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Microbial Pathogenesis Dec 2018The co-colonization prevalence of P. aeruginosa and A. fumigatus in cystic fibrosis (CF) has been inconsistently reported. The purpose of this systematic review and... (Meta-Analysis)
Meta-Analysis
PURPOSE
The co-colonization prevalence of P. aeruginosa and A. fumigatus in cystic fibrosis (CF) has been inconsistently reported. The purpose of this systematic review and meta-analysis was to estimate the overall co-colonization prevalence of P. aeruginosa and A. fumigatus in CF.
METHODS
The Embase, PubMed and Web of Science databases were systematically searched for studies reporting the co-colonization prevalence of P. aeruginosa and A. fumigatus in CF. The co-colonization prevalence of two pathogenic microorganisms in the individual studies was assessed by calculating the proportion and 95% confidence interval (CI). The random effects model was used to calculate the pooled prevalence. The I test was used to assess statistical heterogeneity. The funnel plot and two statistical methods were used to assess publication bias.
RESULTS
Twenty-three eligible studies were included in this analysis. The pooled co-colonization prevalence of P. aeruginosa and A. fumigatus in CF patients was 15.8% (95% CI: 9.9-21.8). The co-colonization prevalence of P. aeruginosa and A. fumigatus chronic colonization was lower than that of intermittent colonization, higher in sputum cultures than in bronchoalveolar lavage (BAL) cultures, and lower in children than in adults. There was a statistically significant difference in co-colonization prevalence among studies from different decades, but the prevalence was similar in different geographical regions and with different study types.
CONCLUSIONS
The co-colonization prevalence of P. aeruginosa and A. fumigatus in the lower respiratory tract of CF patients was high. The anti-infective treatment in exacerbation of CF should be considered to cover the two pathogenic microorganisms simultaneously. Large-scale research is still needed to obtain more accurate co-colonization data.
Topics: Aspergillus fumigatus; Coinfection; Cystic Fibrosis; Humans; Prevalence; Pseudomonas Infections; Pseudomonas aeruginosa; Pulmonary Aspergillosis
PubMed: 30217514
DOI: 10.1016/j.micpath.2018.09.010 -
International Journal of Antimicrobial... May 2019Growing antimicrobial resistance and the resilience of biofilm infections have led researchers to study the potential of antimicrobial combinations, including those...
Catalysing the way towards antimicrobial effectiveness: A systematic analysis and a new online resource for antimicrobial-enzyme combinations against Pseudomonas aeruginosa and Staphylococcus aureus.
Growing antimicrobial resistance and the resilience of biofilm infections have led researchers to study the potential of antimicrobial combinations, including those incorporating enzymes with biofilm-disrupting abilities. This work aimed to evaluate the journey of antimicrobial-enzyme combination research and to gain insights into its current status and most promising leads. Expert curators annotated and analysed all published experimental data on enzyme-containing combinations for two major biofilm-forming pathogens, namely Pseudomonas aeruginosa and Staphylococcus aureus. This entailed the construction of the first publicly accessible online database on antimicrobial-enzyme combinations, the Antimicrobial Enzyme Combinations Database (https://www.ceb.uminho.pt/aecd). Gathered data were also reconstructed as knowledge networks to help analyse and visualise annotated entities (e.g. enzymes, methods, strains, combination outputs). The database currently holds 122 and 206 annotated combinations for P. aeruginosa and S. aureus, respectively, and their analysis allowed a systematic review of the available evidence on enzyme combinations, reliably illustrating the studies being performed. The most tested enzymes (e.g. lysozyme, DNase, lysostaphin) were scrutinised and the rationale behind each combination was explained. This research area is still growing although current research gaps/opportunities were identified, such as lack of biofilm testing and studies on polymicrobial scenarios. Hopefully, this work will shed light on the synergistic potential of enzyme combinations and alleviate some of the time- and resource-consuming tasks related to enzyme combination research by helping the selection and design of new enzyme-related therapeutic options for P. aeruginosa and S. aureus infections.
Topics: Animals; Anti-Bacterial Agents; Databases, Factual; Drug Therapy, Combination; Enzymes; Health Resources; Humans; Internet; Pseudomonas Infections; Staphylococcal Infections
PubMed: 30639529
DOI: 10.1016/j.ijantimicag.2019.01.001 -
Clinical Infectious Diseases : An... Feb 2019Carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPsA) are a serious cause of healthcare-associated...
Control of Carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in Healthcare Facilities: A Systematic Review and Reanalysis of Quasi-experimental Studies.
Carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPsA) are a serious cause of healthcare-associated infections, although the evidence for their control remains uncertain. We conducted a systematic review and reanalysis to assess infection prevention and control (IPC) interventions on CRE-CRAB-CRPsA in inpatient healthcare facilities to inform World Health Organization guidelines. Six major databases and conference abstracts were searched. Before-and-after studies were reanalyzed as interrupted time series if possible. Effective practice and organization of care (EPOC) quality criteria were used. Seventy-six studies were identified, of which 17 (22%) were EPOC-compatible and interrupted time series analyses, assessing CRE (n = 11; 65%), CRAB (n = 5; 29%) and CRPsA (n = 3; 18%). IPC measures were often implemented using a multimodal approach (CRE: 10/11; CRAB: 4/5; CRPsA: 3/3). Among all CRE-CRAB-CRPsA EPOC studies, the most frequent intervention components included contact precautions (90%), active surveillance cultures (80%), monitoring, audit and feedback of measures (80%), patient isolation or cohorting (70%), hand hygiene (50%), and environmental cleaning (40%); nearly all studies with these interventions reported a significant reduction in slope and/or level. The quality of EPOC studies was very low to low.
Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Carbapenems; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Health Facilities; Humans; Pseudomonas aeruginosa
PubMed: 30475989
DOI: 10.1093/cid/ciy752 -
International Journal of Chronic... 2022Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular (PA)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular (PA) in respiratory samples on the prognosis of COPD is unclear.
METHODS
We conducted a systematic review of prognostic studies including patients with isolation of PA in sputum in stable state or during exacerbations of COPD. The main outcomes were all-cause mortality, respiratory mortality, and number and severity of future exacerbations. Data were expressed as hazard ratio (HR) (95% confidence interval [CI]) whenever possible.
RESULTS
Of 2773 studies, eight were finally included (23,228 individuals). The mean age ranged from 65.5 to 73 years. Six studies reported data for all-cause mortality. The adjusted risk of death was almost double in patients with PA isolation (HR 1.95, 95% CI, 1.34 to 2.84; quality of evidence moderate). Patients with PA isolation showed a three times higher adjusted risk of readmission at 30 days after discharge (OR 3.60, 95% CI, 3.60 to 12.03, 1 study; quality of evidence very low), and more than double adjusted risk of death and hospitalization at two years (HR 2.80, 95% CI, 2.20 to 3.56, 1 study; quality of evidence very low).
CONCLUSION
There is moderate certainty that the isolation of PA in sputum is associated with an adjusted increased risk of death in patients with COPD.
Topics: Aged; Bronchitis, Chronic; Disease Progression; Humans; Pseudomonas aeruginosa; Pulmonary Disease, Chronic Obstructive; Quality of Life
PubMed: 35210766
DOI: 10.2147/COPD.S346294 -
Journal of Cystic Fibrosis : Official... Sep 2014A systematic literature review of the last 40 years on the research of serum antibodies to Pseudomonas aeruginosa in cystic fibrosis and its utility as a diagnostic tool. (Review)
Review
BACKGROUND
A systematic literature review of the last 40 years on the research of serum antibodies to Pseudomonas aeruginosa in cystic fibrosis and its utility as a diagnostic tool.
METHODS
Research papers in English, Portuguese, and Spanish were accessed through electronic databases (PubMed, Medline, LILACS, and SciELO).
RESULTS
26 studies were assessed. ELISA technique was the most commonly used technique to detect serum P. aeruginosa antibodies. The most consistent results were those in which the response against the antigen St-Ag:1-17 was evaluated. The accuracy levels of the ELISA technique remain controversial, but most studies showed a good correlation between antibody titers and microbiological culture.
CONCLUSIONS
The detection of serum antibodies to P. aeruginosa shows capacity for early detection of this pathogen and potential utility and viability of incorporation in the diagnostic routine of patients with cystic fibrosis.
Topics: Antibodies, Bacterial; Cystic Fibrosis; Enzyme-Linked Immunosorbent Assay; Humans; Pseudomonas Infections; Pseudomonas aeruginosa
PubMed: 24522086
DOI: 10.1016/j.jcf.2014.01.005 -
The Cochrane Database of Systematic... Sep 2023Cystic fibrosis (CF) is a multisystem disease; the importance of growth and nutritional status is well established given their implications for lung function and overall... (Review)
Review
BACKGROUND
Cystic fibrosis (CF) is a multisystem disease; the importance of growth and nutritional status is well established given their implications for lung function and overall survivability. Furthermore, it has been established that intestinal microbial imbalance and inflammation are present in people with CF. Oral prebiotics are commercially available substrates that are selectively utilised by host intestinal micro-organisms and may improve both intestinal and overall health.
OBJECTIVES
To evaluate the benefits and harms of prebiotics for improving health outcomes in children and adults with CF.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 19 October 2022. We also searched PubMed and online trials registries. Date of last search: 13 January 2023.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of prebiotics in children and adults with CF. We planned to only include the first treatment period from cross-over RCTs, regardless of washout period.
DATA COLLECTION AND ANALYSIS
We did not identify any relevant trials.
MAIN RESULTS
We did not identify any relevant trials for inclusion in this review.
AUTHORS' CONCLUSIONS
This review did not find any evidence for the use of prebiotics in people with CF. Until such evidence is available, it is reasonable for clinicians to follow any local guidelines and to discuss the use of dietary prebiotics with their patients. Large and robust RCTs assessing the dietary prebiotics of inulin or galacto-oligosaccharides or fructo-oligosaccharides, or any combination of these, are needed. Such studies should be of at least 12 months in duration and assess outcomes such as growth and nutrition, gastrointestinal symptoms, pulmonary exacerbations, lung function, inflammatory biomarkers, hospitalisations, intestinal microbial profiling, and faecal short-chain fatty acids. Trials should include both children and adults and aim to be adequately powered to allow for subgroup analysis by age.
Topics: Adult; Child; Humans; Cystic Fibrosis; Feces; Hospitalization; Inflammation; Nutritional Status; Prebiotics
PubMed: 37753791
DOI: 10.1002/14651858.CD015236.pub2 -
Journal of Global Antimicrobial... Sep 2018Treating infections of Gram-negative pathogens, in particular Pseudomonas aeruginosa, is a challenge for clinicians in the Asia-Pacific region owing to inherent and... (Meta-Analysis)
Meta-Analysis
Risk factors for Pseudomonas aeruginosa infections in Asia-Pacific and consequences of inappropriate initial antimicrobial therapy: A systematic literature review and meta-analysis.
OBJECTIVES
Treating infections of Gram-negative pathogens, in particular Pseudomonas aeruginosa, is a challenge for clinicians in the Asia-Pacific region owing to inherent and acquired antimicrobial resistance. This systematic review and meta-analysis provides updated information on risk factors for P. aeruginosa infection in Asia-Pacific as well as the consequences (e.g. mortality, costs) of initial inappropriate antimicrobial therapy (IIAT).
METHODS
Embase and MEDLINE databases were searched for Asia-Pacific studies reporting the consequences of IIAT versus initial appropriate antimicrobial therapy (IAAT) in Gram-negative bacterial infections as well as risk factors for serious P. aeruginosa infection. A meta-analysis of unadjusted mortality was performed using a random-effects model.
RESULTS
A total of 22 studies reporting mortality and 13 reporting risk factors were identified. The meta-analysis demonstrated that mortality was significantly lower in patients receiving IAAT versus IIAT, with a 67% reduction observed for 28- or 30-day all-cause mortality (odds ratio=0.33, 95% confidence interval 0.20-0.55; P<0.001). Risk factors for serious P. aeruginosa infection include previous exposure to antimicrobials, mechanical ventilation and previous hospitalisation.
CONCLUSION
High rates of antimicrobial resistance in Asia-Pacific as well as the increased mortality associated with IIAT and the presence of risk factors for serious infection highlight the importance of access to newer and appropriate antimicrobials.
Topics: Anti-Bacterial Agents; Asia; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Pseudomonas Infections; Risk Factors
PubMed: 29454906
DOI: 10.1016/j.jgar.2018.02.005 -
BMC Infectious Diseases Mar 2020Treatment of resistant Pseudomonas aeruginosa infection continues to be a challenge in Latin American countries (LATAM). We synthesize the literature on the use of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatment of resistant Pseudomonas aeruginosa infection continues to be a challenge in Latin American countries (LATAM). We synthesize the literature on the use of appropriate initial antibiotic therapy (AIAT) and inappropriate initial antibiotic therapy (IIAT) in P. aeruginosa infections, and the literature on risk factors for acquisition of resistant P. aeruginosa among hospitalized adult patients in LATAM.
METHODS
MEDLINE, EMBASE, Cochrane, and LILAC were searched between 2000 and August 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when studies were sufficiently similar.
RESULTS
The screening of 165 citations identified through literature search yielded 98 full-text articles that were retrieved and assessed for eligibility, and 19 articles conducted in Brazil (14 articles), Colombia (4 articles), and Cuba (1 article) met the inclusion criteria. Of 19 eligible articles, six articles (840 subjects) examined AIAT compared to IIAT in P. aeruginosa infections; 17 articles (3203 total subjects) examined risk factors for acquisition of resistant P. aeruginosa; and four articles evaluated both. Four of 19 articles were rated low risk of bias and the remaining were deemed unclear or high risk of bias. In meta-analysis, AIAT was associated with lower mortality for P. aeruginosa infections (unadjusted summary OR 0.48, 95% CI 0.28-0.81; I = 59%), compared to IIAT and the association with mortality persisted in subgroup meta-analysis by low risk of bias (3 articles; unadjusted summary OR 0.46, 95% CI 0.28-0.81; I = 0%). No meta-analysis was performed for studies evaluating risk factors for acquisition of resistant P. aeruginosa as they were not sufficiently similar. Significant risk factors for acquisition of resistant P. aeruginosa included: prior use of antibiotics (11 articles), stay in the intensive care unit (ICU) (3 articles), and comorbidity score (3 articles). Outcomes were graded to be of low strength of evidence owing to unclear or high risk of bias and imprecise estimates.
CONCLUSION
Our study highlights the association of AIAT with lower mortality and prior use of antibiotics significantly predicts acquiring resistant P. aeruginosa infections. This review reinforces the need for rigorous and structured antimicrobial stewardship programs in the LATAM region.
Topics: Adult; Anti-Bacterial Agents; Comorbidity; Drug Resistance, Bacterial; Hospitalization; Humans; Intensive Care Units; Latin America; Pseudomonas Infections; Pseudomonas aeruginosa
PubMed: 32220233
DOI: 10.1186/s12879-020-04973-0 -
Microorganisms Dec 2022: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk... (Review)
Review
: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. : All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. : A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were (510; 66.1%), (111; 14.4%), and (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). : Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
PubMed: 36677371
DOI: 10.3390/microorganisms11010080 -
Infection Control and Hospital... Apr 2024To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. (Review)
Review
OBJECTIVE
To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks.
DESIGN
Systematic review.
SETTING
Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy.
METHODS
PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms "bronchoscopy," "outbreak," and "pseudo-outbreak" from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables.
RESULTS
In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were , , nontuberculous mycobacteria (NTM), , , , , and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of (r = 0.351; = .002) and (r = 0.346; = .002), and between the presence of a contaminated water source and NTM (r = 0.331; = .004) or (r = 0.280; = .015).
CONCLUSIONS
Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.
Topics: Humans; Bronchoscopy; Cross Infection; Equipment Contamination; Bronchoscopes; Pseudomonas aeruginosa; Disease Outbreaks; Nontuberculous Mycobacteria; Klebsiella pneumoniae; Water
PubMed: 38099453
DOI: 10.1017/ice.2023.250