Multidrug-Resistant Bacteria in Immunocompromised Patients
Abstract
:1. Introduction
2. Materials and Methods
3. Colonization and Infection with MDR Bacteria in ICU Patients
4. Colonization and Infection with MDR Bacteria in HIV-Positive Patients
5. Colonization and Infection with MDR Bacteria in Cancer Patients
6. Research Gaps, Future Directions in Research on Multidrug-Resistant Bacteria Infection versus Colonization in Immunocompromised Patients
7. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Group Study | Colonization with MDR Bacteria | Infection with MDR Bacteria | Resistance Pattern | Risk Factors for Colonization/Infection | Study |
---|---|---|---|---|---|
ICU patients | E. coli (57%) K. pneumoniae (16%) C. freundii (7%) E. cloacae (6%) K. aerogenes (5%) | - | ESBL-producing E. coli and other ESBL producers (76%) Derepressed ampC producers (15%) | Liver cirrhosis Previous MDR-GNB carriage Digestive surgery in the last year Length of hospital stay | Fernandez-Martinez et al. (2022) [21] |
ICU patients | VRE (16%) K. pneumoniae (3%) | - | VanA (81%) OXA-48 NDM | - | Karașin et al. (2021) [22] |
ICU patients | - | A. baumannii (35.5%) K. pneumoniae (20.6%) Enterococcus spp. (13%) P. aeruginosa (11.5%) S. aureus (8%) E. coli (6.9%) | MDR (12.5%) XDR (49.2%) PDR (1.2%) | - | Routsi et al. (2020) [23] |
ICU patients | 39.04% colonized with Gram-negative bacteria 7.61% colonized with Gram-positive bacteria 2.61% colonized with both | 45.20% with MDR colonization developed sepsis 32.07% with XDR colonization developed an infection | MDR (43.71%) XDR (31.73%) | ICU length of stay Use of external ventricular drainage and intracerebral pressure-monitoring catheters | Munari et al. (2022) [24] |
ICU patients | 51.85% colonized by carbapenem-resistant A. baumannii and/or carbapenem-resistant K. pneumoniae | - | Carbapenem resistance | Longer ICU stay Extended periods of mechanical ventilation Strong statistical association between prior colonization and the subsequent development of infection | Ceccarelli et al. (2022) [25] |
ICU patients | 68.8% colonized with one bacterial strain—E. coli, Klebsiella spp., S. aureus and E. faecium 24.5% colonized with 2 different bacterial strains—Klebsiella spp. and E. faecium 5.7% colonized with 3 different bacterial strains | - | ESBL producers (75.5%) Carbapenemase producers (32.1%) MRSA (11.3%) VRE (3.8%) | Carmeli score = 3 Previous exposure to antibiotics and hospitalization in the past 6 months | Vlad et al. (2023) [26] |
ICU patients | 28%—carbapenem-resistant K. pneumoniae | 45.9%—subsequent infection with carbapenem-resistant K. pneumoniae | Carbapenem resistance | - | Qin et al. (2020) [27] |
ICU patients | Carbapenemase-producing Enterobacterales 66.2% were colonized upon ICU admission 33.8% acquired them during their ICU stay | - | Carbapenemase producers 89.6% KPC | ICU length of stay Open wounds The presence of catheters or tubes Antibiotic treatment | Kim et al. (2023) [28] |
ICU patients | - | K. pneumoniae (21%) P. aeruginosa (11.8%) S. aureus (13.2%) | 85.1% MDR 28.6% XDR 4.6% PDR | Advanced age (>75 years old) Male gender | Wani et al. (2021) [29] |
Neonatal ICU patients | 43% colonized with K. pneumoniae, Acinetobacter spp., E. coli and C. freundii | Bacteremia (34.5%) with GNB (85.5%) | Resistance to third-generation cephalosporins | Cyanosis, jaundice, number of invasive devices and contaminated cots were associated with GNB bacteremia | Silago et al. (2020) [30] |
ICU patients | 54.54%—fecal carriage of ESBL-producing Enterobacterales 9.32%—nasal carriage of MRSA | - | ESBL producers MRSA | Hospitalization for two or more days before ICU admission Antibiotic use prior to ICU admission (not statistically significant) | Manyahi et al. (2022) [31] |
ICU patients | - | 56%—GNB infections E. coli (33.3%) K. pneumoniae (31.1%) P. aeruginosa (14.4%) | 92% MDR Third-generation cephalosporins resistance Carbapenem resistance Colistin resistance | Previous use of antibiotics Use of nasogastric tube Respiratory and cardiovascular-associated conditions | Maina et al. (2023) [32] |
ICU patients | - | A. baumannii (25.4%) Acinetobacter spp. (14.3%) K. pneumoniae (13.2%) P. aeruginosa (9.6%) S. aureus (8.7%) | Carbapenem resistance—all strains of Acinetobacter and P. aeruginosa MRSA (100%) K. pneumoniae—76% ESBL and 22% KPC | Advanced age Use of orotracheal tube High blood pressure, cardiac and pulmonary diseases, chronic kidney disease | Martins et al. (2024) [33] |
ICU patients | - | 62% had at least one MDR isolate: carbapenem-resistant A. baumannii and P. aeruginosa, carbapenem-resistant K. pneumoniae, MRSA and other carbapenem-resistant Enterobacterales | Carbapenem resistance MRSA | - | Oliveira et al. (2023) [34] |
ICU patients | - | P. aeruginosa (30.17%) K. pneumoniae (20.12%) E. coli (16.05%) | ESBL producers Carbapenemase producers | - | Uc-Cachón et al. (2019) [35] |
ICU patients | 33% were colonized with at least one MDR bacteria: 28% were colonized with VRE 6% were colonized with MRSA 3% were colonized with ESBL-producing Enterobacterales | Infections occurred in 58% of patients, with 42% of these cases being ICU-acquired, and 12% developed infections with MDR bacteria | ESBL producers VRE MRSA | - | Kim et al. (2023) [36] |
ICU patients (Barcelona cohort + Frankfurt cohort) | Barcelona cohort—32.7% were colonized by MDR bacteria, with 64.2% at admission and 35.8% during follow-up Frankfurt cohort—47% were colonized by MDR bacteria, with 66.2% at admission and 33.8% during follow-up | - | Barcelona cohort—ESBL-producing Enterobacterales Frankfurt cohort—VRE | - | Prado et al. (2022) [37] |
ICU patients | - | 69.6%—hospital-acquired infections (bacteremia) K. pneumoniae (23.8%) coagulase-negative staphylococci (17.9%) A. baumannii (11%) S. aureus (8.9%) | 70% MDR ESBL producers (33.1%) MRSA (7%) CRE (4.2%) VRE (1.6%) | - | El-Sokkary et al. (2021) [38] |
ICU patients | - | P. aeruginosa | Carbapenemase producers (35%): VIM (54%) GES (27%) IMP (7%) NDM (5%) | - | Gill et al. (2022) [39] |
Group Study | Colonization with MDR Bacteria | Infection with MDR Bacteria | Resistance Pattern | Risk Factors for Colonization/Infection | Study |
---|---|---|---|---|---|
HIV-positive patients | 32.6% colonized with ESBL-producing Enterobacterales: E. coli (85.7%) K. pneumoniae (13.5%) E. cloacae (0.8%) | - | ESBL producers 97.5%—blaCTX-M genes (92%—blaCTX-M-15 gene) | Low CD4+ count (<350/mL) | Manyahi et al. (2020) [47] |
HIV-positive patients | 6.8% colonized with S. aureus 33.1% colonized with ESBL-producing Enterobacterales: E. coli (63.7%) K. pneumoniae (10.4%) | - | MRSA (59.5%) ESBL producers | History of antibiotic use in the last month | Msanga et al. (2022) [48] |
HIV-positive patients | 81.08% colonized with MDR Enterobacterales, of which 40.67% were colonized with two or more MDR strains E. coli (78.49%) K. pneumoniae (5.91%) | - | ESBL producers (33.26%) blaTEM (62.9%) blaCTX-M (40.86%) blaSHV (10.57%) | - | Dimani et al. (2023) [49] |
HIV-positive patients | 30.83% colonized with Enterobacterales: E. coli (56%) K. pneumoniae (20%) | - | ESBL producers (48%) blaCTX-M gene (48%) blaTEM gene (72%) | - | Zemtsa et al. (2022) [50] |
HIV-positive patients | - | Lower respiratory tract infections: K. pneumoniae (25.37%) H. influenzae (20.9%) E. coli (17.91%) | ESBL producers (43.39%) blaCTX-M gene (47.83%) blaTEM gene (8.6%) both genes (43.48%) | CD4+ count < 200 cells/μL | Maharjan et al. (2022) [52] |
HIV-positive patients | 61.5% colonized with Enterococcus spp. | - | MDR (49.59%) VRE (11.4%) | Previous exposure to antibiotics for more than two weeks Hospitalization for more than six months | Regasa et al. (2021) [53] |
HIV-positive patients | 56% colonized with Enterococcus spp. | - | MDR (87.4%) VRE (13.7%) | Previous exposure to antibiotics Previous hospitalization | Zike et al. (2024) [54] |
HIV-positive patients | 8.85% colonized with Enterococcus spp. | - | MDR (82.35%) VRE (47.05%) | Previous exposure to antibiotics Previous hospitalization | Tilahun et al. (2023) [55] |
HIV-positive patients | - | The prevalence of MDR bacteria was higher in HIV-positive patients (21.5%) compared to HIV-negative patients (16.5%). The most common species isolated were E. coli (58.5%), K. pneumoniae (15.7%) and P. mirabilis (7.5%) | MDR (16.6%) Increased rate of resistance to penicillins, combinations of penicillins with beta-lactamase inhibitors and sulfonamides | - | Henderson et al. (2022) [56] |
HIV-positive patients | - | 1.6%—infections with MDR Enterobacterales | MDR | Nadir CD4 cell count ≤ 200 cells/mm3 A history of an AIDS-defining clinical condition Hospital admission in the prior 12 months | Henderson et al. (2022) [57] |
HIV-positive patients | S. aureus nasal carriage was 15.18% with 60.08% of the S. aureus isolates exhibiting multidrug resistance | - | MRSA | A history of respiratory tract infections | He et al. (2021) [58] |
HIV-positive patients | 3.4% colonized with MRSA | - | MRSA | Cancer Antibiotic use within the past year | Hsu et al. (2020) [59] |
HIV-positive patients | Lower prevalence of MRSA nasal colonization—3.5% (7 out of 200) of the HIV-positive cohort and 5% (10 out of 200) of the control cohort | - | MRSA | No significant difference in MRSA nasal colonization between HIV-positive people and healthy controls | Kapali et al. (2021) [60] |
HIV-positive patients | Prevalence of S. aureus and MRSA carriage among children with HIV was 44.9% and 5.6%, respectively, compared to 23.4% and 0.9% in the control group | - | MRSA | HIV infection is a risk factor for S. aureus colonization among children, though it may not be a risk factor for MRSA colonization The absence of colonization with coagulase-negative staphylococci is a risk factor for S. aureus colonization | Donkor et al. (2019) [61] |
HIV-positive patients | Colonization rates for S. aureus and MRSA were 61.7% and 28.2%, respectively | - | MRSA | CD4 count below 200 Being on HAART for 5 years or less | Muhaba et al. (2022) [62] |
Group Study | Colonization with MDR Bacteria | Infection with MDR Bacteria | Resistance Pattern | Risk Factors for Colonization/Infection | Study |
---|---|---|---|---|---|
Cancer patients | - | E. coli (71.8%) Klebsiella spp. (22.3%) Proteus spp. (2.9%) | All isolates were MDR and 60% of them were carbapenem-resistant 31.7% were MBL-positive | - | Zare et al. (2019) [69] |
Cancer patients | - | 65% invasive infections with GNB E. coli (45.6%) P. aeruginosa (7.5%) A. baumannii (4%) | ESBL producers (79.6%) | - | Haddad et al. (2021) [70] |
Cancer patients | 18.9% were colonized with ESBL-producing Enterobacterales 14.92% were colonized with carbapenem-resistant Enterobacterales | Bloodstream infections occurred in 29 cases (14.42%) GNB bacteremia was observed in 8 of the 38 (21.05%) patients colonized with ESBL-producing Enterobacterales and 4 of the 30 (13.33%) patients colonized with carbapenem-resistant Enterobacterales | ESBL producers Carbapenem resistance | Previous use of quinolones was identified as the only independent risk factor for intestinal colonization with MDR Enterobacterales | Alrstom et al. (2021) [71] |
Cancer patients | - | 34.5%—K. pneumoniae ESBL producers 11.46%—E. coli ESBL producers 32.8%—P. aeruginosa resistant to imipenem and/or ceftazidime 20.75%—MRSA | ESBL producers MRSA Carbapenem resistance | - | Mechergui et al. (2019) [72] |
Cancer patients | 6.56%—intestinal colonization with carbapenem-resistant Enterobacterales 71.43%—K. pneumoniae 28.57%—E. coli | 14.29% developed invasive infections with carbapenem-resistant Enterobacterales | Carbapenem resistance | Age Use of cephalosporins, penicillins, tigecyclines Hematopoietic stem cell transplantation status | Zhu et al. (2022) [73] |
Cancer patients | 10.3% were colonized with carbapenem-resistant Enterobacterales 50%—K. pneumoniae 27.8%—E. coli 9.3%—E. cloacae | 18.4% developed subsequent infections 55.6%—K. pneumoniae 33.3%—E. coli 11.2%—other species | Carbapenem resistance | Use of proton-pump inhibitors and admission to the ICU increased the risk of subsequent CRE infection in patients colonized with CRE with hematologic malignancies | Chen et al. (2023) [74] |
Cancer patients | 14% of patients were colonized with MDR bacteria before infection 20% were colonized upon hospital admission | K. pneumoniae (37%) MRSA (24%) A. baumannii (21%) P. aeruginosa (5%) E. coli (4%) VRE (3%) | ESBL producers Carbapenem resistance MRSA VRE | - | Perdikouri et al. (2019) [75] |
Cancer patients | 23.8% were colonized with VRE | 3% of those with intestinal VRE colonization developed an infection caused by VRE | VRE | - | Chhatwal et al. (2020) [76] |
Cancer patients | 8.1% were colonized with MDR bacteria 79.2% Enterobacterales 16.7% VRE | - | ESBL producers VRE | MDR bacterial colonization is considered an independent risk factor for impaired overall survival of patients with NSCLC | Stratmann et al. (2020) [77] |
Cancer patients | 74.4%—VRE 20%—ESBL-producing Enterobacterales 13.3%—Carbapenem-resistant Enterobacterales 2.2%—MRSA | - | ESBL producers Carbapenem resistance VRE MRSA | Colonized patients experienced significantly more days with fever, spent more time in the intensive care unit and had higher median C-reactive protein levels during their hospital stay | Ballo et al. (2019) [78] |
Cancer patients | - | Bloodstream infections with GNB E. coli (52.7%) K. pneumoniae (19.2%) P. aeruginosa (14.6%) E. cloacae (3.7%) A. baumannii (1.7%) Stenotrophomonas maltophilia (1.7%) | 30.7% MDR | MDR GNB bloodstream infections and chronic renal failure were identified as independent risk factors for 30-day mortality | Trecarichi et al. (2023) [79] |
Cancer patients | P. aeruginosa | P. aeruginosa | MDR | Diabetes mellitus Previous colonization with MDR P. aeruginosa Prior receipt of antibiotics Septic shock These acted as risk factors for developing infections with MDR P. aeruginosa | Hernández-Jiménez et al. (2022) [80] |
Cancer patients | 40.4% were colonized with ESBL-producing Enterobacterales 8.8% were colonized with CRE | Bacteremia with ESBL-producing Enterobacterales occurred in 2 (8.6%) of the patients colonized with ESBL-producing Enterobacterales, and CRE bacteremia was detected in 1 (20%) of the patients colonized with CRE | ESBL producers Carbapenem resistance | Underlying acute myeloid leukemia Prior chemotherapy Use of beta-lactam antibiotics, quinolones or other antibiotics within the last three months Recent hospitalization history | Kömürcü et al. (2020) [81] |
Cancer patients | 19.6% were colonized with carbapenem-resistant GNB or VRE | - | Carbapenem resistance VRE | - | Junior et al. (2023) [82] |
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Duhaniuc, A.; Păduraru, D.; Nastase, E.-V.; Trofin, F.; Iancu, L.-S.; Sima, C.-M.; Dorneanu, O.-S. Multidrug-Resistant Bacteria in Immunocompromised Patients. Pharmaceuticals 2024, 17, 1151. https://doi.org/10.3390/ph17091151
Duhaniuc A, Păduraru D, Nastase E-V, Trofin F, Iancu L-S, Sima C-M, Dorneanu O-S. Multidrug-Resistant Bacteria in Immunocompromised Patients. Pharmaceuticals. 2024; 17(9):1151. https://doi.org/10.3390/ph17091151
Chicago/Turabian StyleDuhaniuc, Alexandru, Diana Păduraru, Eduard-Vasile Nastase, Felicia Trofin, Luminița-Smaranda Iancu, Cristina-Mihaela Sima, and Olivia-Simona Dorneanu. 2024. "Multidrug-Resistant Bacteria in Immunocompromised Patients" Pharmaceuticals 17, no. 9: 1151. https://doi.org/10.3390/ph17091151