scholarly journals 2248. Clinical and Microbiological Outcomes Associated with Real-World Use of Ceftolozane/Tazobactam

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S768-S769 ◽  
Author(s):  
Nicolo Cabrera ◽  
Truc T Tran ◽  
William R Miller ◽  
An Q Dinh ◽  
Blake Hanson ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Real World ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Signs And Symptoms ◽  
Outcome Data ◽  
Advisory Board ◽  
Hospital System ◽  
Gram Negative ◽  
Tract Infections

Abstract Background Ceftolozane/tazobactam (C/T) is a novel cephalosporin/β-lactamase inhibitor combination for treating Gram-negative infections, particularly Pseudomonas aeruginosa (PA). C/T has been FDA-approved for complicated intra-abdominal and urinary tract infections and has just completed a trial in ventilator nosocomial pneumonia, but real-world outcome data are still emerging. Methods Demographic, microbiologic, treatment and outcome data of patients who received C/T for ≥48 hours from January 2016 to August 2018 at multiple centers within a single hospital system were retrospectively collected. Available isolates were analyzed for C/T susceptibility (by Etest) and whole-genome sequencing (WGS). Spades v.3.11.1 was used for assembly, multi-locus sequence typing v2.10 performed for in silico MLST with the PubMLST database and Abricate v0.7 was used for resistance gene screening with the CARD database. Results Among 45 patients, 58% were non-white, 53% were female and 13% were immunocompromised. The median age was 64 years (IQR, 50 to 69). At the time of the index event, a high proportion of patients required ICU care (42%) and pressor support (13%) as well as had invasive devices in place (64%). A minority (2.4%) had prior exposure to C/T. Respiratory infections were most common (38%) followed by urinary tract (20%). Concomitant Gram-negative agents were used in 18%. 69% achieved clinical success (i.e., recovery from infection-related signs and symptoms). The in-hospital mortality rate was 16% of which 5 out of 7 were attributed to infection. Microbiology was available for 91% of patients; 84% had PA isolates resistant to at least 3 antipseudomonal classes (Figures 1 and 2). Ten PA isolates were analyzed with WGS (Table 1). C/T resistance arose during therapy in one patient (MIC increase from 1 to 128 µg/mL). WGS showed a substitution in AmpC β-lactamase (A46D) and presence of blaCARB-2. Conclusion Although C/T was used in a critically ill population with highly resistant organisms, cure rates were high and mortality was low. Acquired β-lactamases were not frequently seen among the PA isolates. C/T is a vital therapeutic option, particularly on MDR isolates for which options are limited. Disclosures Samuel L. Aitken, PharmD, Melinta Therapeutoics: Grant/Research Support, Research Grant; Merck, Sharpe, and Dohme: Advisory Board; Shionogi: Advisory Board.

scholarly journals SINGLE-DOSE PRULIFLOXACIN VERSUS SINGLE-DOSE PEFLOXACIN IN THE TREATMENT OF ACUTE UNCOMPLICATED URINARY TRACT INFECTION IN WOMEN

2010 ◽  
Vol 18 (3) ◽  
pp. 5
Author(s):  
M. CERVIGNI ◽  
G. ORTICELLI ◽  
M. BOLOGNA ◽  
F. NATALE ◽  
E. SALVATORI ◽  
...  
Keyword(s):  
Single Dose ◽  
Urinary Tract ◽  
Eradication Rate ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Uncomplicated Urinary Tract Infection ◽  
Efficacy And Safety ◽  
Success Rates ◽  
The One ◽  
Tract Infections

The aim of the study was to compare the efficacy and safety of singledose prulifloxacin vs. single-dose pefloxacin in the treatment of patients with acute uncomplicated urinary tract infections. Two hundred and thirty-one female out-patients were considered microbiologically evaluable and randomly treated with 600 mg prulifloxacin (116 patients) or 800 mg pefloxacin (115 patients). The most commonly isolated uropathogen at baseline was Escherichia coli (71.4%), followed by Proteus mirabilis (10.8%) and Klebsiella pneumoniae (7.8%). Five-seven days posttreatment, the eradication rate was 97.4% and 92.2% in the prulifloxacin and pefloxacin group, respectively. The one-tailed 95% confidence interval analysis showed the equivalence of treatments. Four weeks from treatment no relapses, reinfections or superinfections were observed. The clinical success rates were 92.2% in the prulifloxacin and 84.3% pefloxacin groups. The safety profile was very good with both drugs. The results of the study make it possible to consider prulifloxacin a possible therapeutic option in patients with acute uncomplicated UTIs.

scholarly journals SINGLE-DOSE PRULIFLOXACIN VERSUS SINGLE-DOSE PEFLOXACIN IN THE TREATMENT OF ACUTE UNCOMPLICATED URINARY TRACT INFECTION IN WOMEN

2010 ◽  
Vol 17 (2) ◽  
pp. 69 ◽  
Author(s):  
M. CERVIGNI ◽  
G. ORTICELLI ◽  
M. BOLOGNA ◽  
F. NATALE ◽  
E. SALVATORI ◽  
...  
Keyword(s):  
Single Dose ◽  
Urinary Tract ◽  
Eradication Rate ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Uncomplicated Urinary Tract Infection ◽  
Efficacy And Safety ◽  
Success Rates ◽  
The One ◽  
Tract Infections

The aim of the study was to compare the efficacy and safety of singledose prulifloxacin vs. single-dose pefloxacin in the treatment of patients with acute uncomplicated urinary tract infections. Two hundred and thirty-one female out-patients were considered microbiologically evaluable and randomly treated with 600 mg prulifloxacin (116 patients) or 800 mg pefloxacin (115 patients). The most commonly isolated uropathogen at baseline was Escherichia coli (71.4%), followed by Proteus mirabilis (10.8%) and Klebsiella pneumoniae (7.8%). Five-seven days posttreatment, the eradication rate was 97.4% and 92.2% in the prulifloxacin and pefloxacin group, respectively. The one-tailed 95% confidence interval analysis showed the equivalence of treatments. Four weeks from treatment no relapses, reinfections or superinfections were observed. The clinical success rates were 92.2% in the prulifloxacin and 84.3% pefloxacin groups. The safety profile was very good with both drugs. The results of the study make it possible to consider prulifloxacin a possible therapeutic option in patients with acute uncomplicated UTIs.

scholarly journals 1608. Efficacy of Ceftolozane/Tazobactam for Multidrug-Resistant Gram-Negative Infections in Multiple Urban Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S798-S799
Author(s):  
Nicolo Cabrera ◽  
Truc T Tran ◽  
Travis J Carlson ◽  
Faris Alnezary ◽  
William R Miller ◽  
...  
Keyword(s):  
Research Study ◽  
Clinical Success ◽  
Significant Proportion ◽  
Scientific Research ◽  
Panel Member ◽  
Multidrug Resistant ◽  
Outcome Data ◽  
Research Support ◽  
Gram Negative ◽  
Study Investigator

Abstract Background Ceftolozane/tazobactam (C/T) is a novel cephalosporin/beta-lactamase inhibitor combination developed for use against multidrug-resistant (MDR) Gram-negative infections, particularly Pseudomonas aeruginosa (PA). C/T is approved for complicated urinary tract and intraabdominal infections as well as hospital-acquired/ventilator-associated bacterial pneumonias. However, comprehensive clinical characterization of patients treated with C/T in non-FDA-approved indications is limited. Methods Patients ≥18 years who received C/T for ≥48 hours while hospitalized in 9 acute care centers in Houston, TX from January 2016 through September 2018 were included. Demographic, microbiologic, treatment and clinical outcome data were retrospectively collected by chart review. In patients who received multiple inpatient courses of C/T, only the first course with C/T was assessed. Results 210 patients met inclusion criteria: 58% were non-white, 35% were female and 13% were immunocompromised. Median age was 61 years (IQR, 48 to 69). Median Charlson comorbidity index was 5 (IQR, 2 to 6). At the onset of the index episode, a significant proportion of patients required intensive care unit admission (44%), mechanical ventilation (37%) and pressor support (22%). Respiratory sources were the most common (50%) followed by urine (15%). Positive cultures were documented in 93% of the cases and PA was found in 86%. Majority (95%) of PA which were MDR. C/T use was guided by susceptibility testing of the index isolate in ca. 52%. In 5.7% of cases, C/T was used to escalate therapy without any documented C/T-susceptible organism. Half (51%) of the cohort received initial dosing appropriate for renal function while 36% receiving a lower than recommended dose. Clinical success (i.e., recovery from infection-related signs and symptoms) occured in 77%. The in-hospital mortality rate in our cohort was 15% with 26 of 31 deaths deemed infection-related. Conclusion We report a large multicenter observational cohort that received C/T. A 77% clinical success with the use of C/T was documented. These data support the use of C/T in critically ill patients infected with MDR PA. Disclosures William R. Miller, MD, Entasis Therapeutics (Scientific Research Study Investigator)Merck (Grant/Research Support)Shionogi (Advisor or Review Panel member) Laura A. Puzniak, PhD, Merck (Employee) Cesar A. Arias, MD, MSc, PhD, FIDSA, Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support)

Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Chemotherapy ◽  
2016 ◽  
Vol 62 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Stephanie E. Giancola ◽  
Monica V. Mahoney ◽  
Michael D. Hogan ◽  
Brian R. Raux ◽  
Christopher McCoy ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Resistance ◽  
Clinical Success ◽  
Patient Characteristics ◽  
Multidrug Resistant ◽  
Enterococcus Spp ◽  
Tract Infections ◽  
Microbiological Cure

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

scholarly journals Comparing the Performance of the New Fully Automated Urine Particle Analyzer UF-5000 with UF-1000i and Gram Stain in Predicting Bacteria Growth Patterns in Women with Uncomplicated Urinary Tract Infections

2020 ◽  
Author(s):  
Stephen Shei-Dei Yang ◽  
Chun-Chun yang ◽  
Yi-Shen Chen ◽  
Shangjen chang
Keyword(s):  
Urinary Tract ◽  
Urine Analysis ◽  
Growth Patterns ◽  
Gram Stain ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Patterns ◽  
Tract Infections ◽  
Sensitivity Specificity ◽  
Gram Positive Cocci

Abstract BackgroudTo compare the performance of the new flow cytometer UF-5000 with UF-1000i (Sysmex, Kobe, Japan) and Gram stain in predicting the bacterial patterns in urine samples MethodsWomen with symptoms suggestive of urinary tract infection were enrolled. Mid-stream urine sample was collected for gram staining, urine analysis and urine culture. Bacterial patterns were classified though UF1000i (none, cocci bacteria or rods/mixed growth), UF-5000 (none, cocci, rods or mixed growth) and Gram stain. Results Among the 102 samples, there were 10 gram-positive cocci, 2 gram-positive bacilli, 66 gram-negative rods, and 24 mixed growth. The sensitivity/specificity of the UF-1000i was 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci.ConclusionsThe UF-5000 demonstrated the good sensitivity and specificity for Gram-negative bacilli bacteria and demonstrated an improved sensitivity for detecting Gram-positive cocci.

scholarly journals Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

2021 ◽  
Author(s):  
Noah Wald-Dickler ◽  
Todd C Lee ◽  
Soodtida Tangpraphaphorn ◽  
Susan M Butler-Wu ◽  
Nina Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Urinary Tract ◽  
Los Angeles ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Outpatient Treatment ◽  
Retrospective Cohort ◽  
Clinical Success ◽  
Public Hospitals ◽  
Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

scholarly journals Isolation and Identification of Uropathogenic E. coli and its Antimicrobial Susceptibility Pattern with Special Reference to Extended Spectrum Beta-Lactamases (Esbl)

2021 ◽  
pp. 56-67
Author(s):  
V. Naveen Kumar ◽  
Chitralekha Saikumar
Keyword(s):  
Urinary Tract ◽  
Special Reference ◽  
Management Plan ◽  
Gram Negative Bacteria ◽  
Susceptibility Pattern ◽  
Isolation And Identification ◽  
Gram Negative ◽  
Microbial Resistance ◽  
E Coli ◽  
Tract Infections

Urinary tract infections (UTI) are the most common bacterial infection among the humans. One of the most important factors impacting the management of UTI over the past decade is emergence of anti-microbial resistance among uropathogens. ESBL production is one of the most common mechanisms of anti-microbial resistance, the other being Amp C β-lactamases in gram negative bacteria. This study was undertaken to establish the prevalence of ESBL producing strains and their anti-microbial susceptibility pattern to newer agents to guide therapy for urinary tract infection. The present studies isolates and identify Uropathogenic Escherichia coli and its antibiotic susceptibility pattern with special reference to ESBL. The emergence of β-lactamase is a Metter of serious concern .The drug resistance in gram negative bacilli is due to production of β-lactamases, AmpC lactamases, Efflux mechanisms and Porin deficiency. Out of the total 3580 urine samples, 987 samples (27.56%) showed No growth, 1786 (49.88%) showed the presence of Gram negative bacteria. Totally, 1081 E. coli species were isolated and < 30% of them were found to be ESBL positive. Uropathogenic E. coli   isolates are highly susceptible towards Meropenem and Imipenem antibiotics and highly resistant towards β-lactam and Cephalosporins antibiotics. Hence, the present study urged to implement the management plan for using those antibiotics in patients for preventing the antibiotic resistance.

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