Razieh Amirfakhrian; Atieh Yaghobi; Roya Saddat Ghaderi; Seyed Isaac Hashemy; Kiarash Ghazvini
Abstract
Introduction: In recent decades, the inappropriate use of antibiotics and the existence of transferable resistant elements have caused the emergence of multidrug-resistant (MDR) gram-negative organisms. Antimicrobial resistance is becoming one of the major challenges to public health and has caused morbidity ...
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Introduction: In recent decades, the inappropriate use of antibiotics and the existence of transferable resistant elements have caused the emergence of multidrug-resistant (MDR) gram-negative organisms. Antimicrobial resistance is becoming one of the major challenges to public health and has caused morbidity and mortality worldwide. The purpose of this study was the assessment of the prevalence and frequency of colistin resistance among gram-negative bacilli (Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp.) in Iran and around the world. Methods: For this systematic review and meta-analysis, we searched international and national databases, including PubMed, Google Scholar, SID, and Magiran, from 1998 to 2018 for articles and abstracts describing colistin resistance among gram-negative bacilli. We have included 92 studies that met our inclusion criteria, and the outcomes were combined using a random-effects model to derive the event rate of colistin resistance among gram-negative bacilli. Data were analyzed by the Comprehensive Meta-Analysis Software (V2), and the heterogeneity of the studies was assessed using the I2 index. Results: Out of the 11050 papers identified, 92 studies met the strict inclusion criteria and were finally included. The overall event rate of colistin resistance among gram-negative bacilli (GNB) was about 6.6%, while the event rate of colistin resistance among Acinetobacter spp. (n = 18504) was 2.8% (summary: 95% confidence interval (CI): [0.02, 0.041], P = 0.001, I2 = 70, df (Q) = 36, Q-value = 121.924). The colistin resistance among Pseudomonas spp. (n = 15094) was 3% (95% CI: [0.022, 0.041], P = 0.001, I2 = 68.3, df (Q) = 25, Q-value = 85.648), and the colistin resistance among Enterobacteriaceae spp. (n = 44772) was 0.8% (95% CI: [0.004, 0.014], P = 0.001, I2 = 87.6, df (Q) = 15, Q-value = 71.291). Therefore, the event rate of resistance to colistin among GNB was relatively low (6.6%). Conclusion: The event rate of resistance to colistin among GNB was low. Therefore, this antimicrobial agent can still be administered as a suitable option against GNB that are resistant to other antibiotics such as carbapenems.
Kobra Salimiyan Rizi; Hadi Farsiani; Saeid Amel Jamehdar; Mahboubeh Mohammadzadeh
Abstract
Elizabethkingia meningoseptica is an emerging nosocomial gram-negative, rod-shaped pathogen in patients with underlying diseases. This bacterium is also considered to be a major pathogen in hospitalized patients. Some of the main risk factors for E. meningosepticum infections include immunosuppression ...
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Elizabethkingia meningoseptica is an emerging nosocomial gram-negative, rod-shaped pathogen in patients with underlying diseases. This bacterium is also considered to be a major pathogen in hospitalized patients. Some of the main risk factors for E. meningosepticum infections include immunosuppression (e.g., end-stage hepatic and renal diseases) and prematurity in neonates. Furthermore, E. meningosepticum could cause pneumonia, endocarditis, and bacteremia in adults. The uncommon resistance pattern of this bacterium, as well as its intrinsic resistance to colistin, makes the treatment of the associated infections challenging unless the susceptibility patterns are available. In this article, we have presented the first case of pulmonary coinfection with multidrug-resistant (MDR) Acinetobacter spp. and E. meningoseptica in Iran. A 20-year-old female patient was admitted to our hospital with tetralogy of fallot as an underlying disease since childhood. The patient underwent cardiac surgery. On the third postoperative day (POD), the patient developed lung infection and left-lung collapse. Antibiotic therapy was initiated for MDR Acinetobacter spp. obtained from her primary culture of tracheal discharges. When fever persisted in the patient, the secondary culture of her tracheal discharges was observed to be positive for E. meningoseptica. In this case report, no clinical correlations were observed between the E. meningoseptica isolated from respiratory secretions and the primary respiratory infection, suggesting that E. meningoseptica is an indicator of severe underlying diseases rather than an actual pathogen.