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Microbial Pathogenesis Nov 2023Gram-negative bacteria are infectious and life-threatening agents after hematopoietic stem cell transplantation (HSCT). So, this study aimed to investigate the... (Review)
Review
Gram-negative bacteria are infectious and life-threatening agents after hematopoietic stem cell transplantation (HSCT). So, this study aimed to investigate the prevalence of Pseudomonas aeruginosa and its antibiotic resistance in patients who have received Hematopoietic Stem-Cell Transplantation through a systematic review. The systematic search was done with key words; Pseudomonas aeruginosa, hematopoietic stem cell transplantation from 2000 to the end of July 2023 in Google Scholar and PubMed/Medline, Scopus, and Web of Science. Twelve studies were able to include our study. Quality assessment of studies was done by Appraisal tool for Cross-Sectional Studies. The most of the included studies were conducted as allo-HSCT. Infections such as respiratory infection, urinary infection and bacteremia have occurred. The rate of prevalence with P. aeruginosa has varied between 3 and 100%. The average age of the participants was between 1 and 74 years. The rate of prevalence of P. aeruginosa resistant to several drugs has been reported to be variable, ranging from 20 to 100%. The highest antibiotic resistance was reported against cefotetan (100%), and the lowest was related to tobramycin (1.8%) followed by amikacin, levofloxacin and ciprofloxacin with the prevalence of 16.6%. Our findings showed a high prevalence and antibiotic resistance rate of P. aeruginosa in Hematopoietic stem cell transplantation. Therefore, more serious health measures should be taken in patients after transplantation.
Topics: Humans; Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Hematopoietic Stem Cell Transplantation; Prevalence; Pseudomonas aeruginosa; Pseudomonas Infections
PubMed: 37769854
DOI: 10.1016/j.micpath.2023.106368 -
Clinical Otolaryngology : Official... May 2023To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and... (Review)
Review
OBJECTIVES
To present a systematic review and critical analysis of clinical studies for necrotising otitis externa (NOE), with the aim of informing best practice for diagnosis and management.
DESIGN
Medline, Embase, Cochrane Library and Web of Science were searched from database inception until 30 April 2021 for all clinical articles on NOE. The review was registered on PROSPERO (ID: CRD42020128957) and conducted in accordance with PRISMA guidelines.
RESULTS
Seventy articles, including 2274 patients were included in the final synthesis. Seventy-three percent were retrospective case series; the remainder were of low methodological quality. Case definitions varied widely. Median patient age was 69.2 years; 68% were male, 84% had diabetes and 10% had no reported immunosuppressive risk factor. Otalgia was almost universal (96%), with granulation (69%) and oedema (76%) the commonest signs reported. Pseudomonas aeruginosa was isolated in 62%, but a range of bacterial and fungal pathogens were reported and 14% grew no organism. Optimal imaging modality for diagnosis or follow-up was unclear. Median antimicrobial therapy duration was 7.2 weeks, with no definitive evidence for optimal regimens. Twenty-one percent had surgery with widely variable timing, indication, or procedure. One-year disease-specific mortality was 2%; treatment failure and relapse rates were 22% and 7%, respectively.
CONCLUSION
There is a lack of robust, high-quality data to support best practice for diagnosis and management for this neglected condition. A minimum set of reporting requirements is proposed for future studies. A consensus case definition is urgently needed to facilitate high-quality research.
Topics: Humans; Male; Aged; Female; Otitis Externa; Retrospective Studies; Risk Factors
PubMed: 36759416
DOI: 10.1111/coa.14041 -
Microorganisms Sep 2023The purpose of the current study is to describe the prevalence of (PA)-producing MβL among Brazilian isolates and the frequency of in MβL-PA-producing isolates. From... (Review)
Review
The purpose of the current study is to describe the prevalence of (PA)-producing MβL among Brazilian isolates and the frequency of in MβL-PA-producing isolates. From January 2009 to August 2023, we carried out an investigation on this subject in the internet databases SciELO, PubMed, Science Direct, and LILACS. A total of 20 papers that met the eligibility requirements were chosen by comprehensive meta-analysis software v2.2 for data retrieval and analysis by one meta-analysis using a fixed-effects model for the two investigations. The prevalence of MβL-producing was 35.8% or 0.358 (95% CI = 0.324-0.393). The studies' differences were significantly different from one another (x = 243.15; < 0.001; I = 92.18%), so they were divided into subgroups based on Brazilian regions. There was indication of asymmetry in the meta-analyses' publishing bias funnel plot; so, a meta-regression was conducted by the study's publication year. According to the findings of Begg's test, no discernible publishing bias was found. prevalence was estimated at 66.9% or 0.669 in MβL-PA isolates (95% CI = 0.593-0.738). The analysis of this one showed an average heterogeneity (x = 90.93; < 0.001; I = 80.20%). According to the results of Begg's test and a funnel plot, no discernible publishing bias was found. The research showed that MβL- and SPM-1 isolates were relatively common among individuals in Brazil. and other opportunistic bacteria are spreading quickly and causing severe infections, so efforts are needed to pinpoint risk factors, reservoirs, transmission pathways, and the origin of infection.
PubMed: 37764210
DOI: 10.3390/microorganisms11092366 -
Microbial Pathogenesis Apr 2022Pseudomonas aeruginosa is an opportunistic pathogen that infects the lungs of people with cystic fibrosis (CF) and is the most common cause of chronic respiratory... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Pseudomonas aeruginosa is an opportunistic pathogen that infects the lungs of people with cystic fibrosis (CF) and is the most common cause of chronic respiratory infections with high morbidity and mortality in CF patients. This study aimed to evaluate the pattern of antibiotic resistance of P. aeruginosa strains from patients with CF using a systematic review and meta-analysis.
METHODS
A comprehensive and systematic search was performed for relevant articles until August 2021 in the following database: PubMed, Scopus, Embase, and Web of Science. Finally, 122 articles with appropriate criteria were included in the meta-analysis. To estimate weighted pooled proportions Freeman-Tukey double arcsine transformation was performed using Metaprop command in Stata software version 17.1.
RESULTS
122 studies evaluated the pattern of P. aeruginosa antibiotic resistance from different antibiotic classes in patients with CF. Cefotaxime had the highest resistance rate of 67% (95% CI 53_80%), while colistin had the lowest 5% (95% CI 2-8%).
CONCLUSION
High resistance to most of the studied antibiotics was observed. The high antibiotic resistance observed is worrying and it indicates the need to monitor using of antibiotics. In addition, colistin is the most appropriate treatment choice, but more randomized controlled trial studies are recommended.
Topics: Anti-Bacterial Agents; Colistin; Cystic Fibrosis; Drug Resistance, Microbial; Humans; Persistent Infection; Prevalence; Pseudomonas Infections; Pseudomonas aeruginosa
PubMed: 35240288
DOI: 10.1016/j.micpath.2022.105461 -
Oman Medical Journal Mar 2023Eye infections can be caused by several microorganisms and the most common causative bacterial agents are staphylococci, streptococci, and This study aimed to estimate... (Review)
Review
OBJECTIVES
Eye infections can be caused by several microorganisms and the most common causative bacterial agents are staphylococci, streptococci, and This study aimed to estimate the prevalence of viridans group streptococci, and as the cause of ocular infections in Iran.
METHODS
We conducted a systematic search on the studies published by Iranian authors from January 2000 to December 2020 in Web of Science, PubMed, Scopus, and Embase. Eligible studies were selected according to the defined inclusion/exclusion criteria. Statistical heterogeneity between and within groups was estimated by the Q-statistic and I index. The funnel plots, Duval and Tweedie trim, and fill methods were obtained to evaluate the evidence of publication bias.
RESULTS
Twenty-seven studies were included in this review. According to the meta-analysis results, the prevalence of was 19.1% (95% CI: 12.5-28.1). It was estimated 6.9% (95% CI: 4.4-10.6), 6.7% (95% CI: 4.6-9.6), and 3.3% (95% CI: 1.8-5.8) for and viridans streptococci, respectively.
CONCLUSIONS
. is the prevalent bacterial agents responsible for eye-associated infections in Iran.
PubMed: 37132006
DOI: 10.5001/omj.2023.22 -
Pharmacotherapy Jul 2022Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired... (Review)
Review
PURPOSE
Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off-label indications.
METHODS
The PRISMA guidelines were utilized for reporting. Databases searched included PubMed, Scopus, and Embase, from inception to September 2021. Manuscripts describing cefiderocol off-label use in clinical settings were included. Exclusion criteria were studies focused on labeled indications, animal studies, pharmacodynamic/pharmacokinetic studies, in vitro or laboratory studies, and manuscripts in languages other than English or Arabic. Each stage of review utilized two independent investigators, with conflicts resolved and critical appraisal performed. Data regarding presentation, clinical course, and infection characteristics were extracted and descriptively analyzed.
RESULTS
The search identified a total of 985 records, narrowed to a final set of 27 studies. Among studies included were 18 (66.7%) case reports, 8 (29.6%) case series, and 1 (3.7%) phase 3 clinical trial. Cefiderocol was most frequently used off-label for bacteremia/sepsis with or without an identified source in 51 (67.1%) out of a total of 76 included patients. Among case series/reports with available data, 43 of 53 patients (81.1%) received combination antibiotic therapy. The most common pathogens identified included multi/extensively drug-resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii. Various clinical end points were reported, while microbiological end points were reported in 18 (66.7%) studies. Cefiderocol-related side effects were uncommon and rarely use-limiting.
CONCLUSIONS
This systematic review depicts relative clinical effectiveness of off-label cefiderocol, most commonly for P. aeruginosa and A. baumannii infections as combination antibiotic therapy. Further study is needed to elucidate the safety and efficacy of cefiderocol across an expanded set of patients and indications.
Topics: Animals; Anti-Bacterial Agents; Cephalosporins; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Off-Label Use; Pseudomonas aeruginosa; Urinary Tract Infections; Cefiderocol
PubMed: 35611627
DOI: 10.1002/phar.2704 -
Infection, Genetics and Evolution :... Nov 2019Pseudomonas aeruginosa (PA) is an opportunistic pathogen that produces widespread and often overwhelming infections. Among different virulence factors, toxins are... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Pseudomonas aeruginosa (PA) is an opportunistic pathogen that produces widespread and often overwhelming infections. Among different virulence factors, toxins are important bacterial agent which increases PA pathogenesis especially in immunocompromised patients. The aim of this meta-analysis was to determine the prevalence of exotoxin production in PA isolates in the world. Also according to the importance of drug resistance in isolates with more pathogenicity this estimation was conducted in resistant isolates.
METHODS
A systematic search was conducted in international database like PubMed, Scopus, Web of Science and Embase up to December 2018. Joanna Briggs Institute Checklist was used to evaluate the quality assessment of studies. Random effect model was applied to pool the prevalence data. Stata 13 software was used to analyze the data.
RESULTS
Total of 58 eligible studies that fulfilled the inclusion criteria of the study were selected for qualitative synthesis. Among exotoxins; the highest prevalence was related to exoT (0.83 (CI95%: 0.64-0.96)). Lowest prevalence rate was seen in exoU with estimated prevalence 0.32 (CI95%: 0.24-0.41). In Carbapenem resistance isolates exoA and exoT had the highest prevalence (1.00 (CI95%: 0.98-1.00)).
CONCLUSION
This first meta-analysis on PA isolates with toxin potency indicated high prevalence of exotoxin production in clinical isolates of PA which is an alarming point as a clinical aspect. It was found that the ExoT has the most prevalence rate among toxins. The results of simultaneous evaluation of exotoxins and antimicrobial resistance can develop treatment policies against PA infections in hospitals and hospitalized patients.
Topics: Bacterial Toxins; Cross Infection; Exotoxins; Humans; Prevalence; Pseudomonas Infections; Pseudomonas aeruginosa; Virulence Factors
PubMed: 31518698
DOI: 10.1016/j.meegid.2019.104037 -
Journal of Anesthesia, Analgesia and... Jul 2022Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until... (Review)
Review
Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (either new or preexisting). Several mechanisms of resistance, especially those mediated by metallo-β-lactamases (MBL), are responsible for the inefficacy of these treatments, leaving an unmet medical need. Intravenous cefiderocol has been recently approved by the American Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of complicated urinary tract infections and nosocomial pneumonia due to Gram-negative, when limited therapeutical options are available. In addition, its ability to hijack bacterial iron uptake mechanisms makes cefiderocol stable against the whole Ambler β-lactamase inhibitors and increases the in vitro efficacy against Gram-negative pathogens (e.g., Enterobacterales spp., Pseudomonas aeruginosa, and Acinetobacter baumannii). Trials have already demonstrated their non-inferiority to comparators. In 2021, ESCMID guidelines released a conditional recommendation supporting the use of cefiderocol against metallo-β-lactamase-producing Enterobacterales and against Acinetobacter baumannii. This review provides the opinion of experts about the general management of empiric treatment of patients with sepsis and septic shock in the intensive care unit and detects the proper place in therapy of cefiderocol considering recent evidence sought through a systematic search.
PubMed: 37386663
DOI: 10.1186/s44158-022-00062-7 -
Respiratory Care Oct 2020COPD and bronchiectasis frequently coexist, which creates an emerging phenotype with a worse prognosis. However, the impact of bronchiectasis on the natural history of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
COPD and bronchiectasis frequently coexist, which creates an emerging phenotype with a worse prognosis. However, the impact of bronchiectasis on the natural history of COPD has not been fully evaluated and is still controversial. This meta-analysis was performed to clarify the associations of the presence of bronchiectasis with the prognosis and quality of life of patients with COPD.
METHODS
A systematic review and meta-analysis was performed following a search of medical databases, and included articles published up to April 2019. The following outcome measures were analyzed: age, sex, smoking history, body mass index, exacerbation rate, lung function, inflammatory biomarkers, albumin, colonization by potentially pathogenic microorganisms, isolates, isolates, hospital admissions, and mortality.
RESULTS
A total of 415,257 subjects with COPD from 18 observational studies were eligible; bronchiectasis was present in 25,929 subjects (6.24%). The coexistence of COPD and bronchiectasis occurred more often in older subjects with lower body mass index. The presence of bronchiectasis in the subjects with COPD increased the risk of daily sputum production (odds ratio [OR] 1.80, 95% CI 1.24-2.61), exacerbation (weighted mean difference [WMD] 0.72 times, 95% CI 0.59-0.85), frequent hospital admissions (WMD 0.35 times, 95% CI 0.21-0.49), and follow-up (>3 years) mortality (OR 2.26, 95% CI 0.95-5.36). The subjects with COPD and bronchiectasis showed poorer pulmonary function (FEV/FVC: WMD -3.37%, 95% CI -5.63 to -1.11), lower albumin (Standardized mean difference [SMD] -0.17, 95% CI -0.26 to -0.08), elevated C-reactive protein (SMD 0.40, 95% CI 0.06-0.74), a greater proportion of chronic colonization by potentially pathogenic microorganisms (OR 6.65, 95% CI 4.44-9.95), and a higher isolation rate of (OR 5.13, 95% CI 4.89-5.38) or (OR 1.90, 95% CI 1.29-2.79) than the subjects with COPD without bronchiectasis.
CONCLUSIONS
This meta-analysis confirmed the significant associations of the presence of bronchiectasis with the natural history, disease course, and outcomes in COPD. The COPD-bronchiectasis phenotype had adverse effects on subjects' health condition and prognosis.
Topics: Bronchiectasis; Disease Progression; Humans; Lung; Pulmonary Disease, Chronic Obstructive; Quality of Life; Sputum
PubMed: 32265292
DOI: 10.4187/respcare.07390 -
Antibiotics (Basel, Switzerland) Dec 2021(PA) is a leading cause of healthcare-associated infections. A variety of antibiotic classes are used in the treatment of PA infections, including beta-lactams (BLs)...
INTRODUCTION
(PA) is a leading cause of healthcare-associated infections. A variety of antibiotic classes are used in the treatment of PA infections, including beta-lactams (BLs) and fluoroquinolones (FQs), given either together in combination therapy or alone in monotherapy. A systematic review and meta-analysis were performed to evaluate the therapeutic efficacy of BL agents versus FQ agents as active, definitive monotherapy in PA infections in adults.
METHODS
Comprehensive literature searches of the Medline and Scopus electronic databases, alongside hand searches of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar, were performed without a time restriction to identify studies published in English comparing BL and FQ agents given as monotherapy for PA infection in hospitalized adults for which mortality, bacteriological eradication, or clinical response was evaluated. One reviewer screened search results based on pre-defined selection criteria. Two reviewers independently assessed included studies for methodological quality using NIH assessment tools. Two fixed-effects meta-analyses were performed.
RESULTS
A total of 368 articles were screened, and six studies involving 338 total patients were included in the meta-analysis. Upon evaluation of methodological quality, two studies were rated good, three fair, and one poor. A meta-analysis of three studies demonstrates FQ monotherapy is associated with significantly improved survival compared to BL monotherapy for patients with PA bacteremia (OR, 3.65; 95% CI, 1.27-10.44; = 0.02). A meta-analysis of three studies demonstrates FQ monotherapy is associated with equivalent bacteriological eradication compared to BL monotherapy for PA pneumonia or skin and soft tissue infection (RD, 0.07; 95% CI, -0.09 to 0.24; = 0.39).
CONCLUSION
The meta-analyses demonstrate FQ monotherapy significantly improves survival in PA bacteremia and is associated with similar rates of bacteriological eradication in pneumonia and skin and soft tissue infection caused by PA compared to BL monotherapy. However, more research is needed to make meaningful clinical recommendations.
PubMed: 34943695
DOI: 10.3390/antibiotics10121483