scholarly journals Meta-analysis of Outcomes Using Ceftolozane-Tazobactam and Ceftazidime-Avibactam for Multidrug-Resistant Organism Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s316-s316
Author(s):  
Geneva Wilson ◽  
Margaret Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Charlesnika Evans
Keyword(s):  
Success Rate ◽  
Clinical Experience ◽  
Salvage Therapy ◽  
Clinical Success ◽  
Infection Type ◽  
Clinical Success Rate ◽  
Multidrug Resistant ◽  
Solid Organ ◽  
Success Rates ◽  
Tract Infections

Background: Ceftolozane-tazobactam (C/T) and ceftazidime-avibactam (C/A) are new β-lactam/β-lactamase combination antibiotics that were approved by the FDA in 2014 and 2015, respectively, to treat complicated intra-abdominal and urinary tract infections. They are commonly used to treat multidrug-resistant Pseudomonas aeruginosa (MDRPA) and carbapenem-resistant Enterobacteriaceae (CRE) infections at any site. Both medications are also often used as salvage therapy when empiric therapy has failed or when the infectious organism tests resistant to all other available antibiotics. The purpose of this review is to present the clinical experience and reported clinical success rates of C/T and C/A. Methods: PubMed, EMBASE, and Google Scholar were searched from January 1, 2013, through October 1, 2019, for publications detailing clinical experience with C/T and C/A in patients with CRE and MDRPA infections. Included study designs were extended cases series and clinical observational studies. Information on infection type, bacterial agent, salvage therapy uses, clinical success, and resistance development during treatment were abstracted. Meta-regression analysis was used to determine the pooled effectiveness of C/T and C/A among included studies. Results: The literature search returned 1,645 publications. After exclusion criteria were applied, 16 publications representing 769 patients were retained. The study population was mostly male (pooled average, 62%). The major comorbidities represented in the pooled population were solid organ transplantation (20.0%), kidney disease (19.5%), cardiovascular disease (15.3%), and diabetes (15.3%). Pneumonia was the predominant infection type (41.4%) and MDRPA was the pathogen most frequently evaluated (57.7%). The pooled clinical success rate was 70.2% (95% CI, 64.5%–75.3%). Also, 10 studies explicitly evaluated C/A or C/T as salvage therapy. The pooled clinical success rate for salvage therapy studies was 75.2% (95% CI, 69.7%–80.0%). Development of resistance to C/T or C/A during or after treatment was reported for 2.0% of the population. Conclusion: Overall, these medications have a high clinical success rate in patients with severe and complicated infections and limited treatment options. Pooled clinical success rates were high (70.2%) and the medications were particularly effective as salvage therapy. Resistance rates were low, although this could have been biased by the small percentage of studies that reported on this outcome. More longitudinal studies comparing the effectiveness of C/T and C/A against other antibiotic regimens are needed.Funding: NoneDisclosures: None

scholarly journals Meta-analysis of Clinical Outcomes Using Ceftazidime/Avibactam, Ceftolozane/ Tazobactam, and Meropenem/ Vaborbactam for the Treatment of Multidrug Resistant Gram-Negative Infections

2021 ◽  
Author(s):  
Geneva Wilson ◽  
Margaret Fitzpatrick ◽  
Kyle Walding ◽  
Beverly Gonzalez ◽  
Marin L Schweizer ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Infection Type ◽  
Meta Analysis ◽  
Treatment Options ◽  
Clinical Success Rate ◽  
Multidrug Resistant ◽  
Success Rates ◽  
Beta Lactam ◽  
Review Reports

Abstract Ceftolozane-tazobactam (C/T), Ceftazidime-avibactam (C/A), and Meropenem/vaborbactam (M/V) are new beta-lactam/beta-lactamase combination antibiotics commonly used to treat multi-drug resistant Pseudomonas aeruginosa (MDRPA) and carbapenem-resistant Enterobacteriaceae (CRE) infections. This review reports the clinical success rates for C/T, C/A., and M/V. PubMed and EMBASE were searched from January 1 st, 2012 through September 2 nd, 2020 for publications detailing use of C/T, C/A, and M/V. Meta-analysis determined the pooled effectiveness of C/T, C/A, and M/V. The literature search returned 1,950 publications, 29 publications representing 1,620 patients were retained. Pneumonia was the predominant infection type (49.8%). MDRPA was the major pathogen treated (65.3%). The pooled clinical success rate was 73.3% (95% CI 68.9%-77.5%). C/T, C/A, or M/V resistance was reported in 8.9% of the population. These antibiotics had a high clinical success rate in patients with complicated infections and limited treatment options. Larger studies comparing C/T, C/A, and M/V against other antibiotic regimens are needed.

Lower Respiratory Tract Infections Treated with Bacampicillin: A Dose Comparison

1977 ◽  
Vol 5 (5) ◽  
pp. 313-321 ◽  
Author(s):  
J Sjövall
Keyword(s):  
Success Rate ◽  
Chronic Bronchitis ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Success Rates ◽  
Dose Comparison ◽  
Number Of Patients ◽  
Acute Exacerbations ◽  
Tract Infections

In an open multicentre study of bacampicillin (Penglobe®), a new orally well absorbed prodrug of ampicillin, 516 patients with acute exacerbations of chronic bronchitis or pneumonia were treated by a group of Belgian pneumologists or internists. Bacampicillin was given in a dosage regimen of 400 mg or 800 mg three times daily. In patients with acute exacerbations of chronic bronchitis the clinical success rate was high, over 95% in both groups. A n improvement in the sputum purulence score was seen in 93% of the patients with an initially purulent sputum and 69% had a normal mucoid sputum at follow-up. The clinical success rate in patients with pneumonia was also similar in both dosage groups with success rates over 96%. The total number of patients with adverse reactions was not more than 5·4%, of which the majority were considered mild or moderate. Each type of side-effect occurred in a frequency of 1·2% or less. There were no differences between the two dosage regimens as regards the frequency of side-effects which indicates a remarkably good tolerance of bacampicillin also with the higher dosage.

scholarly journals 2263. Fosfomycin Trometerol Use for Complicated UTIs Including Pyelonephritis, a 1-year Review of Outcomes and Prescribing Habits

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S774-S775
Author(s):  
Timothy J Hatlen ◽  
Richard Flor ◽  
Megan Nguyen ◽  
Loren G Miller
Keyword(s):  
Los Angeles ◽  
Clinical Success ◽  
Multidrug Resistant ◽  
Pharmacokinetic Data ◽  
Oral Antibiotic ◽  
Success Rates ◽  
E Coli ◽  
Upper Tract ◽  
Predominant Pathogen ◽  
Tract Infections

Abstract Background Treatment of complicated urinary tract infections (UTI) caused by multidrug-resistant organisms (MDROs) is increasingly problematic given limited oral antibiotic options. In these situations, fosfomycin is increasingly used. However, there are limited outcome and pharmacokinetic data to support fosfomycin use for complicated UTIs (cUTI), especially in the upper tract. We describe fosfomycin use for complicated cUTI in our healthcare system. Methods We performed a retrospective review of all fosfomycin prescriptions between 1/1-December 31/17 in the Los Angeles Department of Health Service system, which consists of 4 medical centers and 19 clinics that provide care to >600,000 patients annually. In our system, fosfomycin use requires ID approval. We collected demographics, clinical characteristics, adverse effects, and 30-day success rates. Subsequent urine cultures up to December 31/18 were examined for fosfomycin susceptibility. Results A total of 156 patients received fosfomycin; 21 (13%) had lower UTI, 39 (25%) had lower tract cUTI, 24 (15%) had upper tract not pyelonephritis, and 37 (24%) had pyelonephritis. The majority (n = 98, 63%) were female, 82 (53%) had urological or functional abnormalities, 67 (43%) had diabetes, 26 (17%) were immunocompromised and most (n = 135, 87%) presented from the community. E.coli was the predominant pathogen (n = 123, 79%), 112 (91%) of these produced ESBL. For cUTI (n = 100), dosing interval was q24h (3%), q48h (51%) and q72h (46%). Among patients with 30-day outcomes (n = 100, 64%), success was seen in 84 (84%), and was 79% (14/64) among those with cUTI. Failure was associated with male gender (p = 0.005), urological abnormalities (p = 0.047), and non-E. coli UTIs (p = 0.03). Only 1 adverse effect at 30 days was described. Fosfomycin-resistant E. coli were found in 9/64 (14%) of patients with follow-up urine cultures > 30 days after initial treatment (mean 5.7 ± 4.03 mo.). Conclusion Despite the lack of data supporting its use, we found that most patients receiving fosfomycin for complicated upper UTIs had clinical success. However, emergence of subsequent resistance warrants caution. Further studies should be done to better understand optimal use of fosfomycin for complicated UTIs. Disclosures All authors: No reported disclosures.

First experience of efficacy and radiation exposure in 320-detector row CT fluoroscopy-guided interventions

2021 ◽  
pp. 20200754
Author(s):  
Shota Yamamoto ◽  
Tomohiro Matsumoto ◽  
Satoshi Suda ◽  
Kosuke Tomita ◽  
Shunsuke Kamei ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Success Rate ◽  
Dose Reduction ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Total Radiation ◽  
Success Rates ◽  
Technical Success ◽  
Total Radiation Dose ◽  
Interventional Ct

Objective: We investigated the efficacy and exposure to radiation in 320-detector row computed tomography fluoroscopy-guided (CTF-guided) interventions. Methods: We analysed 231 320-detector row CTF-guided interventions (207 patients over 2 years and 6 months) in terms of technical success rates, clinical success rates, complications, scanner settings, overall radiation doses (dose–length product, mGy*cm), patient doses of peri-interventional CT series, and interventional CT (including CTF), as a retrospective cohort study. The relationships between patient radiation dose and interventional factors were assessed using multivariate analysis. Results: Overall technical success rate was 98.7% (228/231). The technical success rates of biopsies, drainages, and aspirations were 98.7% (154/156), 98.5% (66/67), and 100% (8/8), respectively. The clinical success rate of biopsies was 93.5% (146/156). All three major complications occurred in chest biopsies. The median total radiation dose was 522.4 (393.4–819.8) mGy*cm. Of the total radiation dose, 87% was applied during the pre- and post-interventional CT series. Post-interventional CT accounted for 24.4% of the total radiation dose. Only 11.4% of the dose was applied by CTF-guided intervention. Multilinear regression demonstrated that male sex, body mass index, drainage, intervention time, and helical scan as post-interventional CT were significantly associated with higher dose. Conclusion: The 320-detector row CTF interventions achieved a high success rate. Dose reduction in post-interventional CT provides patient dose reduction without decreasing the technical success rates. Advances in knowledge: This is the first study on the relationship between various interventional outcomes and patient exposure to radiation in 320-detector row CTF-guided interventions, suggesting a new perspective on dose reduction.

scholarly journals Outcomes of EUS-guided choledochoduodenostomy as primary drainage for distal biliary obstruction with covered self-expandable metallic stents

2020 ◽  
Vol 08 (07) ◽  
pp. E861-E868
Author(s):  
Naosuke Kuraoka ◽  
Kazuo Hara ◽  
Nozomi Okuno ◽  
Takamichi Kuwahara ◽  
Nobumasa Mizuno ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Cancer Center ◽  
Biliary Duct ◽  
Metallic Stent ◽  
Success Rates ◽  
Stent Patency ◽  
Technical Success Rate ◽  
Drainage Technique

Abstract Background and study aims Endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) is an alternative therapy for percutaneous transhepatic biliary drainage. Outcomes of EUS-CDS for distal biliary tract obstruction with a covered self-expandable metallic stent (SEMS) as a primary drainage technique are unclear because there are few relevant reports. This study aimed to determine outcomes in patients undergoing EUS-CDS using SEMS as the primary drainage technique for malignant distal biliary duct obstruction. Patients and methods This retrospective study was conducted at Aichi Cancer Center Hospital, from January 2010 to July 2018, using data from our database. Results EUS-CDS was performed as a primary drainage technique for 92 patients. The technical success rate was 92.8 %, and the clinical success rate was 91.6 %. The overall incidence of adverse events was 15.7 %. The median stent patency time for the EUS-CDS was 396 days. Nineteen patients required re-intervention because of cholangitis or jaundice. Conclusion EUS-CDS as a primary drainage technique using SEMS has high technical and clinical success rates. It should be considered an effective drainage method with respect to long-term stent patency, low re-intervention rates, and absence of severe complications.

scholarly journals Clinical Feasibility and Safety of Endoscopic Self-Expandable Metal Stent Placement for Upper Gastrointestinal Pathologies

2019 ◽  
Vol 103 (11-12) ◽  
pp. 605-612
Author(s):  
Bünyamin Gürbulak ◽  
Esin Kabul Gürbulak ◽  
Hasan Bektaş ◽  
İsmail Ethem Akgün ◽  
Hızır Yakup Akyildiz ◽  
...  
Keyword(s):  
Success Rate ◽  
Stent Placement ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Endoscopic Stenting ◽  
Covered Stents ◽  
Success Rates ◽  
Endoscopic Stent ◽  
Technical Success Rate ◽  
Upper Gastrointestinal

We aimed to review our experiences to evaluate the practicality, safety, and effectiveness of endoscopic stent placement for the palliation of malignant obstructions of the upper gastrointestinal system (GIS) and the treatment of postoperative complications such as failure of anastomoses and fistulae. Endoscopic stent placement is increasingly used in the upper GIS for the management of both high grade malignancies causing obstruction and benign pathologies such as anastomosis failures, gastrointestinal fistulae, and strictures. Hospital records, clinical data, and endoscopy reports of 61 patients who had undergone endoscopic stenting between the years 2012 and 2015 were analyzed retrospectively. For all patients, self-expandable metal covered stents were used. Data involving technical and clinical success rates, complication, morbidity, and mortality rates of the endoscopic stenting procedure was collected and simple statistical analyses were made. Endoscopic stenting was successful in 60 of 61 patients (98.3%). Overall technical success rate was found to be 98.3%; clinical success rate, 86.6%; complication rate, 4.9%. No stent related mortality was observed in our series. Endoscopic stents can be effectively and safely used in the treatment of various lesions of the upper GIS.

scholarly journals CT-Guided Transhepatic Catheter Drainage of Deep Postoperative Collections: Initial Experience

2021 ◽  
Author(s):  
Akhil Baby ◽  
Danny Joy ◽  
Nihar R. Dash ◽  
Sujoy Pal ◽  
Deep N. Srivastava ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Patient Positioning ◽  
Success Rates ◽  
Catheter Drainage ◽  
Drainage Procedure ◽  
Ct Guided ◽  
Technical Success Rate ◽  
Transhepatic Drainage

Abstract Introduction This article assesses the safety and utility of transhepatic drainage of deep seated postoperative intra-abdominal collections under computed tomography (CT) guidance in a short series. Materials and Methods This retrospective study included five patients (mean age: 45.8 years; 3 males, 2 females) who underwent CT-guided transhepatic drainage of postoperative abdominal abscess in our department between April 2019 and December 2020. The clinical and surgical details and the details of the transhepatic drainage procedure were evaluated along with success rates and complications. Results The surgical procedures were Whipple's pancreaticoduodenectomy in four patients and gastrectomy in one patient. Four out of five abscesses were drained through the right lobe of liver, while one was through the left lobe with a technical success rate of 100%. The mean total time for catheter drainage procedure including patient positioning and preparation was 29.2 minutes. None of the patients had procedure-related complications. Mean duration of catheter drainage was 12 days. All patients had complete resolution of symptoms after drainage and the clinical success rate was 100%. Conclusion Transhepatic approach is safe and effective for the drainage of inaccessible postoperative abdominal collections or abscesses where a standard percutaneous approach is not possible.

Impact of peritoneal carcinomatosis on clinical outcomes of patients receiving self-expandable metal stents for malignant colorectal obstruction

Endoscopy ◽  
2018 ◽  
Vol 50 (12) ◽  
pp. 1163-1174 ◽  
Author(s):  
Jae Park ◽  
Kwangwon Rhee ◽  
Jin Yoon ◽  
Soo Park ◽  
Joo Kim ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Success Rate ◽  
Clinical Outcomes ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Metal Stents ◽  
Independent Factor ◽  
Success Rates ◽  
Colorectal Obstruction ◽  
Technical Success Rate

Abstract Background Peritoneal carcinomatosis can influence clinical outcomes of patients receiving self-expandable metal stents (SEMS) for malignant colorectal obstruction, but data regarding this issue are sparse. We analyzed the clinical outcomes of post-SEMS insertion for malignant colorectal obstruction based on carcinomatosis status. Methods Stent- and patient-related clinical outcomes were compared for carcinomatosis status in a retrospective review involving 323 consecutive patients (colorectal cancer 198 patients; extracolonic malignancy 125 patients) who underwent palliative SEMS placement for malignant colorectal obstruction from January 2005 to March 2012. Severity of carcinomatosis was classified as mild, moderate, or severe. Results Carcinomatosis was observed in 190 patients (58.8 %). The rates of technical (84.7 vs. 94.7 %; P = 0.005) and clinical (73.2 vs. 83.5 %; P = 0.03) success were lower in patients with vs. without carcinomatosis. Rates of early (2.1 % vs. 3.0 %; P = 0.72) and delayed (1.6 % vs. 6.0 %; P = 0.08) perforation and stent failure (27.9 % vs. 26.3 %; P = 0.75) showed no difference. Technical and clinical success rates were significantly different based on the severity of carcinomatosis (technical success rate: mild 90.7 %, moderate 97.4 %, severe 76.3 %, P = 0.003; clinical success rate: mild 83.3 %, moderate 82.1 %, severe 63.9 %, P = 0.01). In multivariate analysis, severe carcinomatosis was identified as an independent factor related to technical (odds ratio [OR] 0.18, 95 % confidence interval [CI] 0.06 – 0.56) and clinical (OR 0.33, 95 %CI 0.15 – 0.74) success. Conclusions Peritoneal carcinomatosis was associated with decreased technical and clinical success rates in patients receiving SEMS for malignant colorectal obstruction. Moreover, the presence of severe carcinomatosis was an independent factor determining these clinical outcomes.

scholarly journals Review of follow-up of clinical success of implant-supported complete dental prostheses

2014 ◽  
Vol 62 (3) ◽  
pp. 261-266
Author(s):  
Gustavo Diniz GRECO ◽  
Amanda Beatriz Dahdah Aniceto de FREITAS ◽  
Cláudia Silami de MAGALHÃES ◽  
Allyson Nogueira MOREIRA
Keyword(s):  
Success Rate ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Success Rates ◽  
Oral Rehabilitation ◽  
Dental Prostheses ◽  
Feasible Alternative ◽  
Edentulous Patients ◽  
Very High

OBJECTIVE: The aim of this study was to assess the clinical success rate of implant-supported complete dental prostheses, which are being used as a feasible alternative in planning of oral rehabilitation. Over the years, the two-stage surgical protocol has increasingly been replaced by immediate loading procedures, especially in the mandibular anterior region in cases of rehabilitation of completely edentulous patients. This procedure has become feasible due to the high success rate of the technique with very satisfactory results. METHODS: By means of a literature review focused on published articles with clinical follow-up between 8 and 15 years. RESULTS: Implants placed in the mandible had higher success rates than those inserted in the maxilla. Cases with longer follow-up periods, 15 years, showed higher success rates in comparison with follow-up periods of 8 and 10 years. CONCLUSION: Success rates of implant-supported complete dental prostheses are very high.

National Survey of Thai Infectious Disease Physicians on Treatment of Carbapenem-ResistantAcinetobacter baumanniiVentilator-Associated Pneumonia: The Role of Infection Control Awareness

2015 ◽  
Vol 37 (1) ◽  
pp. 61-69 ◽  
Author(s):  
Aubonphan Buppajarntham ◽  
Anucha Apisarnthanarak ◽  
Thana Khawcharoenporn ◽  
Sasinuch Rutjanawech ◽  
Nalini Singh
Keyword(s):  
Infectious Disease ◽  
Infection Control ◽  
Clinical Response ◽  
Success Rate ◽  
Clinical Success ◽  
Treatment Success ◽  
Clinical Success Rate ◽  
Success Rates ◽  
Case Scenario ◽  
Carbapenem Resistant

OBJECTIVETo evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistantAcinetobacter baumannii(CRAB) ventilator-associated pneumonia (VAP)METHODSFrom June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (<60%), standard (60%–80%), and high (>80%) categories and were then compared with standard clinical response rates archived in the existing literature.RESULTSOf 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17–7.73;P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16–15.37;P<.01) and having higher number of ID consultation cases per month (aOR, 4.84; 95% CI, 1.98–11.80;P<.01) were associated with standard and high clinical success rates (>60%). We identified a significant correlation between expected and clinical success rates (r=0.58;P<.001).CONCLUSIONSAwareness of IC among IDPs can improve physicians’ expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success.Infect. Control Hosp. Epidemiol.2015;37(1):61–69

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