1601. Combination Therapy versus Monotherapy for Carbapenem-resistant Organisms: Is More Really Better?

Abstract Background Carbapenem-resistant organisms (CROs) represent an urgent public health threat and associated with mortality rates up to 60%. Pharmacotherapy for these infections remain challenging and historically included multiple agents. Meropenem/vaborbactam and ceftazidime/avibactam are options to treat CRO infections as monotherapy; however, combination therapy is still frequently utilized. Data evaluating outcomes of patients who received combination therapy compared to those receiving monotherapy for CRO infections is limited. Methods This retrospective analysis was completed across 7 campuses at AdventHealth Orlando (AHO) from March 2018-October 2019. AHO implemented CRO PCR testing in March 2018, to identify carbapenemase producing CROs (CP-CROs). Inclusion criteria were hospitalization, age ≥ 18 years, culture with CP-CRO detected by PCR, and ≥ 72 hours of either monotherapy or combination therapy. Primary outcome was clinical success, defined as resolution of signs and symptoms of infection and absence of recurrent infection. Secondary outcomes included mean length of therapy, mean length of stay, inpatient mortality, adverse reactions and 30-day all cause readmissions. Results CRO was isolated 68 times in 59 unique patients (56% male, mean age 62 years). Most common sources included urine (41%), sputum (24%) and wound (22%). Commonly isolated organisms include K. pneumoniae (44%) and E. cloacae (29%). Thirty infections (44%) were polymicrobial and 28 patients (41%) had a secondary source of infection. Forty-three patients (63%) received definitive treatment therapy with a single antibiotic. Monotherapy treated patients had higher rates of treatment success (79% vs 68%, p=0.39), lower in-hospital mortality (4% vs 9%, p=0.066), less nephrotoxicity (6% vs 10%, p=0.084), shorter length of therapy (9.6 vs 13.4 days, p=0.034) and shorter hospital stay (20 vs 34 days, p=0.056). All-cause readmission rates were higher in the monotherapy group (18% vs 9%, p=0.78). Minimum inhibitory concentrations (MIC) were reported in 97% of patients. Conclusion Treatment with a single antibiotic for carbapenem-resistant infections can lead to treatment success, while minimizing adverse events, compared to utilizing combination therapy. Disclosures All Authors: No reported disclosures

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.730 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S303-S303 ◽

Cited By ~ 1

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.

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

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02313-19 ◽

2020 ◽

Vol 64 (5) ◽

Cited By ~ 13

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.

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Ceftazidime-Avibactam Therapy Versus Ceftazidime-Avibactam-Based Combination Therapy in Patients With Carbapenem-Resistant Gram-Negative Pathogens: A Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.707499 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dan Li ◽

Fan Fei ◽

Hua Yu ◽

Xiangning Huang ◽

Shanshan Long ◽

...

Keyword(s):

Mortality Rate ◽

Combination Therapy ◽

Clinical Success ◽

Meta Analysis ◽

Current Evidence ◽

Gram Negative ◽

Beneficial Effects ◽

Development Of Resistance ◽

Carbapenem Resistant ◽

Significant Difference

Objective: To systematically review and compare the efficacy and posttreatment resistance of ceftazidime-avibactam therapy and ceftazidime-avibactam-based combination therapy in patients with Gram-negative pathogens.Methods: PubMed, Embase, Web of Science, CNKI, and Wanfang Data databases were searched from their inception up to March 31, 2021, to obtain studies on ceftazidime-avibactam therapy versus ceftazidime-avibactam-based combination therapy in patients with carbapenem-resistant Gram-negative pathogens. The primary outcome was mortality rate, and the second outcomes were microbiologically negative, clinical success, and the development of resistance after ceftazidime-avibactam treatment.Results: Seventeen studies representing 1,435 patients (837 received ceftazidime-avibactam-based combination therapy and 598 received ceftazidime-avibactam therapy) were included in the meta-analysis. The results of the meta-analysis showed that no statistically significant difference was found on mortality rate (Petos odds ratio (OR) = 1.03, 95% confidence interval (CI) 0.79–1.34), microbiologically negative (OR = 0.99, 95% CI 0.54–1.81), and clinical success (OR =0.95, 95% CI 0.64–1.39) between ceftazidime-avibactam-based combination therapy and ceftazidime-avibactam therapy. Although there was no difference in posttreatment resistance of ceftazidime-avibactam (OR = 0.65, 95% CI 0.34–1.26) in all included studies, a trend favoring the combination therapy was found (according to the pooled three studies, OR = 0.18, 95% CI 0.04–0.78).Conclusions: The current evidence suggests that ceftazidime-avibactam-based combination therapy may not have beneficial effects on mortality, microbiologically negative, and clinical success to patients with carbapenem-resistant Gram-negative pathogens. A trend of posttreatment resistance occurred more likely in ceftazidime-avibactam therapy than the combination therapy. Due to the limited number of studies that can be included, additional high-quality studies are needed to verify the above conclusions.

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Carbapenems vs β-Lactam Monotherapy or Combination Therapy for the Treatment of Complicated Intra-abdominal Infections: Systematic Review and Meta-analysis of Randomized Controlled Trials

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz394 ◽

2019 ◽

Vol 6 (10) ◽

Author(s):

Yan Li ◽

Lingyuan Chen ◽

Junsong Jiang ◽

Xianshu Li ◽

Tianguo Huang ◽

...

Keyword(s):

Combination Therapy ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Treatment Success ◽

Cochrane Library ◽

Controlled Trials ◽

Antibacterial Resistance ◽

Randomized Controlled ◽

Carbapenem Resistant ◽

Abdominal Infections

Abstract Background Complicated intra-abdominal infections (cIAIs) result in significant morbidity, mortality, and cost. Carbapenem-resistant sepsis has increased dramatically in the last decade, resulting in infections that are difficult to treat and associated with high mortality rates. To prevent further antibacterial resistance, it is necessary to use carbapenem selectively. The objective of this study was to compare the effectiveness and safety of carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs. Methods The PubMed, Embase, Medline (via Ovid SP), and Cochrane library databases were systematically searched. We included randomized controlled trials (RCTs) comparing carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs. Results Twenty-two studies involving 7720 participants were included in the analysis. There were no differences in clinical treatment success (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.71–1.05; I2 = 35%), microbiological treatment success (OR, 0.88; 95% CI, 0.71–1.09; I2 = 25%), adverse events (OR, 0.98; 95% CI, 0.87–1.09; I2 = 17%), or mortality (OR, 0.96; 95% CI, 0.68–1.35; I2 = 7%). Patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy. Conclusions No differences in clinical outcomes were observed between carbapenems and noncarbapenem β-lactams in cIAIs. Patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy.

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460. Ceftriaxone vs. Standard of Care for Definitive Treatment of Methicillin-Susceptible Staphylococcus aureus Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.533 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S226-S226

Author(s):

Jessica Snawerdt ◽

Sarah Withers ◽

John Schrank

Keyword(s):

Staphylococcus Aureus ◽

Soft Tissue ◽

Length Of Stay ◽

Clinical Success ◽

Recurrent Infection ◽

Standard Of Care ◽

Generation Cephalosporin ◽

Definitive Treatment ◽

Joint Infections ◽

Proven Efficacy

Abstract Background β-Lactam antibiotics, specifically nafcillin, oxacillin, and cefazolin, have proven efficacy for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Outpatient antimicrobial therapy (OPAT) with these agents is limited due to side effects and multiple doses required per day. Ceftriaxone, a third-generation cephalosporin, has a favorable profile for OPAT. Limited evidence supporting ceftriaxone therapy for MSSA infections prevents its widespread use. Methods A multi-center, retrospective cohort study comparing patients who received cefazolin or nafcillin to patients who received ceftriaxone for treatment of microbiologically proven MSSA infections was conducted from February 2016 to February 2018. The primary outcome of interest was a clinical success, defined as the absence of infection-related readmission, worsening infection, or recurrent infection within 90 days. Secondary outcomes included the rate of adverse reactions, length of stay, and impact of Infectious Diseases (ID) consult. Results 66 patients treated with ceftriaxone and 156 patients treated with cefazolin or nafcillin were included. Skin and soft tissue and bone and joint were the most common infections in the ceftriaxone group, whereas bacteremia was most common in the nafcillin and cefazolin group. There were significant differences in baseline age (61 years vs. 59 years; P = 0.036) and intravenous drug use (1 patient vs. 25 patients; P = 0.002) between groups. As shown in Table 1, there were significantly lower rates of clinical success with ceftriaxone compared with standard of care as a composite of all infection sites (78.8% vs. 91%; P = 0.012). No statistically significant differences were seen in safety outcomes or ID consultation. Length of stay was significantly longer in the nafcillin and cefazolin group (5.2 days vs. 12.8 days; P ≤ 0.0001). Conclusion The results of this study indicate that patients treated with ceftriaxone for MSSA infections had significantly lower rates of clinical success compared with standard of care antibiotics. Nafcillin or cefazolin should remain as first-line agents for treatment of bone and joint infections and skin and soft-tissue infections due to MSSA. Disclosures All authors: No reported disclosures.

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

Clinical Infectious Diseases ◽

10.1093/cid/ciz1131 ◽

2019 ◽

Vol 71 (3) ◽

pp. 667-671 ◽

Cited By ~ 10

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.

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Survival of carbapenem-resistant Acinetobacter baumannii bacteremia: colistin monotherapy versus colistin plus meropenem

Journal of International Medical Research ◽

10.1177/0300060519879336 ◽

2019 ◽

Vol 47 (12) ◽

pp. 5977-5985 ◽

Cited By ~ 2

Author(s):

So Yeon Park ◽

Hye Jin Si ◽

Joong Sik Eom ◽

Jin Seo Lee

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Combination Therapy ◽

Acinetobacter Baumannii ◽

Logistic Regression Analysis ◽

Clinical Success ◽

Clinical Success Rate ◽

Study Cohort ◽

Treatment Groups ◽

Carbapenem Resistant

Objective The aim of this study was to compare clinical outcomes between patients with carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia treated with colistin monotherapy and those treated with colistin plus meropenem. Methods We retrospectively evaluated data from 71 patients with CRAB bacteremia treated from November 2006 to February 2018. Predictors of 14-day mortality were determined through logistic regression analysis. Results Our study cohort included 40 bacteremia patients (44.6 %) treated with colistin monotherapy and 31 (55.4 %) treated with colistin plus meropenem. Overall 14-day mortality tended to be higher with monotherapy rather than combination therapy (47.5% vs 25.8%). The latter also showed a tendency for higher clinical success rate compared with monotherapy (61.3% vs 40.0%). Logistic regression analysis showed that Pitt bacteremia score, pneumonia, and combination therapy were significantly associated with mortality. In patients with higher Pitt bacteremia score (≥4), mortality was significantly higher with monotherapy compared with combination therapy (66.7% vs 27.8%). In patients with lower Pitt bacteremia score (≤3), mortality was similar between the two treatment groups (26.3% vs 23.1%). Conclusion Treatment with colistin plus meropenem improves survival in critically-ill patients with CRAB.

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518. Comparing the Mortality of Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.587 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S249-S250

Author(s):

Hyeonji Seo ◽

Eunmi Yang ◽

Seongman Bae ◽

Hyemin Chung ◽

Eunbeen Cho ◽

...

Keyword(s):

Risk Factors ◽

Combination Therapy ◽

Resistance Mechanism ◽

Carbapenem Resistance ◽

Source Control ◽

Definitive Treatment ◽

Clinical Issue ◽

Carbapenem Resistant ◽

Independent Risk Factors ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) infection is an emerging clinical issue. One of the mechanisms of carbapenem-resistance is carbapenemase production. This study aimed to identify whether clinical outcomes differ by CRE resistance mechanism and to evaluate risk factors for mortality in patients with CRE bacteremia. Methods We conducted a retrospective cohort study comparing 14-day mortality between patients with carbapenemase-producing (CP)-CRE and non-CP-CRE bacteremia during January 2011 to October 2018. Only monomicrobial Escherichia coli or Klebsiella pneumoniae bacteremia were included in the study. A modified carbapenem inactivation method was used for phenotypic detection of carbapenemase production. The presence of a variety of carbapenemase genes was evaluated by PCR with specific primers. Results Of 134 patients with monomicrobial CRE bacteremia, 48 (35.8%) were infected with CP-CRE, and 86 (64.1%) were infected with non-CP-CRE. The most common carbapenemase in CP-CRE isolates was KPC (66.7%), followed by NDM-1 (18.8%), OXA-48-like (10.4%), and VIM (4.1%). Baseline characteristics were similar between the two groups (Table 1). However, the CP-CRE group was significantly more likely to undergo removal of eradicable foci and to have meropenem MIC >8 µg/mL. A total of 33 (24.6%) patients died within 14 days, including 9 (18.8%) in the CP-CRE group and 24 (27.9%) in the non-CP-CRE group. Deceased patients were more likely to have a higher Pitt bacteremia score, nosocomial acquisition, ineradicable or not-eradicated foci, immunosuppressant use, inappropriate definitive treatment (Table 2). Combination therapy for definitive treatment was associated with decreased mortality. In a multivariate analysis including carbapenemase production, a higher Pitt bacteremia score (aOR, 5.15), ineradicable or not-eradicated foci (aOR, 4.05) and combination therapy for definitive treatment (aOR, 0.35) were independent risk factors for mortality. Conclusion Our study suggests that carbapenemase production is not a mortality risk factor in CRE bacteremia and provides additional evidence for early source control and combination therapy. Disclosures All authors: No reported disclosures.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.240 ◽

2015 ◽

Vol 37 (1) ◽

pp. 61-69 ◽

Cited By ~ 3

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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Seroprevalence of leptospirosis in Chennai city, India.

International Journal of Bioassays ◽

10.21746/ijbio.2016.03.0011 ◽

2016 ◽

Vol 5 (03) ◽

pp. 4897 ◽

Cited By ~ 1

Author(s):

Padma Kumari J.* ◽

Sheila Doris T. ◽

Usha Krishnan K.

Keyword(s):

Control Strategies ◽

Signs And Symptoms ◽

Laboratory Diagnosis ◽

Community Change ◽

Standard Test ◽

Agglutination Test ◽

Source Of Infection ◽

Potential Reservoir ◽

Study Population ◽

Chennai City

Leptospirosis is a zoonotic disease, it occurs worldwide but is most common in tropical and subtropical countries. The magnitude of the problem varies from community to community. The serovars which cause the disease in a community change with adaptation to a new maintenance host and is epidemiologically important. Aims and Objectives: To determine the seroprevalence of leptospirosis in Chennai city. To identify the prevalent serovar in Chennai causing leptospirosis by using gold standard test Microscopic Agglutination Test (MAT). Methods: 1209 patients from Chennai, with fever of one-week duration and with signs and symptoms of Leptospirosis were the study population and were screened for Leptospirosis by Macroscopic Slide Agglutination Test (MSAT). The positive samples by MSAT were tested for the prevalent serovar and for confirmation by MAT and the results were analyzed statistically. Result: The seroprevalence of Leptospirosis is 17.8%. The prevalent serovar circulating in Chennai is L. grippotyphosa. Conclusion: Laboratory diagnosis is essential to confirm the current illness, and for epidemiological and public health reasons, namely to determine which serovar caused the infection, the likely source of infection and the potential reservoir and its location. This helps in control strategies.

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