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1. Elevated MICs of Susceptible Antipseudomonal Cephalosporins in Non-Carbapenemase-Producing, Carbapenem-Resistant Pseudomonas aeruginosa: Implications for Dose Optimization

Author

Gill, C. M., Aktas, E., Alfouzan, W., Bourassa, L., Brink, A., Burnham, C. -A. D., Canton, R., Carmeli, Y., Falcone, M., Kiffer, C., Marchese, A., Martinez, O., Pournaras, S., Seifert, H., Thabit, A. K., Villegas, M. V., Westblade, L. F., Nicolau, D. P., Wille, J., Rezende, T. T. F., Cekin, Z., Malkocoglu, G., Gijon, D., Tarakmeh, L. A., Chu, C. Y., Opperman, C. J., Tootla, H. D., Moodley, C., Coetzee, J., Vourli, S., Dimopoulos, G., Attallah, D. M., Tiseo, G., Leonildi, A., Giordano, C., Barnini, S., Menichetti, F., Di Pilato, V., Codda, G., Vena, A., Giacobbe, D. R., Satlin, M., Cardona, A., Curtis, L., Fang, F., Thomson, G., and Thomson, K.

Subjects
Carbapenem resistance, medicine.drug_class, Cefepime, Cephalosporin, Ceftazidime, Microbial Sensitivity Tests, Clinical Therapeutics, medicine.disease_cause, Microbiology, Pharmacokinetics, Pharmacodynamics, Pseudomonas aeruginosa, Anti-Bacterial Agents, Azabicyclo Compounds, Carbapenems, Humans, Cephalosporins, Pseudomonas Infections, medicine, Potency, Pharmacology (medical), Pharmacology, business.industry, Carbapenemase producing, Infectious Diseases, business, medicine.drug
Abstract

The present study evaluated the in vitro potency of ceftazidime and cefepime among carbapenem-resistant Pseudomonas aeruginosa isolates collected as part of a global surveillance program and assessed the pharmacodynamic implications using previously published population pharmacokinetics. When susceptible, MICs resulted at the high end of distribution for both ceftazidime and cefepime, thus 6 g/day was required to achieve optimal pharmacodynamic profiles. These findings should be considered in the clinic and for the application of CLSI susceptibility breakpoints.

Published
2021
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2. EUCAST Technical Note on tigecycline

Author

Brown, D.F.J., Canton, R., MacGowan, A.P., Mouton, J.W., Rodloff, A., Goldstein, F., Odenholt, I., Steinbakk, M., Varaldo, P., Hryniewicz, W., The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Steering Committee, and Kahlmeter, G.

Subjects
Breakpoints, Microbiology (medical), Clinical Trials as Topic, Susceptibility testing, medicine.medical_specialty, Bacteria, business.industry, Minocycline, Technical note, susceptibility testing, Bacterial Infections, Microbial Sensitivity Tests, General Medicine, Tigecycline, biochemical phenomena, metabolism, and nutrition, EUCAST Technical Note, Anti-Bacterial Agents, Infectious Diseases, Species Specificity, medicine, Humans, Medical physics, business, medicine.drug
Published
2006
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3. High genetic diversity among community-associated Staphylococcus aureus in Europe: results from a multicenter study

Author

Joana, Rolo, Maria, Miragaia, Agata Turlej Rogacka, Joanna, Empel, Ons, Bouchami, Faria, Nuno A., Ana, Tavares, Waleria, Hryniewicz, Fluit, Ad C., De Lencastre, H., Nashev, D., Melter, O., Zemlicková, H., Fridrichova, M., Westh, H., Salmenlinna, S., Lina, G., Spiliopoulou, I., Drougka, E., Kristóf, K., Rozgonyi, F., Raponi, Giammarco, Ghezzi, Maria Cristina, Wulf, M., Codita, I., Ionescu, G., Nica, M., Lísková, A., Ruiz Garbajosa, P., Canton, R., Dominguez, M. a., Petersson, A. c., Walker, R., Anderson, R., and Andrews, J.

Subjects
Male, Epidemiology, medicine.disease_cause, Polymerase Chain Reaction, Staphylococci, 0303 health sciences, education.field_of_study, Molecular Epidemiology, Multidisciplinary, respiratory system, Staphylococcal Infections, Bacterial Pathogens, Bacterial Typing Techniques, Electrophoresis, Gel, Pulsed-Field, Community-Acquired Infections, Europe, Infectious Diseases, Medical Microbiology, Medicine, Female, Research Article, Skin Infections, Methicillin-Resistant Staphylococcus aureus, Staphylococcus aureus, Science, Population, Microbial Sensitivity Tests, Biology, Staphylococcal infections, Microbiology, Infectious Disease Epidemiology, 03 medical and health sciences, Arginine catabolic mobile element, medicine, Humans, education, Microbial Pathogens, 030304 developmental biology, Genetic diversity, Population Biology, 030306 microbiology, SCCmec, Genetic Variation, biochemical phenomena, metabolism, and nutrition, medicine.disease, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Genetics, Population, Multilocus sequence typing, Panton–Valentine leukocidin
Abstract

BackgroundSeveral studies have addressed the epidemiology of community-associated Staphylococcus aureus (CA-SA) in Europe; nonetheless, a comprehensive perspective remains unclear. In this study, we aimed to describe the population structure of CA-SA and to shed light on the origin of methicillin-resistant S. aureus (MRSA) in this continent.Methods and findingsA total of 568 colonization and infection isolates, comprising both MRSA and methicillin-susceptible S. aureus (MSSA), were recovered in 16 European countries, from community and community-onset infections. The genetic background of isolates was characterized by molecular typing techniques (spa typing, pulsed-field gel electrophoresis and multilocus sequence typing) and the presence of PVL and ACME was tested by PCR. MRSA were further characterized by SCCmec typing. We found that 59% of all isolates were associated with community-associated clones. Most MRSA were related with USA300 (ST8-IVa and variants) (40%), followed by the European clone (ST80-IVc and derivatives) (28%) and the Taiwan clone (ST59-IVa and related clonal types) (15%). A total of 83% of MRSA carried Panton-Valentine leukocidin (PVL) and 14% carried the arginine catabolic mobile element (ACME). Surprisingly, we found a high genetic diversity among MRSA clonal types (ST-SCCmec), Simpson's index of diversity = 0.852 (0.788-0.916). Specifically, about half of the isolates carried novel associations between genetic background and SCCmec. Analysis by BURP showed that some CA-MSSA and CA-MRSA isolates were highly related, suggesting a probable local acquisition/loss of SCCmec.ConclusionsOur results imply that CA-MRSA origin, epidemiology and population structure in Europe is very dissimilar from that of USA.

Published
2012

4. Antimicrobial resistance research in a post-pandemic world: Insights on antimicrobial resistance research in the COVID-19 pandemic

Author

Margo Warren, Birgitta Henriques-Normark, Ramanan Laxminarayan, Ghada Zoubiane, Gian Maria Rossolini, Till T. Bachmann, Adam P. Roberts, Alison Holmes, Sabiha Y. Essack, Benedikt Huttner, Steven J. Hoffman, Charu Kaushic, Herman Goossens, Norio Ohmagari, Srinivas Murthy, Evelina Tacconelli, Jesús Rodríguez-Baño, Shawon Lahiri, Laura Plant, Patriq Fagerstedt, Rafael Cantón, Cornelius J. Clancy, Constance Schultsz, [Rodríguez-Baño,J] Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain. [Rodríguez-Baño,J] Departamento de Medicina, Universidad de Sevilla, Seville, Spain. [Rodríguez-Baño,J] Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Rossolini,GM] Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. [Rossolini,GM] Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy. [Schultsz,C] Department of Global Health–AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. [Tacconelli,E] Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy. [Murthy,S] BC Children’s Hospital, University of British Columbia, Vancouver, Canada. [Ohmagari,N] Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. [Holmes,A] Department of Medicine, Faculty of Medicine, Imperial College London, London, UK. [Bachmann,T] The University of Edinburgh, Edinburgh Medical School, Division of Infection and Pathway Medicine, The Chancellor’s Building, Edinburgh, UK. [Goossens,H] Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium. [Canton,R] Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain. [Canton,R] Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain. [Roberts,AP] Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. [Henriques-Normark,B] Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. [Henriques-Normark,B] Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden. [Clancy,CJ] University of Pittsburgh, Pittsburgh, PA, USA. [Huttner,B] Division of Infectious Diseases, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland. [Fagerstedt,P, Lahiri,S] JPIAMR Secretariat, Swedish Research Council, Stockholm, Sweden. [Kaushic,C, Plant,L] Institute of Infection and Immunity, Canadian Institutes of Health Research, Canada. [Kaushic,C] McMaster Immunology Research Center, Department Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. [Hoffman,SJ] Global Strategy Lab, Dahdaleh Institute for Global Health Research, School of Global Health and Osgoode Hall Law School, York University, Toronto, Canada. [Warren,M] Access to Medicine Foundation, Amsterdam, The Netherlands. [Zoubiane,G, Essack,S] International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark. [Essack,S] Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa. [Laxminarayan,R] Center for Disease Dynamics, Economics & Policy, New Delhi, India. [Rodríguez-Baño,J] Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III. Madrid, Spain., APR would like to acknowledge funding from the AMR CrossCouncil Initiative through a grant from the Medical Research Council, a Council of UK Research and Innovation [grant number MR/S004793/1], the National Institute for Health Research [grant number NIHR200632] and the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via the Medical Research Council in the UK [grant number MR/S037640/1]. JRB and RC acknowledge funding on AMR from Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001 and RD16/0016/ 0011], co-financed by the European Regional Development Fund ‘A way to achieve Europe’, Operative Program Intelligence Growth 2014–2020. JRB also acknowledges the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via Instituto de Salud Carlos III [grant number AC16/00076]. ET acknowledges funding on AMR from the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via the German Federal Ministry of Education and Research (BMBF) [grant number 01KI1830], Innovative Medicines Initiative 1 and 2 Joint Undertaking [grants number 115737,115523 and820755] and the Global Antibiotic Research and Development Partnership (GARDP). LP, PF and SL would like to acknowledge funding to the JPIAMR from the European Commission (EXEDRA, JPI-EC-AMR and JPIAMR-ACTION)., Medical Research Council (UK), UK Research and Innovation, National Institute for Health Research (UK), Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, European Commission, Federal Ministry of Education and Research (Germany), Innovative Medicines Initiative, Global Health, AII - Infectious diseases, and APH - Global Health

Subjects
0301 basic medicine, Vulnerability, Antimicrobial stewardship, Antimicrobial resistance, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Pandemic, wc_505, Immunology and Allergy, Phenomena and Processes::Microbiological Phenomena::Bacterial Physiological Phenomena::Drug Resistance, Bacterial [Medical Subject Headings], 030212 general & internal medicine, wb_330, Surveillance, Transmission (medicine), Pharmacology. Therapy, QR1-502, Anti-Bacterial Agents, Investigación, qw_160, Healthcare system, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings], Microbiology (medical), medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Infecciones por coronavirus, 030106 microbiology, Immunology, Microbiology, Article, qw_45, Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Data Collection::Health Surveys::Population Surveillance::Public Health Surveillance [Medical Subject Headings], 03 medical and health sciences, Antibiotic resistance, Stewardship, covid-19, research, surveillance, Drug Resistance, Bacterial, medicine, Humans, Intensive care medicine, Pandemics, Programas de optimización del uso de los antimicrobianos, Pandemia, business.industry, SARS-CoV-2, Research, COVID-19, Health Care::Environment and Public Health::Public Health::Disease Outbreaks::Epidemics::Pandemics [Medical Subject Headings], Diseases::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [Medical Subject Headings], Infectious disease (medical specialty), wc_518, Clinical Microbiology and Infection, Human medicine, Disciplines and Occupations::Health Occupations::Medicine::Public Health::Epidemiology [Medical Subject Headings], business
Abstract

Antimicrobial resistance must be recognised as a global societal priority - even in the face of the worldwide challenge of the COVID-19 pandemic. COVID-19 has illustrated the vulnerability of our healthcare systems in co-managing multiple infectious disease threats as resources for monitoring and detecting, and conducting research on antimicrobial resistance have been compromised during the pandemic. The increased awareness of the importance of infectious diseases, clinical microbiology and infection control and lessons learnt during the COVID-19 pandemic should be exploited to ensure that emergence of future infectious disease threats, including those related to AMR, are minimised. Harnessing the public understanding of the relevance of infectious diseases towards the long-term pandemic of AMR could have major implications for promoting good practices about the control of AMR transmission., APR would like to acknowledge funding from the AMR Cross-Council Initiative through a grant from the Medical Research Council, a Council of UK Research and Innovation [grant number MR/S004793/1], the National Institute for Health Research [grant number NIHR200632] and the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via the Medical Research Council in the UK [grant number MR/S037640/1]. JRB and RC acknowledge funding on AMR from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001 and RD16/0016/0011], co-financed by the European Regional Development Fund ‘A way to achieve Europe’, Operative Program Intelligence Growth 2014–2020. JRB also acknowledges the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via Instituto de Salud Carlos III [grant number AC16/00076]. ET acknowledges funding on AMR from the Joint Programming Initiative for Antimicrobial Resistance (JPIAMR) via the German Federal Ministry of Education and Research (BMBF) [grant number 01KI1830], Innovative Medicines Initiative 1 and 2 Joint Undertaking [grants number 115737, 115523 and820755] and the Global Antibiotic Research and Development Partnership (GARDP). LP, PF and SL would like to acknowledge funding to the JPIAMR from the European Commission (EXEDRA, JPI-EC-AMR and JPIAMR-ACTION).

Published
2021
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5. In vitro and in vivo efficacy of combinations of colistin and different endolysins against clinical strains of multi-drug resistant pathogens

Author

Elena Pérez-Nadales, Lucia Blasco, Timothy J. Kidd, Julián Torre-Cisneros, María Tomás, Antonio Oliver, Rafael Cantón, Antón Ambroa, Elisenda Miró, Germán Bou, Jesús Oteo-Iglesias, Ines Bleriot, Felipe Fernández-Cuenca, Ferran Navarro, Álvaro Pascual, Laura Fernandez-Garcia, Miriam Moscoso, Luis Martínez-Martínez, Rocio Trastoy, [Blascom,L, Ambroa,A, Trastoy,R, Bleriot,I, Moscoso,M, Fernández-Garcia,L, Bou,G, Tomas,M] Microbiology Department-Research Institute Biomedical A Coruña (INIBIC), Hospital A Coruña (CHUAC), University of A Coruña (UDC), A Coruña, Spain. [Perez-Nadales,E, Torre-Cisneros,J, Martínez-Martínez,L] Unit of Microbiology, University Hospital Reina Sofía, Department of Microbiology, University of Córdoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain. [Fernández-Cuenca,F, Pascual,A] Clinical Unit for Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena / Department of Microbiology and Medicine, University of Seville/ Biomedicine Institute of Seville (IBIS), Seville, Spain. [Oteo-Iglesias,J] Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain. [Oliver,A] Microbiology Department- Research Institute Biomedical Islas Baleares (IdISBa), Hospital Son Espases, Palma de Mallorca, Spain. [Canton,R] Microbiology Department-Research Institute Biomedical Ramón and Cajal (IRYCIS), Hospital Ramón and Cajal, Madrid, Spain. [Kidd,T] School of Chemistry and Molecular Biosciences and Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia. [Navarro,F, Miró,E] Microbiology Department-Sant Pau Hospital, Barcelona, Spain. [Blascom,L, Fernández-Cuenca,F, Oteo-Iglesias,J, Oliver,A, Canton,R, Navarro,F, Miró,E, Pascual,A, Martínez-Martínez,L, Tomas,M] Study Group on Mechanisms of Action and Resistance to Antimicrobials (GEMARA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain. [Moscoso,M, Perez-Nadales,E, Oteo-Iglesias,A, Tomas,M] Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain., This study was funded by grant PI16/01163 awarded to M. Tomás within the State Plan for R + D + I 2013–2016 (National Plan for Scientific Research, Technological Development and Innovation 2008–2011) and co-financed by the ISCIII-Deputy General Directorate for Evaluation and Promotion of Research - European Regional Development Fund 'A way of Making Europe' and Instituto de Salud Carlos III FEDER, Spanish Network for the Research in Infectious Diseases (REIPI, RD16/0016/0001, RD16/0016/0002, RD16/0016/0004, RD16/0016/0006, RD16/0016/0008, and RD16/0016/0011) and by the Study Group on Mechanisms of Action and Resistance to Antimicrobials, GEMARA (SEIMC, http://www.seimc.org/). M. Tomás was financially supported by the Miguel Servet Research Programme (SERGAS and ISCIII). R. Trastoy and L. Fernández-García were financially supported by respectively an SEIMC grant and predoctoral fellowship from the Xunta de Galicia (GAIN, Axencia de Innovación). TJK is supported by a National Health and Medical Research Council Early Career Fellowship (GNT1088448)., Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (España), European Commission, Red Española de Investigación en Patología Infecciosa, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, Xunta de Galicia, Axencia Galega de Innovación, National Health and Medical Research Council (Australia), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Red de Investigación Cooperativa en Investigación en Patología Infecciosa (España), and Xunta de Galicia (España)

Subjects
0301 basic medicine, Klebsiella pneumoniae, resistencia a medicamentos, Drug Resistance, lcsh:Medicine, Drug resistance, medicine.disease_cause, colistina, Phenomena and Processes::Microbiological Phenomena::Drug Resistance, Microbial::Drug Resistance, Bacterial::Drug Resistance, Multiple, Bacterial [Medical Subject Headings], Organisms::Viruses::Bacteriophages [Medical Subject Headings], Drug Resistance, Multiple, Bacterial, polycyclic compounds, Organisms::Eukaryota::Animals [Medical Subject Headings], Antiinfecciosos, lcsh:Science, Colistina, Pruebas de sensibilidad microbiana, Multidisciplinary, Genome, biology, Drug discovery, Antimicrobial, bacterias gramnegativas, Acinetobacter baumannii, Farmacorresistencia bacteriana múltiple, endopeptidasas, Organisms::Bacteria::Gram-Negative Bacteria [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Clinical Laboratory Techniques::Microbiological Techniques::Microbial Sensitivity Tests [Medical Subject Headings], pruebas de sensibilidad microbiana, Anti-infective agents, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents [Medical Subject Headings], medicine.drug, 030106 microbiology, Microbial Sensitivity Tests, Microbiology, Article, Phenomena and Processes::Genetic Phenomena::Genetic Structures::Genome [Medical Subject Headings], 03 medical and health sciences, Endopeptidases, Gram-Negative Bacteria, medicine, Bacterias gramnegativas, Genoma, Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Hydrolases::Peptide Hydrolases::Endopeptidases [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Rodentia::Muridae::Murinae::Mice [Medical Subject Headings], Pseudomonas aeruginosa, Colistin, lcsh:R, Pathogenic bacteria, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Multiple drug resistance, 030104 developmental biology, Chemicals and Drugs::Polycyclic Compounds::Macrocyclic Compounds::Peptides, Cyclic::Polymyxins::Colistin [Medical Subject Headings], lcsh:Q
Abstract

The emergence of multidrug resistant (MDR) pathogenic bacteria is jeopardizing the value of antimicrobials, which had previously changed the course of medical science. In this study, we identified endolysins ElyA1 and ElyA2 (GH108-PG3 family), present in the genome of bacteriophages Ab1051 Phi and Ab1052 Phi, respectively. The muralytic activity of these endolysins against MDR clinical isolates (Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae) was tested using the turbidity reduction assay. Minimal inhibitory concentrations (MICs) of endolysin, colistin and a combination of endolysin and colistin were determined, and the antimicrobial activity of each treatment was confirmed by time kill curves. Endolysin ElyA1 displayed activity against all 25 strains of A. baumannii and P. aeruginosa tested and against 13 out of 17 strains of K. pneumoniae. Endolysin ElyA2 did not display any such activity. The combined antimicrobial activity of colistin and ElyA1 yielded a reduction in the colistin MIC for all strains studied, except K. pneumoniae. These results were confirmed in vivo in G. mellonella survival assays and in murine skin and lung infection models. In conclusion, combining colistin (1/4 MIC) with the new endolysin ElyA1 (350 mu g) enhanced the bactericidal activity of colistin in both in vitro and in vivo studies. This will potentially enable reduction of the dose of colistin used in clinical practice., This study was funded by grant PI16/01163 awarded to M. Tomas within the State Plan for R+D+I 2013-2016 (National Plan for Scientific Research, Technological Development and Innovation 2008-2011) and co-financed by the ISCIII-Deputy General Directorate for Evaluation and Promotion of Research - European Regional Development Fund A way of Making Europe and Instituto de Salud Carlos III FEDER, Spanish Network for the Research in Infectious Diseases (REIPI, RD16/0016/0001, RD16/0016/0002, RD16/0016/0004, RD16/0016/0006, RD16/0016/0008, and RD16/0016/0011) and by the Study Group on Mechanisms of Action and Resistance to Antimicrobials, GEMARA (SEIMC, . M. Tomas was financially supported by the Miguel Servet Research Programme (SERGAS and ISCIII). R. Trastoy and L. Fernandez-Garcia were financially supported by respectively an SEIMC grant and predoctoral fellowship from the Xunta de Galicia (GAIN, Axencia de Innovacion). TJK is supported by a National Health and Medical Research Council Early Career Fellowship (GNT1088448).

Published
2020

6. Comparative in vitro activity of oral antimicrobial agents against Enterobacteriaceae from patients with community-acquired urinary tract infections in three European countries

Author

N. Batista, Michael Kresken, Rafael Cantón, B. Van Meensel, Hilmar Wisplinghoff, Harald Seifert, Álvaro Pascual, V. Besard, Douglas J. Biedenbach, María García-Castillo, Wiltrud Kalka-Moll, Barbara Körber-Irrgang, R. Schwarz, [Kresken, M.] Antiinfect Intelligence GmbH, D-53359 Rheinbach, Germany, [Koerber-Irrgang, B.] Antiinfect Intelligence GmbH, D-53359 Rheinbach, Germany, [Biedenbach, D. J.] Int Hlth Management Associates Inc, Schaumburg, IL USA, [Batista, N.] Hosp Univ Virgen Macarena, Microbiol Serv, Seville, Spain, [Pascual, A.] Hosp Univ Virgen Macarena, Microbiol Serv, Seville, Spain, [Besard, V.] Practimed CVBA Clin Lab, Tessenderlo, Belgium, [Canton, R.] Hosp Ramon & Cajal, Microbiol Serv, E-28034 Madrid, Spain, [Garcia-Castillo, M.] Hosp Ramon & Cajal, Microbiol Serv, E-28034 Madrid, Spain, [Canton, R.] Inst Ramon y Cajal Invest Sanitaria, Madrid, Spain, [Garcia-Castillo, M.] Inst Ramon y Cajal Invest Sanitaria, Madrid, Spain, [Kalka-Moll, W.] Med Versorgungszentrum Dr Stein & Kollegen, Monchengladbach, Germany, [Schwarz, R.] Med Versorgungszentrum Dr Stein & Kollegen, Monchengladbach, Germany, [Van Meensel, B.] MCH Leuven, Leuven, Belgium, [Wisplinghoff, H.] Lab Med Koln Dres Med Wisplinghoff & Kollegen, Cologne, Germany, [Seifert, H.] Univ Cologne, Inst Med Microbiol Immunol & Hyg, D-50931 Cologne, Germany, [Seifert, H.] German Ctr Infect Res, Bonn, Germany, and Merck Inc.

Subjects
Male, 0301 basic medicine, Klebsiella pneumoniae, cephalosporin, Resistance, Escherichia-coli, Ambulatory Care Facilities, Trimethoprim, Anti-Infective Agents, Belgium, Antibiotics, Germany, gender, Medicine, Outpatient clinic, Ceftibuten, Aged, 80 and over, biology, Enterobacteriaceae Infections, General Medicine, Middle Aged, Community-Acquired Infections, Ciprofloxacin, Infectious Diseases, Urinary Tract Infections, Ceftriaxone, Female, Pathogens, medicine.drug, Adult, Microbiology (medical), Adolescent, Evolution, 030106 microbiology, Microbial Sensitivity Tests, Fosfomycin, Beta-lactamases, Microbiology, Young Adult, 03 medical and health sciences, Age, Enterobacteriaceae, Drug Resistance, Bacterial, Humans, extended-spectrum beta-lactamase rates, Aged, business.industry, biology.organism_classification, Proteus mirabilis, Spain, Susceptibility, Nitrofurantoin, Therapy, business
Abstract

Enterobacteriaceae causing community-acquired urinary tract infections were examined in selected outpatient clinics and hospitals in Belgium, Germany and Spain using EUCAST breakpoints for susceptibility. A total of 1190 isolates were collected. Escherichia coli isolates were resistant to amoxicillin-clavulanic acid (28.1%), ciprofloxacin (23.4%) and trimethoprim-sulfamethoxazole (21.4%) compared with fosfomycin and nitrofurantoin (each

Published
2016
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7. European survey on principles of prudent antibiotic prescribing teaching in undergraduate students

Author

C. Pulcini, F. Wencker, N. Frimodt-Møller, W.V. Kern, D. Nathwani, J. Rodríguez-Baño, G.S. Simonsen, V. Vlahović-Palčevski, I.C. Gyssens, F. Jacobs, W. Peetermans, I. Francetić, N. Frimodt-Mǿller, N. Høiby, M. Kilian, F. Ader, C. Cazorla, M. Etienne, G. Fätkenheuer, M.W. Pletz, B. Salzberger, B. Cacopardo, M. Mikulska, C. Mussini, G. Orlando, S. Stefani, S.H. Lowe, J.L. Nouwen, J.E. Afset, K. Bergh, F. Müller, B. Carevic, O. Horvat, S. Jankovic, B. Beović, J.R. Gorisek, R. Canton, M.C. Fariñas, F. Gudiol, J.R. Paño Pardo, J. Rodríguez Baño, S. Harbarth, G. Zanetti, G. Barlow, N. Brown, B. Healy, Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Radboud University Medical Center [Nijmegen], Canisius-Wilhelmina Hospital, Rigshospitalet [Copenhagen], Center for Infectious Diseases and Travel Medicine, University Hospital Freiburg, Ninewells Hospital and Medical School [Dundee], Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Universidad de Sevilla, UNN, University Hospital of North Norway, Tromsoe, Norvège, The Arctic University of Norway ( UiT ), University Hospital Rijeka, University of Rijeka, Hasselt University, Gyssens I, Jacobs F, Peetermans W, Francetić I, Vlahović-Palčevski V, Frimodt-Mǿller N, Høiby N, Kilian M, Ader F, Cazorla C, Etienne M, Pulcini C, Fätkenheuer G, Kern W, Pletz M, Salzberger B, Cacopardo B, Mikulska M, Mussini C, Orlando G, Stefani S, Gyssens I, Lowe S, Nouwen J, Afset J, Bergh K, Müller F, Simonsen G, Carevic B, Horvat O, Jankovic S, Beović B, Gorisek J, Canton R, Fariñas M, Gudiol F, Pardo J, Baño J, Harbarth S, Zanetti G, Barlow G, Brown N, Healy B, Nathwani D., Medical Microbiology & Infectious Diseases, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université Paris Diderot - Paris 7 (UPD7), The Arctic University of Norway (UiT), Copenhagen University Hospital, and Hasselt University (UHasselt)

Subjects
Pediatrics, Cross-sectional study, MESH : Drug Prescriptions, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], curriculum, MESH : Drug Utilization, law.invention, 0302 clinical medicine, MESH : Cross-Sectional Studies, MESH: Drug Prescriptions, law, Surveys and Questionnaires, Medicine, 030212 general & internal medicine, Duration (project management), MESH: Drug Utilization, MESH : Anti-Bacterial Agents, Schools, Medical, Antibiotic stewardship, 0303 health sciences, education, Clinical pharmacology, Schools, Education, Medical, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, BIOMEDICINA I ZDRAVSTVO. Temeljne medicinske znanosti. Farmakologija, antibiotic stewardship, medical student, medical school, questionnaire, 3. Good health, Anti-Bacterial Agents, Europe, Infectious Diseases, ntibiotic stewardship, MESH: Communicable Diseases, MESH : Surveys and Questionnaires, Microbiology (medical), medicine.medical_specialty, MESH : Schools, Medical, MESH: Education, Medical, MESH : Europe, BIOMEDICINE AND HEALTHCARE. Basic Medical Sciences. Pharmacology, Communicable Diseases, Drug Prescriptions, Antibiotic prescribing, 03 medical and health sciences, MESH: Cross-Sectional Studies, SDG 3 - Good Health and Well-being, Antibiotic therapy, Medical, MESH: Anti-Bacterial Agents, Curriculum, Education, Medical school, Medical student, Questionnaire, Cross-Sectional Studies, Drug Utilization, Antibiotic use, medical schoo, MESH: Surveys and Questionnaires, MESH : Education, Medical, ntibiotic stewardship, curriculum, education, medical school, medical student, questionnaire, Medical education, MESH: Schools, Medical, 030306 microbiology, business.industry, MESH : Communicable Diseases, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, business
Abstract

We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology. In-depth interviews were conducted with four lecturers. Thirty-five of 37 medical schools were included in the study. Prudent antibiotic use principles were taught in all but one medical school, but only four of 13 countries had a national programme. Interactive teaching formats were used less frequently than passive formats. The teaching was mandatory for 53% of the courses and started before clinical training in 71%. We observed wide variations in exposure of students to important principles of prudent antibiotic use among countries and within the same country. Some major principles were poorly covered (e.g. reassessment and duration of antibiotic therapy, communication skills). Whereas 77% of the respondents fully agreed that the teaching of these principles should be prioritized, lack of time, mainly due to rigid curriculum policies, was the main reported barrier to implementation. Given the study design, these are probably optimistic results. Teaching of prudent antibiotic prescribing principles should be improved. National and European programmes for development of specific learning outcomes or competencies are urgently needed. Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved

Published
2015
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8. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Author

Álvaro Pascual, Domingo Hernández, Francisco López-Medrano, Pilar Martín-Dávila, Rafael Cantón, M.J. Goyanes, Belén Gutiérrez-Gutiérrez, Elisa Vidal, A. Solé-Jover, J. Fortún, Patricia Muñoz, Julián Torre-Cisneros, Rafael López-Andújar, Oscar Len, A. Román-Broto, Antonio Oliver, Valentín Cuervas-Mons, Miguel Montejo, Mario Fernández-Ruiz, Joan Gavaldà, Emilia Cercenado, Carlota Gudiol, A. Moreno, Elena Pérez-Nadales, Juan José Castón, Elisa Cordero, Rafael San-Juan, Daniel Serón, Carlos Cervera, J.T. Silva, María G. Crespo-Leiro, Luis Martínez-Martínez, Benito Almirante, José María Aguado, Luis Almenar, M.C. Fariñas, Maricela Valerio, J. Elizalde-Fernández, José Miguel Cisneros, Jordi Carratalà, Universidad de Cantabria, Universitat de Barcelona, [Aguado, J. M.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Fernandez-Ruiz, M.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Lopez-Medrano, F.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [San-Juan, R.] Univ Complutense, Univ Hosp 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i +72, Madrid, Spain, [Silva, J. T.] Univ Extremadura, Fdn Formac & Invest Profes Salud Extremadura Fund, Univ Hosp Badajoz, Dept Infect Dis, Badajoz, Spain, [Cordero, E.] Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville, IBiS,Univ Hosp Virgen Rocio,CSIC, Seville, Spain, [Cisneros, J. M.] Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville, IBiS,Univ Hosp Virgen Rocio,CSIC, Seville, Spain, [Fortun, J.] Univ Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain, [Martin-Davila, P.] Univ Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain, [Gudiol, C.] Univ Barcelona, Dept Infect Dis, Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Barcelona, Spain, [Carratala, J.] Univ Barcelona, Dept Infect Dis, Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Barcelona, Spain, [Martinez-Martinez, L.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Microbiol, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Vidal, E.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Caston, J. J.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Perez-Nadales, E.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Torre-Cisneros, J.] Univ Cordoba, Reina Sofia Univ Hosp, Clin Unit Infect Dis, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Andalusia, Spain, [Almenar, L.] Hosp Univ La Fe, Cardiol Dept, Heart Failure & Heart Transplant Unit, Valencia, Spain, [Almirante, B.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Gavalda, J.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Len, O.] Univ Autonoma Barcelona, Dept Infect Dis, Hosp Univ Vail Hebron, Barcelona, Spain, [Canton, R.] Univ Hosp Ramon & Cajal, Microbiol Dept, IRYCIS, Madrid, Spain, [Cercenado, E.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Goyanes, M. J.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Valerio, M.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Munoz, P.] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Hosp Gregorio Maranon, Clin Microbiol & Infect Dis, Madrid, Spain, [Cercenado, E.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Goyanes, M. J.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Valerio, M.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Munoz, P.] CIBERES C606 06 0058, Enfermedades Resp, Madrid, Spain, [Cercenado, E.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Goyanes, M. J.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Valerio, M.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Munoz, P.] Univ Complutense Madrid, Sch Med, Med Dept, Madrid, Spain, [Cervera, C.] Univ Alberta, Div Infect Dis, Dept Med, Edmonton, AB, Canada, [Crespo-Leiro, M. G.] Complexo Hosp Univ A Coruna, Cardiol Dept, La Coruna, Spain, [Cuervas-Mons, V.] Hosp Clin Puerto Hierro, Liver Transplantat Internal Med, Madrid, Spain, [Elizalde-Fernandez, J.] Hosp Navarra, Intens Care Unit, Pamplona, Spain, [Farinas, M. C.] Univ Cantabria, Univ Hosp Marques Valdecilla, Unit Infect Dis, Santander, Spain, [Gutierrez-Gutierrez, B.] Univ Seville, Clin Unit Infect Dis & Microbiol, Unidad Gest Clin Enfermedades Infecciosas & Micro, Inst Biomed Sevilla,Hosp Univ Virgen Macarena,IBi, Seville, Spain, [Pascual, A.] Univ Seville, Clin Unit Infect Dis & Microbiol, Unidad Gest Clin Enfermedades Infecciosas & Micro, Inst Biomed Sevilla,Hosp Univ Virgen Macarena,IBi, Seville, Spain, [Hernandez, D.] Univ Malaga, Dept Nephrol, Carlos Haya Reg Univ Hosp, Inst Biomed Res Malaga IBIMA, Malaga, Spain, [Lopez-Andujar, R.] Hosp Univ & Politecn La Fe, Gen Surg Serv, Hepatobiliopancreat Surg & Transplantat Unit, Valencia, Spain, [Montejo, M.] Univ Hosp Cruces, Unit Infect Dis, Bilbao, Spain, [Moreno, A.] Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain, [Oliver, A.] Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Dept Microbiol, Palma de Mallorca, Spain, [Oliver, A.] Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Res Unit, Palma de Mallorca, Spain, [Roman-Broto, A.] Univ Autonoma Barcelona, Hosp Univ Vall Hebron, Lung Transplant Unit, Barcelona, Spain, [Seron, D.] Hosp Univ Vall Hebron, Nephrol Dept, Barcelona, Spain, [Sole-Jover, A.] Hosp Univ La Fe, Dept Pneumol, Lung Transplant Unit, Valencia, Spain, Spanish Ministry of Economy and Competitiveness, Institute de Salud Carlos III, and Fundacion pars la Formacion e Investigacion de los Profesionales de la Salud de Extremadura (FundeSalud), Institute de Salud Carlos III

Subjects
0301 basic medicine, medicine.medical_treatment, Antibiotics, Carbapenem-resistant enterobacteriaceae, Communicable diseases, Organ transplantation, Lactamase-producing enterobacteriaceae, Postoperative Complications, Solid organ transplantation, Medicine, Blood-stream infections, Kidney transplantation, Transplantation of organs, Carbapenem-resistant Gram-negative bacilli, High-risk patients, Multidrug resistant Gram-negative bacilli, Disease Management, Drug Resistance, Multiple, Tissue Donors, Anti-Bacterial Agents, Pseudomonas-aeruginosa bacteremia, medicine.medical_specialty, medicine.drug_class, 030106 microbiology, Urinary-tract-infections, 03 medical and health sciences, Surgical prophylaxis, Acinetobacter-baumannii infections, Pseudomonas, Ventilator-associated pneumonia, Lung transplantation, Humans, Extended-spectrum β-lactamases, Intensive care medicine, Contraindication, Transplantation, business.industry, Bacils, Extensively-drug-resistant, Organ Transplantation, Malalties infeccioses, medicine.disease, Transplant Recipients, Trasplantament d'òrgans, Bacillus (Bacteria), Spectrum beta-lactamases, Intensive-care-unit, business, Gram-Negative Bacterial Infections
Abstract

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection. J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III.

Published
2017

10. Bacterial infections in cirrhosis: A position statement based on the EASL Special Conference 2013

Author

José Such, Agustín Albillos, Alexander Wilmer, Vicente Arroyo, Vanessa Stadlbauer, Richard Moreau, Javier Fernández, Paolo Angeli, R. Garcia-Martinez, Thierry Gustot, Andrew K. Burroughs, Reiner Wiest, Pere Ginès, Guadalupe Garcia-Tsao, Julia Wendon, Jordi Vila, Juan Córdoba, Bernd Schnabl, Frank Lammert, Rajeshwar P. Mookerjee, Rajiv Jalan, Arun J. Sanyal, Mauro Bernardi, Rafael Cantón, Jalan R, Fernandez J, Weist R, Schnabl B, Moreau R, Angeli P, Stadlbauer V, Gustot T, Bernardi M, Canton R, Albillos A, Lammert F, Wilmer A, Mookerjee R, Vila J, Garcia-Martinez R, Wendon J, Such J, Cordoba J, Sanyal A, Garcia-Tsao G, Arroyo V, and Ginès P.

Subjects
Liver Cirrhosis, medicine.medical_specialty, Gastrointestinal bleeding, Alcoholic liver disease, Cirrhosis, medicine.drug_class, Antibiotics, DIAGNOSIS, Gastroenterology, Quality of life, Internal medicine, Drug Resistance, Bacterial, medicine, Gastro-entérologie, Humans, Intensive care medicine, CIRRHOSIS, Hepatic encephalopathy, Multiresistant bacteria, Hepatology, biology, business.industry, BACTERIAL INFECTIONS, C-reactive protein, medicine.disease, Anti-Bacterial Agents, MULTIRESISTANT PATHOGENS, Practice Guidelines as Topic, biology.protein, Bacterial infection, business, Hyponatremia
Abstract

Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

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