Keywords
Beta-lactamases
Carbapenems
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Abstract
Objective: To report the first case of nosocomial infection by Acinetobacter baumannii producing carbapenemase type IMP in the state of Piauí, Brazil. Case details: A 37-year-old man with ventilator-associated pneumonia treated with a combination of antibiotics including meropenem and polymyxin B, victim of a gunshot wound to the face, coming from a health service in the north of the state, was admitted to the Intensive Care Unit of a university hospital in the state of Piauí, northeastern Brazil. At the hospital of origin, orotracheal intubation, analgesia, sedation and prophylaxis with ceftriaxone (2g, IV, 12/12h) and clindamycin (600mg, IV, 6/6h) were performed due to a contaminated fracture caused by the gunshot. He arrived hemodynamically stable, without the use of vasoactive drugs and without fever. He underwent neurosurgery on the same day he was admitted to the university hospital, and continued with prophylactic antibiotic therapy with ceftriaxone and clindamycin. Final considerations: Polymyxins are drugs used as the last line of treatment for serious infections caused by gram-negative bacteria, due to their reports of nephrological and neurological toxicity. The management carried out by the institution's Healthcare-Associated Infection Control Committee prevented the spread of resistance, highlighting the importance of control strategies in hospital settings.
References
AHUATZIN-FLORES OE, et al. Acinetobacter baumannii, a Multidrug-Resistant Opportunistic Pathogen in New Habitats: A Systematic Review. Microorganisms, 2024; 12 (4):644.
ARDEBILI A, et al. Polymyxin combination therapy for multidrug-resistant, extensively-drug resistant, and difficult-to-treat drug-resistant gram-negative infections: is it superior to polymyxin monotherapy? Expert Review of Anti-infective Therapy, 2023; 21 (4): 387-429.
BAHR G, et al. Metallo-β-lactamases in the age of multidrug resistance: from structure and mechanism to evolution, dissemination, and inhibitor design. Chemical reviews, 2021; 121 (13): 7957-8094.
BASSETTI M, GARAU J. Current and future perspectives in the treatment of multidrug-resistant Gram-negative infections. Journal of Antimicrobial Chemotherapy, 2021; 76 (4): iv23-iv37.
BRASILIENSE D, et al. Diversity of metallo-β-lactamase-encoding genes found in distinct species of Acinetobacter isolated from the Brazilian Amazon Region. Memórias do Instituto Oswaldo Cruz, 2019; 114: p. e190020.
BRCAST. Tabelas de pontos de corte para interpretação de CIMs e diâmetros de halos. Disponível em: https://brcast.org.br/documentos/documentos-3/. Acessado em: 07 de julho de 2024.
CORNAGLIA G, et al. Appearance of IMP-1 metallo-β-lactamase in Europe. The Lancet, 1999; 353 (9156): 899-900.
GALES AC, et al. Emergence of an IMP-like metallo-enzyme in an Acinetobacter baumannii clinical strain from a Brazilian teaching hospital. Diagnostic microbiology and infectious disease, 2003; 45 (1): 77-79.
KANG SJ, et al. Metallo-β-lactamase inhibitors: A continuing challenge for combating antibiotic resistance. Biophysical Chemistry, 2024; 309: 107228.
LI Q, et al. Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention–a comprehensive review. Frontiers in Public Health, 2024; 12: 1376513.
LIMA AVA, et al. Occurrence and diversity of intra-and interhospital drug-resistant and biofilm-forming Acinetobacter baumannii and Pseudomonas aeruginosa. Microbial Drug Resistance, 2020; 26 (7): 802-814.
LUCIDI M, et al. Pathogenicity and virulence of Acinetobacter baumannii: Factors contributing to the fitness in healthcare settings and the infected host. Virulence, 2024; 15 (1): 2289769.
MATSUMURA Y, et al. Global molecular epidemiology of IMP-producing Enterobacteriaceae. Antimicrobial agents and chemotherapy, 2017; 61 (4): 10.1128/aac. 02729-16.
MOHAPATRA SS, et al. Polymyxins, the last-resort antibiotics: Mode of action, resistance emergence, and potential solutions. Journal of Biosciences, 2021; 46 (3): 85.
NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION. Pathogen Detection. Disponível em: https://www.ncbi.nlm.nih.gov/pathogens/isolates/. Acessado em: 12 de julho de 2024.
NAAS T, et al. Beta-lactamase database (BLDB)–structure and function. Journal of enzyme inhibition and medicinal chemistry, 2017; 32 (1): 917-919.
PARIENTE N, PLOS BIOLOGY STAFF EDITORS. The antimicrobial resistance crisis needs action now. PLoS biology, 2022; 20 (11): e3001918.
PELLEGRINO FLPC, et al. Occurrence of a multidrug-resistant Pseudomonas aeruginosa clone in different hospitals in Rio de Janeiro, Brazil. Journal of Clinical Microbiology, 2002; 40 (7): 2420-2424.
POTRON A, et al. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: mechanisms and epidemiology. International journal of antimicrobial agents, 2015; 45 (6): 568-585.
RAMIREZ MS, et al. Carbapenemases: transforming Acinetobacter baumannii into a yet more dangerous menace. Biomolecules, 2020; 10 (5): 720.
ROBERTS JA, et al. Meropenem dosing in critically ill patients with sepsis and without renal dysfunction: intermittent bolus versus continuous administration? Monte Carlo dosing simulations and subcutaneous tissue distribution. Journal of antimicrobial chemotherapy, 2009; 64 (1): 142-150.
SABATH LD, ABRAHAM EP. Zinc as a cofactor for cephalosporinase from Bacillus cereus 569. Biochemical Journal, 1966; 98 (1): 11C.
SAVOLDI A, et al. The role of combination therapy in the treatment of severe infections caused by carbapenem resistant gram-negatives: a systematic review of clinical studies. BMC Infectious Diseases, 2021; 21 (1): 545.
TANG KWK, et al. Antimicrobial resistance (AMR). British Journal of Biomedical Science, 2023; 80: 11387.
TAVARES LCB, et al. Genomic and clinical characterization of IMP-1-producing multidrug-resistant Acinetobacter bereziniae isolates from bloodstream infections in a Brazilian tertiary hospital. Microbial Drug Resistance, 2020; 26 (11): 1399-1404.
TOLEMAN MA, et al. Molecular characterization of SPM-1, a novel metallo-β-lactamase isolated in Latin America: report from the SENTRY antimicrobial surveillance programme. Journal of Antimicrobial Chemotherapy, 2002; 50 (5): 673-679.
UDDIN TM, et al. Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects. Journal of infection and public health, 2021; 14 (12): 1750-1766.
WINTERSDORFF CJH, et al. Dissemination of antimicrobial resistance in microbial ecosystems through horizontal gene transfer. Frontiers in microbiology, 2016; 7: 173.
WATANABE M, et al. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrobial agents and chemotherapy, 1991; 35 (1): 147-151.
WHO - World Health Organization. Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: WHO, 2024: 72.
ZHANG J, et al. The combination effect of meropenem/sulbactam/polymyxin-B on the pharmacodynamic parameters for mutant selection windows against carbapenem-resistant Acinetobacter baumannii. Frontiers in Microbiology, 2022; 13: 1024702.