that compromise human and animal health. On livestock farms, veterinarians prescribe and dispense antimicrobials, but producers use rapid judgements of disease severity to make routine decisions on the initiation of empirical antimicrobial therapy. Therefore, the knowledge and skills required to accurately diagnose treatable bacterial infections is necessary for optimal antimicrobial stewardship. Veal calves often undergo stressors and environmental exposures that increase calves' risk of bacterial infections, and antimicrobials are sometimes necessary to ensure their health. The objective of this trial was to measure the impact of antimicrobial stewardship training on calf producers' knowledge of antimicrobial stewardship, accuracy of identifying calves for treatment, and quantified antimicrobial use. Eight farms were evenly allocated into either intervention or control groups. Training resulted in both higher scores on assessments and higher sensitivity for detecting cases that required antimicrobial therapy relative to a veterinarian. Importantly, there was a 50% reduction in the antimicrobial dosing rate among intervention farms relative to control farms. Antimicrobial stewardship training among calf producers was effective at changing producers' behaviors and reducing antimicrobial use.
Antimicrobial Stewardship
Stewardship
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ABSTRACT Several Pseudomonas aeruginosa strains, including one urinary isolate producing an extended-spectrum β-lactamase TEM-24, were isolated from a long-term-hospitalized woman. Three TEM-24-producing enterobacterial species ( Enterobacter aerogenes , Escherichia coli , and Proteus mirabilis ) were isolated from the same patient. TEM-24 and the resistance markers for aminoglycosides, chloramphenicol, and sulfonamide were encoded by a 180-kb plasmid transferred by conjugation into E. coli HB101.
Enterobacter aerogenes
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Fifteen carbapenemase-producing Enterobacteriaceae isolates and 12 carbapenemase-producing Pseudomonas aeruginosa isolates were recovered from patients hospitalized between August 2011 and March 2013 at the Hospital of Infectious Disease, Cluj-Napoca, Romania. One KPC-, nine NDM-1-, four OXA-48-, and one VIM-4-producing Enterobacteriaceae isolates along with 11 VIM-2-producing and one IMP-13-producing P. aeruginosa isolates were recovered from clinical samples. All carbapenemase genes were located on self-conjugative plasmids and were associated with other resistance determinants, including extended-spectrum β-lactamases and RmtC methylases.
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Antimicrobial peptides are promising alternative antimicrobial agents to combat MDR. DP7, an antimicrobial peptide designed in silico, possesses broad-spectrum antimicrobial activities and immunomodulatory effects. However, the effects of DP7 against Pseudomonas aeruginosa and biofilm infection remain largely unexplored.To assess (i) the antimicrobial activity of DP7 against MDR P. aeruginosa; and (ii) the antibiofilm activity against biofilm infection. Also, to preliminarily investigate the possible antimicrobial mode of action.The MICs of DP7 for 104 clinical P. aeruginosa strains (including 57 MDR strains) and the antibiofilm activity were determined. RNA-Seq, genome sequencing and cell morphology were conducted. Both acute and chronic biofilm infection mouse models were established. Two mutants, resulting from point mutations associated with LPS and biofilms, were constructed to investigate the potential mode of action.DP7, at 8-32 mg/L, inhibited the growth of clinical P. aeruginosa strains and, at 64 mg/L, reduced biofilm formation by 43% to 68% in vitro. In acute lung infection, 0.5 mg/kg DP7 exhibited a 70% protection rate and reduced bacterial colonization by 50% in chronic infection. DP7 mainly suppressed gene expression involving LPS and outer membrane proteins and disrupted cell wall structure. Genome sequencing of the DP7-resistant strain DP7R revealed four SNPs controlling LPS and biofilm production. gshA44 and wbpJ139 mutants displayed LPS reduction and motility deficiency, conferring the reduction of LPS and biofilm biomass of strain DP7R and indicating that LPS was a potential target of DP7.These results demonstrate that DP7 may hold potential as an effective antimicrobial agent against MDR P. aeruginosa and related infections.
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Virulence factor
Lipid A
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Citrobacter
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Pseudomonas aeruginosa remains one of the most difficult to treat and to control nosocomial infections. In vitro antimicrobial susceptibility data are required for successful therapy because acquired resistance to such antimicrobials as -lactams, fluoroquinolones and aminoglycosides is so prevalent in P. aeruginosa. Strategies for controlling P. aeruginosa infections include early detection of P. aeruginosa as the causative pathogen, determination of its antimicrobial susceptibilities, initiation of effective and adequate therapy and strict infection control practice such as hand hygiene and equipment procedures. Once antimicrobial therapy has been initiated against a P. aeruginosa infection, its susceptibility to antimicrobials, especially to carbapenems and fluoroquinolones, should be monitored during antimicrobial therapy to detect clonal shifts in resistance and microbial substitutions as early as possible. Continued surveillance of nosocomial infections and monitoring of antimicrobial resistance by the infection control staff plays major roles in preventing nosocomial infections and the spread of antimicrobial resistance. Additional strategies for controlling antimicrobial resistance in P. aeruginosa include the development of new methods for rapid detection of antimicrobial resistance and new agents and vaccines against P. aeruginosa infections in the laboratories and pharmaceuticals, while preserving the efficacy of currently available antimicrobials for as long as possible in the hospital settings.
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Horizontal gene transfer has contributed to the global spread of the blaNDM-1 gene. Multiple studies have demonstrated plasmid transfer of blaNDM-1 between Gram-negative bacteria, primarily Enterobacteriaceae species, but conjugational transfer of natural blaNDM-1 plasmids from Enterobacteriaceae into Pseudomonas aeruginosa and Acinetobacter baumannii has not previously been shown. As P. aeruginosa and A. baumannii are both typically strong biofilm formers, transfer of natural blaNDM-1 plasmids could potentially occur more readily in this environment. To determine whether natural blaNDM-1 plasmids could transfer to P. aeruginosa or A. baumannii in biofilms, three clinical and environmental Enterobacteriaceae strains carrying NDM-1-encoding plasmids of different incompatibility types were mated with E. coli J53, producing E. coli J53- blaNDM-1 transconjugants. Subsequently, dual-species biofilms were created using the E. coli J53 transconjugants as plasmid donors and either P. aeruginosa or A. baumannii as recipients. Biofilm transfer of NDM-encoding plasmids to P. aeruginosa and A. baumannii was successful from one and two E. coli J53- blaNDM-1 transconjugants, respectively. This demonstrates the potential for the spread of blaNDM-1, genes to P. aeruginosa and A. baumannii in clinical and environmental settings.
Acinetobacter baumannii
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