scholarly journals Early Experience With Meropenem-Vaborbactam for Treatment of Carbapenem-resistant Enterobacteriaceae Infections

2019 ◽  
Vol 71 (3) ◽  
pp. 667-671 ◽  
Author(s):  
Ryan K Shields ◽  
Erin K McCreary ◽  
Rachel V Marini ◽  
Ellen G Kline ◽  
Chelsea E Jones ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Clinical Success ◽  
Survival Rates ◽  
Recurrent Infection ◽  
Early Experience ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Twenty patients with carbapenem-resistant Enterobacteriaceae infections were treated with meropenem-vaborbactam. Thirty-day clinical success and survival rates were 65% (13/20) and 90% (18/20), respectively. Thirty-five percent of patients had microbiologic failures within 90 days. One patient developed a recurrent infection due to meropenem-vaborbactam–nonsusceptible, ompK36 porin mutant Klebsiella pneumoniae.

scholarly journals 662. Recurrence of Infection and Emergence of Drug Resistance After Treatment with Meropenem/Vaborbactam Compared with Ceftazidime/Avibactam in Carbapenem-Resistant Enterobacteriaceae Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S303-S303 ◽  
Author(s):  
Renee Ackley ◽  
Danya Roshdy ◽  
Jacqueline Isip ◽  
Sarah B, Minor ◽  
Amanda L Elchynski ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Combination Therapy ◽  
Clinical Success ◽  
Recurrent Infection ◽  
Signs And Symptoms ◽  
Development Of Resistance ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Post Hoc ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Options for treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections were historically limited to antibiotics with limited efficacy and significant toxicities. Ceftazidime/avibactam (CA) and meropenem/vaborbactam (MV) are superior to older regimens; however, a direct comparison of the agents is lacking. This study compared clinical outcomes including recurrence of infection and emergence of drug resistance in patients who received CA vs. MV for CRE infections. Methods This was a multicenter, retrospective cohort study of adults with CRE infections who received CA or MV for ≥72 hours from February 2015 to October 2018. Patients with localized urinary tract infection were excluded. The primary endpoint was clinical success (30-day survival, resolution of signs and symptoms of infection, sterilization of blood cultures within 7 days in patients with bacteremia, absence of recurrent infection). Secondary endpoints included 30- and 90-day mortality, adverse events (AE), recurrent CRE infection within 90 days, and development of resistance in patients with recurrent infection. We conducted a post hoc subgroup analysis in patients with recurrence to compare development of resistance in those who received CA monotherapy, CA combination therapy, and MV monotherapy. Results 131 patients were included (CA: 105 patients, MV: 26 patients), 40% had bacteremia. No statistical difference in clinical success was observed between groups (62% vs. 69%, respectively, P = 0.49). Patients in the CA arm received combination therapy more often than patients in the MV arm (61% vs. 15%, P < 0.01). No difference in 30- and 90-day mortality resulted among groups, but numerically higher rates of AE were observed in the CA group (38% vs. 23%, P = 0.17). In patients with recurrent infection, development of resistance occurred more often with CA monotherapy, though not statistically significant (Table 1). One case of MV resistance was observed in a patient who had received 4 prior courses of MV, but this episode was outside of the study period. Conclusion Clinical success was similar between the groups despite MV being used more often as monotherapy. Development of resistance and rates of AE were higher in the CA group compared with MV therapy. Disclosures All authors: No reported disclosures.

scholarly journals Appropriate Treatment for Bloodstream Infections Due to Carbapenem-Resistant Klebsiella pneumoniae and Escherichia coli: A Nationwide Multicenter Study in Taiwan

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Yi-Tsung Lin ◽  
Chin-Fang Su ◽  
Chien Chuang ◽  
Jung-Chung Lin ◽  
Po-Liang Lu ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multivariate Analysis ◽  
Klebsiella Pneumoniae ◽  
Multicenter Study ◽  
Bloodstream Infections ◽  
Carbapenem Resistant ◽  
Appropriate Treatment ◽  
Comorbidity Index ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background In a multicenter study from Taiwan, we aimed to investigate the outcome of patients who received different antimicrobial therapy in carbapenem-resistant Enterobacteriaceae bloodstream infections and proposed a new definition for tigecycline use. Methods Patients from 16 hospitals in Taiwan who received appropriate therapy for bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were enrolled in the study between January 2012 and June 2015. We used a cox proportional regression model for multivariate analysis to identify independent risk factors of 14-day mortality. Tigecycline was defined as appropriate when the isolates had a minimum inhibitory concentration (MIC) ≤0.5 mg/L, and we investigated whether tigecycline was associated with mortality among patients with monotherapy. Results Sixty-four cases with carbapenem-resistant K pneumoniae (n = 50) and E coli (n = 14) bloodstream infections were analyzed. Of the 64 isolates, 17 (26.6%) had genes that encoded carbapenemases. The 14-day mortality of these cases was 31.3%. In the multivariate analysis, Charlson Comorbidity Index (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03–1.42; P = .022) and colistin monotherapy (HR, 5.57; 95% CI, 2.13–14.61; P &lt; .001) were independently associated with 14-day mortality. Among the 55 patients with monotherapy, the 14-day mortality was 30.9% (n = 17). Tigecycline use was not associated with mortality in the multivariate analysis. Conclusions Tigecycline monotherapy was a choice if the strains exhibited MIC ≤0.5 mg/L, and colistin monotherapy was not suitable. Our findings can initiate additional clinical studies regarding the efficacy of tigecycline in carbapenem-resistant Enterobacteriaceae infections.

scholarly journals Multicenter Study of Outcomes with Ceftazidime-Avibactam in Patients with Carbapenem-Resistant Enterobacteriaceae Infections

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Madeline King ◽  
Emily Heil ◽  
Safia Kuriakose ◽  
Tiffany Bias ◽  
Vanthida Huang ◽  
...  
Keyword(s):  
Chart Review ◽  
Clinical Success ◽  
Retrospective Chart Review ◽  
Beta Lactamase ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Microbiological Cure ◽  
Inhibitor Combination ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT Ceftazidime-avibactam is a novel cephalosporin–beta-lactamase inhibitor combination that is active against many carbapenem-resistant Enterobacteriaceae (CRE). We describe a retrospective chart review for 60 patients who received ceftazidime-avibactam for a CRE infection. In-hospital mortality was 32%, 53% of patients had microbiological cure, and 65% had clinical success. In this severely ill population with CRE infections, ceftazidime-avibactam was an appropriate option.

scholarly journals Meropenem-Vaborbactam versus Ceftazidime-Avibactam for Treatment of Carbapenem-Resistant Enterobacteriaceae Infections

2020 ◽  
Vol 64 (5) ◽  
Author(s):  
Renee Ackley ◽  
Danya Roshdy ◽  
Jacqueline Meredith ◽  
Sarah Minor ◽  
William E. Anderson ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Clinical Success ◽  
Recurrent Infection ◽  
Study Drug ◽  
First Episode ◽  
Development Of Resistance ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
Enterobacteriaceae Infections ◽  
Post Hoc

ABSTRACT The comparative efficacy of ceftazidime-avibactam and meropenem-vaborbactam for treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections remains unknown. This was a multicenter, retrospective cohort study of adults with CRE infections who received ceftazidime-avibactam or meropenem-vaborbactam for ≥72 hours from February 2015 to October 2018. Patients with a localized urinary tract infection and repeat study drug exposures after the first episode were excluded. The primary endpoint was clinical success compared between treatment groups. Secondary endpoints included 30- and 90-day mortality, adverse events (AE), 90-day CRE infection recurrence, and development of resistance in patients with recurrent infection. A post hoc subgroup analysis was completed comparing patients who received ceftazidime-avibactam monotherapy, ceftazidime-avibactam combination therapy, and meropenem-vaborbactam monotherapy. A total of 131 patients were included (ceftazidime-avibactam, n = 105; meropenem-vaborbactam, n = 26), 40% of whom had bacteremia. No significant difference in clinical success was observed between groups (62% versus 69%; P = 0.49). Patients in the ceftazidime-avibactam arm received combination therapy more often than patients in the meropenem-vaborbactam arm (61% versus 15%; P < 0.01). No difference in 30- and 90-day mortality resulted, and rates of AE were similar between groups. In patients with recurrent infection, development of resistance occurred in three patients that received ceftazidime-avibactam monotherapy and in no patients in the meropenem-vaborbactam arm. Clinical success was similar between patients receiving ceftazidime-avibactam and meropenem-vaborbactam for treatment of CRE infections, despite ceftazidime-avibactam being used more often as a combination therapy. Development of resistance was more common with ceftazidime-avibactam monotherapy.

scholarly journals A Bibliometric Meta-Analysis of Colistin Resistance in Klebsiella pneumoniae

Diseases ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 44
Author(s):  
Ozioma Forstinus Nwabor ◽  
Pawarisa Terbtothakun ◽  
Supayang P. Voravuthikunchai ◽  
Sarunyou Chusri
Keyword(s):  
Klebsiella Pneumoniae ◽  
Research Collaboration ◽  
Research Output ◽  
Meta Analysis ◽  
Research Articles ◽  
Colistin Resistance ◽  
Carbapenem Resistant ◽  
The Usa ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Linkage Strength

Colistin is a last resort antibiotic medication for the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae. In recent years, various mechanisms have been reported to mediate colistin resistance in K. pneumoniae. This study reports a bibliometric analysis of published articles retrieved from the Scopus database relating to colistin resistance in K. pneumoniae. The research trends in colistin resistance and mechanisms of resistance were considered. A total of 1819 research articles published between 1995 and 2019 were retrieved, and the results indicated that 50.19% of the documents were published within 2017–2019. The USA had the highest participation with 340 (14.31%) articles and 14087 (17.61%) citations. Classification based on the WHO global epidemiological regions showed that the European Region contributed 42% of the articles while the American Region contributed 21%. The result further indicated that 45 countries had published at least 10 documents with strong international collaborations amounting to 272 links and a total linkage strength of 735. A total of 2282 keywords were retrieved; however, 57 keywords had ≥15 occurrences with 764 links and a total linkage strength of 2388. Furthermore, mcr-1, colistin resistance, NDM, mgrB, ceftazidime-avibactam, MDR, combination therapy, and carbapenem-resistant Enterobacteriaceae were the trending keywords. Concerning funders, the USA National Institute of Health funded 9.1% of the total research articles, topping the list. The analysis indicated poor research output, collaboration, and funding from Africa and South-East Asia and demands for improvement in international research collaboration.

Carbapenem-Resistant Enterobacteriaceae Rectal Screening during an Outbreak of New Delhi Metallo-β-Lactamase–Producing Klebsiella pneumoniae at an Acute Care Hospital

2014 ◽  
Vol 35 (4) ◽  
pp. 434-436 ◽  
Author(s):  
Larissa M. Pisney ◽  
M. A. Barron ◽  
E. Kassner ◽  
D. Havens ◽  
N. E. Madinger
Keyword(s):  
Klebsiella Pneumoniae ◽  
Acute Care ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Acute Care Hospital ◽  
University Teaching ◽  
New Delhi ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

We describe the results of carbapenem-resistant Enterobacteriaceae (CRE) screening as part of an outbreak investigation of New Delhi metallo-β-lactamase–producing CRE at a tertiary care university teaching hospital. The manual method for CRE screening was useful for detecting patients with asymptomatic CRE carriage but was time-consuming and costly.

scholarly journals The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

2019 ◽  
Author(s):  
Xiu-Qin Jia ◽  
Feng Pang ◽  
Xin Luo ◽  
Jian Zhang
Keyword(s):  
Antimicrobial Resistance ◽  
Adjuvant Therapy ◽  
Pathogenic Bacteria ◽  
Antimicrobial Agents ◽  
Pediatric Patients ◽  
Tertiary Hospital ◽  
Invasive Procedures ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The aim of this study was to performe a retrospective analysis of prevalence and treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections in children in a tertiary hospital. Methods The non-repeat clinical isolates of CRE in children were collected in Liaocheng People's Hospital from January, 2013 to December, 2018. The bacterial identification and antibiotic susceptibility was performed according to the standard methods. The isolated strains will be detected carbapenemases genotypes and homology analysis. All data on the culture-positive strains and associated clinical infection from different pediatric wards were reviewed. Results A total of 20 CRE strains isolated from pediatric patients, which derived from different infection sites and present a classification of multiple species of Enterobacteriaceae. And the production of IMP-type carbapenemase in these strains is the main reason of antimicrobial resistance. Most of the infected patients have severe comorbidities and invasive procedures, and use insensitive drugs due to the high resistance rates and medication restrictions. Nevertheless, most infected children have been treated despite the resistance of pathogens to multiple antimicrobial agents. In our follow-up survey, most children received adjuvant therapy such as human intravenous immunoglobulin, which may be an important factor in helping patients defeat pathogenic bacteria. Conclusions This study demonstrates a high prevalence of IMP-mediated CRE infection in pediatric patients with severe comorbidities and invasive procedures. Most children have been cured, which may be related to application of adjuvant therapy and weaker pathogenicity of the IMP-type Enterobacteriaceae.

scholarly journals Treatment of Carbapenem-Resistant Enterobacteriaceae Infections with Ceftazidime-Avibactam

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S286-S286
Author(s):  
Elham Rahmati ◽  
Emily Blodget ◽  
Rosemary C She ◽  
Jennifer Cupo Abbott ◽  
Robert A Bonomo ◽  
...  
Keyword(s):  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals A public health concern: emergence of carbapenem-resistant Klebsiella pneumoniae in a public transportation environment

2020 ◽  
Vol 75 (10) ◽  
pp. 2769-2772
Author(s):  
Tingting Cao ◽  
Yuanyuan Liu ◽  
Yiming Li ◽  
Yang Wang ◽  
Zhangqi Shen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Public Transportation ◽  
Genetic Relationships ◽  
Brain Heart Infusion ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Beijing Subway

Abstract Objectives This study was designed to understand the prevalence of antibiotic-resistant bacteria in the Beijing subway environment and the potential transmission of carbapenem-resistant Enterobacteriaceae in a public transportation environment. Methods Carbapenem-resistant isolates were selected on brain heart infusion agar supplemented with meropenem (0.5 mg/L) and antimicrobial susceptibility testing was conducted using the broth microdilution method. WGS analyses were conducted for 11 Klebsiella pneumoniae isolates to identify resistance genes. The genetic relationships among the isolates were evaluated by MLST and PFGE. Results We identified 11 carbapenem-resistant K. pneumoniae isolates from the Beijing subway environment. WGS revealed three STs among the 11 isolates, with 9 isolates classified as ST726 and containing a blaNDM-5-carrying IncX3 plasmid. The genetic environment of blaNDM-5 was very similar to that observed in other blaNDM-5-containing clinical isolates. Conclusions The presence of carbapenem-resistant Enterobacteriaceae in a public transportation environment is concerning and indicates that regular antimicrobial resistance surveillance is urgent and necessary.

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