Introduction
The study aim was to assess the influence of inflammatory response modifiers, including anti-interleukin-6 (IL-6) biologics and corticosteroids, on the incidence of hospital-acquired ...infections in patients with coronavirus disease 2019 (COVID-19).
Methods
Case–control study performed at a university hospital from February 26 to May 26, 2020. Cases were defined as patients with COVID-19 who developed hospital-acquired infections. For each case, two controls were selected among patients without infections. Cases and controls were matched obeying three criteria in a hierarchical sequence: length of hospital stay up until the first infection; comorbidity; and need for Intensive care unit (ICU) admission. Conditional logistic regression analysis was used to estimate the association of exposures with being a case.
Results
A total of 71 cases and 142 controls were included. Independent predictors for acquiring a hospital infection were chronic liver disease odds ratio (OR) 16.56, 95% CI 1.87–146.5,
p
= 0.012, morbid obesity (OR 6.11, 95% CI 1.06–35.4,
p
= 0.043), current or past smoking (OR 4.15, 95% CI 1.45–11.88,
p
= 0.008), exposure to hydroxychloroquine (OR 0.2, 95% CI 0.041–1,
p
= 0.053), and invasive mechanical ventilation (OR 61.5, 95% CI 11.08–341,
p
≤ 0.0001).
Conclusions
Inflammatory response modifiers had no influence on acquisition of nosocomial infections in admitted patients with COVID-19. Hospital-acquired infections primarily occurred in the critically ill and invasive mechanical ventilation was the main exposure conferring risk.
The incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a ...risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient.
A 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5 mg/l, flucytosine 64 mg/l, fluconazole 64 mg/l, itraconazole 4 mg/l, voriconazole 0.75 mg/l, and caspofungin 0.047 mg/l. He was treated with anidulafungin with resolution of candidemia.
The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients.
Patients in intensive care units (ICUs) present a high risk of developing an infection caused by multi-drug resistant (MDR) bacteria. Consequently, new antimicrobials and combinations are needed. We ...evaluated the activity of ceftolozane-tazobactam against Enterobacterales (n=400) and Pseudomonas aeruginosa (n=80) isolates collected from patients in Spanish intensive care units (ICUs) with complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI). Overall susceptibility of ceftolozane-tazobactam in P. aeruginosa isolates by infection type was 95.7% in cUTI (MIC
, 1/4 mg/L) and 85.3% in cIAI (MIC
, 1/64 mg/L). The activity against P. aeruginosa was maintained regardless of its resistance pattern, confirming that ceftolozane-tazobactam is one of the best antipseudomonal agents along with colistin and amikacin. Susceptibility of ceftolozane-tazobactam in Enterobacterales by infection type was 79.5%/81.9% and 89.3/92.3% (EUCAST/CLSI) in cIAI and cUTI isolates, respectively. The activity was excellent against wild-type organisms, was 100% susceptible, and inhibited at MIC ≤1 mg/L. Nevertheless, ceftolozane-tazobactam susceptibility decreased against extended-spectrum β-lactamase producers: Escherichia coli (80.4%/84.8%) and Klebsiella pneumoniae (59.1%/77.3%). No activity of ceftolozane-tazobactam was observed in carbapenemase producers. The in-vitro activity of ceftolozane-tazobactam observed in this surveillance study suggests that this agent can be considered as a therapeutic option in cUTI and cIAI due to Enterobacterales and P. aeruginosa in ICU patients, particularly when carbapenemase producers are not involved.
Abstract
Objectives
To analyse by WGS the ceftolozane/tazobactam (C/T) resistance mechanisms in Escherichia coli and Klebsiella spp. isolates recovered from complicated intra-abdominal and urinary ...tract infections in patients from Spanish ICUs (SUPERIOR surveillance study, 2016–17).
Methods
The clonal relatedness, the resistome and the virulome of 45 E. coli and 43 Klebsiella spp. isolates with different C/T susceptibility profiles were characterized.
Results
In E. coli, two (C/T susceptible) carbapenemase producers (VIM-2-CC23, OXA-48-ST38) were detected. The most relevant clone was ST131-B2-O25:H4-H30 (17/45), particularly the CTX-M-15-ST131-H30-Rx sublineage (15/17). ST131 strains were mainly C/T susceptible (15/17) and showed an extensive virulome. In non-ST131 strains (28/45), CTX-M enzymes CTX-M-14 (8/24); CTX-M-15 (6/24); CTX-M-1 (3/24); CTX-M-32 (2/24) were found in different clones. C/T resistance was detected in non-clonal E. coli isolates (13%, 6/45) with ESBL (4/6) and non-ESBL (2/6) genotypes. Among Klebsiella spp., Klebsiella pneumoniae (42/43) and Klebsiella michiganensis (1/43) species were identified; 42% (18/43) were carbapenemase producers and 58% showed a C/T resistance phenotype (25/43). OXA-48-ST11 (12/18), OXA-48-ST392 (2/18), OXA-48-ST15 (2/18), NDM-1-ST101 (1/18) and OXA-48+VIM-2-ST15 (1/18) isolates were found, all C/T resistant. Correlation between carbapenemase detection and resistance to C/T was demonstrated (P < 0.001). In non-carbapenemase-producing K. pneumoniae (25/43), C/T resistance (28%, 7/25) was detected in ESBL (3/7) and AmpC (2/7) producers. Overall, an extensive virulome was found and was correlated with carbapenemase carriage (P < 0.001) and C/T resistance (P < 0.05), particularly in OXA-48-ST11 strains (P < 0.05).
Conclusions
Prediction of antimicrobial susceptibility profiles using WGS is challenging. Carbapenemase-encoding genes are associated with C/T resistance in K. pneumoniae, but other resistance mechanisms might be additionally involved.
Macrolides and ketolides are two families of antibiotics that share the same mechanism of action. They bind to different bases of the peptidyl transferase center of 23S RNA. The antibacterial ...spectrum of these drugs virtually overlaps, but dissimilarities in the affinity and number of binding sites results in differences in the intensity of their antibacterial effects (bacteriostatic or bactericidal) and their activity against strains with acquired resistance mechanisms. These agents are active against most gram-positive microorganisms and many intracellular microorganisms. Over the last ten years in Spain, the percentage of macrolide-resistant pneumococci and Streptococcus pyogenes strains has increased substantially. Telithromycin, a ketolide, has maintained the activity against these strains. Macrolides and ketolides are metabolized in the liver through CYP3A4 and they can partially block the activity of the enzyme, interfering with the metabolism of other drugs that use the same metabolic pathway. There is little elimination through the urine, with the exception of clarithromycin. High concentrations are reached in the cellular cytoplasm, but they do not diffuse to cerebrospinal fluid. These agents are included among class B drugs for use during pregnancy. Tolerance to macrolides is good and they have few associated adverse effects. The main clinical indication for these drugs is in empirical treatment of mild to moderate, community-acquired, upper and lower respiratory tract infections. Some patients treated with telithromycin developed severe hepatitis; therefore, its use is limited to community-acquired pneumonia in cases with no other available alternative.
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