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Antibiotic resistance is a major public health concern that arises when bacteria evolve mechanisms to withstand the effects of antibiotic treatments. This resistance can be intrinsic, acquired through genetic mutations, or transferred between bacteria via horizontal gene transfer. The development of antibiotic resistance poses significant challenges in treating bacterial infections and necessitates ongoing research to develop new therapeutic strategies.Intrinsic resistance occurs when bacterial...
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Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
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Multidrug-Resistant Gram-Negative Bacteria in Burn Patients.

Laura Ruegsegger1, Jamie Xiao1, Arash Naziripour1

  • 1Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.

Antimicrobial Agents and Chemotherapy
|September 6, 2022
PubMed
Summary

Multidrug-resistant Gram-negative bacteria (MDR GNB) colonization is common in burn intensive care units. Patient-to-patient transmission of highly resistant GNB, including ceftazidime-avibactam-resistant Citrobacter freundii, was detected, highlighting infection control needs.

Keywords:
CitrobacterPseudomonas aeruginosaburncarbapenemaseceftazidime-avibactamhospital infectionsplasmid-mediated resistance

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Critical Care Medicine

Background:

  • Patients with severe burn injuries face a high risk of infectious complications, a leading cause of mortality after 72 hours of hospitalization.
  • Hospital-acquired infections caused by multidrug-resistant Gram-negative bacteria (MDR GNB) are a significant concern in burn intensive care units.

Purpose of the Study:

  • To evaluate the prevalence of intestinal carriage of MDR GNB in patients admitted to a tertiary-care burn intensive care unit.
  • To investigate the potential for patient-to-patient transmission of specific MDR GNB strains.

Main Methods:

  • Screening of 29 burn unit patients for intestinal carriage of MDR GNB using selective culture media.
  • Isolation and identification of bacterial species, with a focus on MDR GNB.
  • Whole-genome sequencing and plasmid analysis of key isolates, including ceftazidime-avibactam-resistant Citrobacter freundii.
  • Plasmid curing experiments to confirm the role of specific genes in resistance.

Main Results:

  • MDR GNB were recovered from 21 out of 29 (72%) patients.
  • Pseudomonas aeruginosa was the most common species (38%), with two patients developing bloodstream infections.
  • Transmission of KPC-31-producing ST22 Citrobacter freundii was identified, including isolates resistant to ceftazidime-avibactam.
  • Whole-genome sequencing revealed the blaKPC-31 gene within a Tn4401b transposon on different plasmids in C. freundii.

Conclusions:

  • Colonization with MDR GNB is highly prevalent in burn intensive care unit patients.
  • Patient-to-patient transmission of highly resistant GNB, such as ceftazidime-avibactam-resistant C. freundii, occurs within this setting.
  • Robust infection prevention and antimicrobial stewardship programs are crucial for managing these vulnerable patients.