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International Journal of Molecular... Oct 2023is the primary opportunistic human pathogen responsible for a range of acute and chronic infections; it poses a significant threat to immunocompromised patients and is... (Review)
Review
is the primary opportunistic human pathogen responsible for a range of acute and chronic infections; it poses a significant threat to immunocompromised patients and is the leading cause of morbidity and mortality for nosocomial infections. Its high resistance to a diverse array of antimicrobial agents presents an urgent health concern. Among the mechanisms contributing to resistance in , the horizontal acquisition of antibiotic resistance genes (ARGs) via mobile genetic elements (MGEs) has gained recognition as a substantial concern in clinical settings, thus indicating that a comprehensive understanding of ARG dissemination within the species is strongly required for surveillance. Here, two approaches, including a systematic literature analysis and a genome database survey, were employed to gain insights into ARG dissemination. The genome database enabled scrutinizing of all the available sequence information and various attributes of isolates, thus providing an extensive understanding of ARG dissemination within the species. By integrating both approaches, with a primary focus on the genome database survey, mobile ARGs that were linked or correlated with MGEs, important sequence types (STs) carrying diverse ARGs, and MGEs responsible for ARG dissemination were identified as critical factors requiring strict surveillance. Although human isolates play a primary role in dissemination, the importance of animal and environmental isolates has also been suggested. In this study, 25 critical mobile ARGs, 45 critical STs, and associated MGEs involved in ARG dissemination within the species, are suggested as critical factors. Surveillance and management of these prioritized factors across the One Health sectors are essential to mitigate the emergence of multidrug-resistant (MDR) and extensively resistant (XDR) in clinical settings.
Topics: Animals; Humans; Pseudomonas aeruginosa; Drug Resistance, Microbial; Anti-Bacterial Agents
PubMed: 37894890
DOI: 10.3390/ijms242015209 -
Expert Review of Anti-infective Therapy 2015Pseudomonas aeruginosa is a Gram-negative human pathogen with extensively drug-resistant (XDR) strains emerging in hospitals across the globe. This systematic review is... (Review)
Review
Pseudomonas aeruginosa is a Gram-negative human pathogen with extensively drug-resistant (XDR) strains emerging in hospitals across the globe. This systematic review is focused on the worldwide prevalence of XDR P. aeruginosa (XDR-PA) and on the risk factors associated with its colonization and infection, based on literature available through PubMed, Web of Science and BioMed Central databases. An overview of surveillance systems is provided as well as a synopsis on the prevalence of XDR-PA, showing an increase in recent reports. Risk factors independently associated with XDR-PA colonization or infections are described in four groups with reference to antimicrobial therapy, medical devices as well as patient- and hospital environment-related factors.
Topics: Animals; Anti-Bacterial Agents; Colony Count, Microbial; Drug Resistance, Multiple, Bacterial; Humans; Prevalence; Pseudomonas Infections; Pseudomonas aeruginosa; Risk Factors
PubMed: 26153817
DOI: 10.1586/14787210.2015.1064310 -
Journal of Research in Medical Sciences... Sep 2014Pseudomonas aeruginosa is an opportunistic human pathogen which causes serious problems, especially in people who have immunodeficiency. Metallo beta-lactamase (MBL)... (Review)
Review
BACKGROUND
Pseudomonas aeruginosa is an opportunistic human pathogen which causes serious problems, especially in people who have immunodeficiency. Metallo beta-lactamase (MBL) resistance in this bacterium has led some difficulties in treating bacterial infections. MBLs are being reported with increasing frequency worldwide. The aim of the present systematic review and meta-analysis was to collect data about the relative frequency (RF) of VIM-1-imipenem resistant P. aeruginosa (VIM-1-IRPA) in different regions of Iran and report an overall prevalence if possible.
MATERIALS AND METHODS
PubMed, ISI web of science, Scopus and Google Scholar were searched using following key terms: "P. aeruginosa," "imipenem," "VIM-1" and "Iran" were. Articles/abstracts, which used clinical specimens and had done polymerase chain reaction to detect the VIM-1 gene of MBL genes, were included in this review. STATA SE version 11.2 (StataCorp, College Station, TX, USA) was used for statistical analysis.
RESULTS
Out of 5457 results found, 10 articles were eligible to be included in our systematic review and meta-analysis. These studies were carried out in Tehran, Isfahan, Kurdistan, Ahvaz, Markazi and Northwest of Iran (Orumieh and Tabriz). Pooled estimation of 1972 P. aeruginosa samples showed that 13% (95% confidence interval = 10.5-16.5%]) of strains were VIM-1 positive. VIM-1-IRPA RF in different studies varied from 0% to 19.5% in Isfahan and Markazi provinces, respectively. We found a moderate heterogeneity (Chochran Q-test, P = 0.032, I-squared = 50.7%) of VIM-1-IRPA RF among studies.
CONCLUSION
According to the results of this study VIM-1-IRPA RF in Iran is in low-level Prevention strategies to reduce the prevalence rates of VIM-1 positive strains in Iran are needed.
PubMed: 25535506
DOI: No ID Found -
Frontiers in Medicine 2023Carbapenem-resistant (CRE) and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infections are associated with a high risk of morbidity, mortality, and treatment...
, and clinical studies comparing the efficacy of ceftazidime-avibactam monotherapy with ceftazidime-avibactam-containing combination regimens against carbapenem-resistant and multidrug-resistant isolates or infections: a scoping review.
INTRODUCTION
Carbapenem-resistant (CRE) and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infections are associated with a high risk of morbidity, mortality, and treatment costs. We aimed to evaluate , and clinical studies comparing the efficacy of ceftazidime-avibactam (CZA) combination regimens with CZA alone against CRE and/or MDR-PA isolates or infections.
METHODS
We systematically reviewed the relevant literature in CINAHL/MEDLINE, Pubmed, Cochrane, Web of Science, Embase, and Scopus until December 1, 2022. Review articles, grey literature, abstracts, comments, editorials, non-peer reviewed articles, non-English articles, and in vitro synergy studies conducted on single isolates were excluded.
RESULTS
22 , 7 and 20 clinical studies were evaluated. studies showed reliable synergy between CZA and aztreonam against metallo-β-lactamase (MBL)-producing isolates. Some studies indicated good in vitro synergy between CZA and amikacin, meropenem, fosfomycin and polymyxins against CRE isolates. For MDR-PA isolates, there are comparatively fewer or studies. In observational clinical studies, mortality, clinical cure, adverse events, and development of CZA resistance after exposure were generally similar in monotherapy and combination therapy groups. However, antibiotic-related nephrotoxicity and infection relapses were higher in patients receiving CZA combination therapies.
DISCUSSION
The benefit, if any, of CZA combination regimens in MDR-PA infections is elusive, as very few clinical studies have included these infections. There is no currently documented clinical benefit for the use of CZA combination regimens rather than CZA monotherapy. CZA combined with aztreonam for serious infections due to MBL producers should be evaluated by randomized controlled trials.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278552, CRD42021278552.
PubMed: 37727767
DOI: 10.3389/fmed.2023.1249030 -
The Journal of Hospital Infection Sep 2006An understanding of the epidemiology of multi-drug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa infections is necessary in order to develop... (Review)
Review
An understanding of the epidemiology of multi-drug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa infections is necessary in order to develop strategies to curtail their spread. For this purpose, the evidence linking the isolation of MDR A. baumannii and P. aeruginosa with specific risk factors was evaluated. PubMed was searched for the 20-year period from September 1985 to September 2005, and eligible studies were considered to be those that: (1) linked the isolation of A. baumannii and P. aeruginosa with specific risk factors; (2) described the characteristics of the affected patients in detail; and (3) provided data on the antibiotic resistance profile of the isolated micro-organisms. Fifty-five studies were found referring to A. baumannii (28 with case-control methodology and 27 outbreak investigations without case-control methodology), and 42 studies were found referring to P. aeruginosa (25 with case-control methodology and 17 outbreak investigations without case-control methodology). Although heterogeneous study designs and investigated risk factors limited this analysis, it was concluded that acquisition and spread of these micro-organisms appear to be related to a large number of variables. Among the most important were deficiencies in the implementation of infection control guidelines and the use of broad-spectrum antibiotics. Use of carbapenems and third-generation cephalosporins appear to be related to the development of an MDR phenotype by A. baumannii, while carbapenems and fluoroquinolones are implicated in MDR P. aeruginosa. The diversity of risk factors associated with the development of MDR A. baumannii and P. aeruginosa suggests that a separate outbreak investigation should be performed in each hospital setting. The development of innovative control strategies is needed in order to limit the spread of these pathogens.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Anti-Bacterial Agents; Cross Infection; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Humans; Pseudomonas Infections; Pseudomonas aeruginosa; Risk Factors
PubMed: 16822583
DOI: 10.1016/j.jhin.2006.04.015 -
Clinical Microbiology and Infection :... Aug 2019Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional.
OBJECTIVES
To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy.
DATA SOURCE
A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered.
INTERVENTION
Empiric antimicrobial therapy for CO-BSI-PA.
METHODS
A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model.
RESULTS
Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52-141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12-2.98l p 0.02).
CONCLUSIONS
CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions.
Topics: Anti-Bacterial Agents; Bacteremia; Cross Infection; Humans; Inappropriate Prescribing; Pseudomonas Infections; Pseudomonas aeruginosa; Risk Factors; Shock, Septic
PubMed: 30995530
DOI: 10.1016/j.cmi.2019.04.005 -
Health Technology Assessment... Dec 2013Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of... (Review)
Review
Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model.
BACKGROUND
Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of thick sticky mucus in the lungs, pancreas, liver, intestine and reproductive tract, and an increase in the salt content in sweat. Among other problems, people with CF experience recurrent respiratory infections and have difficulties digesting food. CF affects over 9000 individuals in the UK. CF shortens life expectancy and adversely affects quality of life. In 2010, CF was recorded as the cause of 103 deaths in England and Wales.
OBJECTIVE
To evaluate the clinical effectiveness and cost-effectiveness of colistimethate sodium dry powder for inhalation (DPI) (Colobreathe(®), Forest Laboratories) and tobramycin DPI (TOBI Podhaler(®), Novartis Pharmaceuticals) for the treatment of Pseudomonas aeruginosa lung infection in CF.
DATA SOURCES
Electronic databases were searched in February and March 2011 [MEDLINE, MEDLINE In-Process & Other Non-Indexed citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Conference Proceedings Citation Index (CPCI) and Bioscience Information Service (BIOSIS) Previews]. Relevant databases were searched for ongoing and unpublished studies, and bibliographies of relevant systematic reviews and the manufacturers' submissions were also hand-searched.
REVIEW METHODS
A systematic review of the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI for the treatment of chronic P. aeruginosa lung infection in CF was conducted. Existing economic evidence within the literature was reviewed and a de novo health economic model was also developed.
RESULTS
Three randomised controlled trials (RCTs) were included in the clinical effectiveness review. Both colistimethate sodium DPI and tobramycin DPI were reported to be non-inferior to nebulised tobramycin for the outcome forced expiratory volume in first second percentage predicted (FEV1%). It was not possible to draw any firm conclusions as to the relative efficacy of colistimethate sodium DPI compared with tobramycin DPI. The economic analysis suggests that colistimethate sodium DPI produces fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Given the incremental discounted lifetime cost of tobramycin DPI compared with nebulised tobramycin, it highly unlikely that tobramycin DPI has an incremental cost-effectiveness ratio that is better than £30,000 per QALY gained.
LIMITATION
The uncertainty surrounding the short-term evidence base inevitably results in uncertainty surrounding the long-term clinical effectiveness and cost-effectiveness of colistimethate sodium DPI.
CONCLUSIONS
Both DPI formulations have been shown to be non-inferior to nebulised tobramycin as measured by FEV1%. The results of these trials should be interpreted with caution owing to the means by which the results were analysed, the length of follow-up, and concerns about the ability of FEV1% to accurately represent changes in lung health. Although the increase in QALYs is expected to be lower with colistimethate sodium DPI than with nebulised tobramycin, a price for this intervention had not been agreed at the time of the assessment. Depending on the price of colistimethate sodium DPI, this results either in a situation whereby colistimethate sodium DPI is dominated by nebulised tobramycin or in one whereby the incremental cost-effectiveness of nebulised tobramycin compared with colistimethate sodium DPI is in the range of £24,000-277,000 per QALY gained. The economic analysis also suggests that, given its price, it is unlikely that tobramycin DPI has a cost-effectiveness ratio of < £30,000 per QALY gained when compared with nebulised tobramycin. A RCT to assess the longer-term (≥ 12 months) efficacy of colistimethate sodium DPI and tobramycin DPI in comparison with nebulised treatments would be beneficial. Such a study should include the direct assessment of HRQoL using a relevant preference-based instrument. Future studies should ensure that the European Medicines Agency guidelines are adhered to. In addition, high-quality research concerning the relationship between forced expiratory volume in first second % (FEV1%) predicted or other measures of lung function and survival/health-related quality of life (HRQoL) would be useful.
STUDY REGISTRATION
PROSPERO CRD42011001350.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Administration, Inhalation; Child; Colistin; Cost-Benefit Analysis; Cystic Fibrosis; Disease Progression; Humans; Outcome Assessment, Health Care; Pseudomonas Infections; Pseudomonas aeruginosa; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Therapeutic Equivalency; Tobramycin; United Kingdom
PubMed: 24290164
DOI: 10.3310/hta17560 -
Age and Ageing Jan 2021aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care. (Meta-Analysis)
Meta-Analysis
BACKGROUND
aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care.
OBJECTIVES
determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk.
DATA SOURCES
PUBMED/MEDLINE, CINAHL, EMBASE, COCHRANE, PROQUEST, Google Scholar, Web of Science.
STUDY ELIGIBILITY CRITERIA
published between January 2001 and December 2019 addressing oral microorganisms, aspiration pneumonia, oral health and treatment.
PARTICIPANTS
people 60 years and older in residential aged care.
STUDY APPRAISAL AND SYNTHESIS METHODS
the Newcastle-Ottawa Scale and the Standard Protocol Items: Recommendations for Intervention Trials checklist.
RESULTS
twelve studies (four cross-sectional, five cohort and three intervention) reported colonisation of the oral cavity of older people by microorganisms commonly associated with respiratory infections. Aspiration pneumonia occurred less in people who received professional oral care compared with no such care. Isolation of Candida albicans, Staphylococcus aureus, methicillin-resistant S. aureus and Pseudomonas aeruginosa was related to mortality due to aspiration pneumonia. An interesting finding was isolation of Escherichia coli, a gut bacterium.
LIMITATIONS
more information may be present in publications about other co-morbidities that did not meet inclusion criteria. A high degree of heterogeneity prevented a meta-analysis. Issues included sampling size, no power and effect size calculations; different oral health assessments; how oral specimens were analysed and how aspiration pneumonia was diagnosed.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
pathogenic microorganisms colonising the oral microbiome are associated with aspiration pneumonia in older people in residential care; professional oral hygiene care is useful in reducing aspiration pneumonia risk.
Topics: Aged; Cross-Sectional Studies; Humans; Methicillin-Resistant Staphylococcus aureus; Oral Health; Oral Hygiene; Pneumonia, Aspiration
PubMed: 32677660
DOI: 10.1093/ageing/afaa102 -
Cureus Jun 2022Eculizumab, first-line therapy for paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), has infectious side effects in addition to... (Review)
Review
Eculizumab, first-line therapy for paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), has infectious side effects in addition to its therapeutic benefits. This study aims to discuss the mechanism of development of infections, prevention, and timely treatment to prevent complications such as septic shock and mortality. The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and reporting guidelines for systematic review. Inclusion and exclusion criteria were determined. A total of 10 research papers were extracted after exploring Pubmed and Google Scholar from 2001 to 2021. The New Castle Ottawa Questionnaire for non-randomized clinical trials and the National Institutes of Health (NIH) quality assessment tool for case reports and case series were used to assess the risk of bias. The studies included in this systematic review describe infections with , , unusual species, , and . The main goal of this review is to impress upon the seriousness of the infectious complications associated with eculizumab. Health care providers should maintain a high index of suspicion for early identification and treatment.
PubMed: 35784997
DOI: 10.7759/cureus.25640 -
Le Infezioni in Medicina Mar 2020Biofilm formation is one of the important resistance mechanisms in Pseudomonas aeruginosa. This study aimed to consider the correlation between biofilm formation and... (Meta-Analysis)
Meta-Analysis
Biofilm formation is one of the important resistance mechanisms in Pseudomonas aeruginosa. This study aimed to consider the correlation between biofilm formation and antibiotic resistance in Pseudomonas aeruginosa through a systematic review and meta-analysis. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) strategies. Scientific databases were searched by MeSH terms and keywords such as "Pseudomonas aeruginosa", "biofilm formation", "antibiotic resistance", "prevalence" AND "Iran", to obtain articles published from 1st January 2016 to 30th November 2019. Studies recording biofilm formation and antibiotic resistance in P. aeruginosa recovered from clinical samples of Iranian patients were included. Data analysis was performed using CMA software. The combined biofilm formation rate was reported as 87.6 % (95% CI: 80-92.5). The heterogeneity index among the selected articles was Q2=96.5, I2=85.5, and t=0.26 (p=0.16). The pooled occurrences of strong, moderate and weak biofilms were 47.7% (95% CI: 28.7-67.3), 30.2% (95% CI: 19.4-43.8), and 27.4% (95% CI: 8.8-59.8), respectively. The pooled prevalence of MDR P. aeruginosa strains was as follows: 62.5% (95% CI: 40-77.2). The highest combined rates of antibiotic resistance were against ceftriaxone and tobramycin with the rates of 79.2.9% (95% CI: 54.2-96.2) and 64.4% (95% CI: 36.3-92), respectively. Also, the lowermost antibiotic resistance rates were against colistin and polymyxin B, with the prevalence of 2.1% (95% CI: 0.2-18.1), and 3% (95% CI: 0.5-17.3), respectively. More than half of the studies included in the present review showed a significant correlation between biofilm formation and antibiotic resistance pattern.
Topics: Anti-Bacterial Agents; Biofilms; Ceftriaxone; Colistin; Drug Resistance, Bacterial; Humans; Iran; Polymyxin B; Pseudomonas aeruginosa; Tobramycin
PubMed: 32172260
DOI: No ID Found