Fluoroquinolone versus Beta-Lactam Oral Step-Down Therapy for Uncomplicated Streptococcal Bloodstream Infections

ABSTRACT Fluoroquinolones (FQs) are often preferred as oral step-down therapy for bloodstream infections (BSIs) due to favorable pharmacokinetic parameters; however, they are also associated with serious adverse events. The objective of this study was to compare clinical outcomes for patients who received an oral FQ versus an oral beta-lactam (BL) as step-down therapy for uncomplicated streptococcal BSIs. This multicenter, retrospective cohort study analyzed adult patients who completed therapy with an oral FQ or BL with at least one blood culture positive for a Streptococcus species from 1 January 2014 to 30 June 2019. The primary outcome was clinical success, defined as the lack of all-cause mortality, recurrent BSI with the same organism, and infection-related readmission at 90 days. A multivariable logistic regression model for predictors of clinical failure was conducted. A total of 220 patients were included, with 87 (40%) receiving an FQ and 133 (60%) receiving a BL. Step-down therapy with an oral BL was noninferior to an oral FQ (93.2% versus 92.0%; mean difference, 1.2%; 90% confidence interval [CI], −5.2 to 7.8). No differences were seen in 90-day mortality, 90-day recurrent BSI, 90-day infection-related readmission, or 90-day incidence of Clostridioides difficile-associated diarrhea. Predictors of clinical failure included oral step-down transition before day 3 (odds ratio [OR] = 5.18; 95% CI, 1.21, 22.16) and low-dose oral step-down therapy (OR = 2.74; 95% CI, 0.95, 7.90). Our results suggest that oral step-down therapy for uncomplicated streptococcal BSI with a BL is noninferior to an FQ.

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308. Re-purposing Beta-lactam Antibiotics as Fluoroquinolone Sparing Stepdown Therapy for the Treatment of Enterobacteriales Bloodstream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.351 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S151-S152

Author(s):

Matthew Davis ◽

Dayna McManus ◽

Michael Ruggero ◽

Jeffrey E Topal

Keyword(s):

Positive Culture ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Central Line ◽

Cost Of Care ◽

Cns Infection ◽

Oral Antibiotic ◽

Beta Lactam ◽

Clostridioides Difficile ◽

Secondary Outcomes

Abstract Background Oral antimicrobial therapy for Enterobacteriales bloodstream infection (EB-BSI) is advantageous to reduce the risk of central line complications, cost of care, and length of stay. Fluoroquinolones (FQ) given their high bioavailability have been utilized as the standard for stepdown therapy (SDT) for EB-BSI. Given the recent increased warnings around FQ use including Clostridioides difficile infection (CDI) and the increasing FQ resistance alternative oral options for treatment are warranted. Recent literature has suggested beta-lactams (BLM) may be an option for EB-BSI. To enhance the antimicrobial stewardship goal of reducing FQ use, our team began recommending de-escalation to a BLM for EB-BSI and the objective of this study is to evaluate the outcomes of this approach. Methods This study was a retrospective chart review of patients with EB-BSI due to ceftriaxone sensitive monomicrobial E. coli, Klebsiella spp., or P. mirabilis who received a BLM or a FQ as SDT. Patients were excluded if < 18 years of age; pregnant; ANC < 1000 cells/µL; had endocarditis, a bone/joint, or a CNS infection; discharged to hospice or expired prior to discharge; anaphylactic BLM allergy; or prior kidney transplant. SDT was defined as a switch to a definitive oral antibiotic after empiric IV therapy. The primary outcome was clinical cure defined as completion of therapy without signs of infection (increase in WBC > 2000 cells/mL if WBC was ≥ 12,000 cells/mL, fever (>38°C), or change in antibiotic due to failure). Secondary outcomes included 30 day re-admission rates, reinfection rate defined as positive culture within 30 days of completion of therapy, antibiotic associated adverse events defined as side effects leading to discontinuation and/or CDI within 90 days from start of treatment. Results A total of 159 patients were included in the study (Figure 1). The BLM patients had a higher median age (78 vs 72, p=0.008), higher median PITT bacteremia score (2 vs 1, p=0.037), were less likely to be immunosuppressed (9% vs 25%, p=0.045), and had shorter median duration of therapy (13 vs 14, p=0.034). There was no difference in the primary or secondary outcomes (Table 2). Conclusion BLM may enhance stewardship efforts as a FQ sparing option for treatment of EB-BSI; however, prospective studies in this area are warranted. Disclosures All Authors: No reported disclosures

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Pharmacokinetics, Safety, and Tolerability of Oxfendazole in Healthy Volunteers: a Randomized, Placebo-Controlled First-in-Human Single-Dose Escalation Study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02255-18 ◽

2019 ◽

Vol 63 (4) ◽

Cited By ~ 8

Author(s):

Guohua An ◽

Daryl J. Murry ◽

Kiran Gajurel ◽

Thanh Bach ◽

Greg Deye ◽

...

Keyword(s):

Healthy Volunteers ◽

Phase 1 ◽

Treatment Options ◽

Taenia Solium ◽

Current Treatment ◽

Pharmacokinetic Parameters ◽

Serious Adverse Events ◽

Dose Escalation Study ◽

Content Type ◽

Dose Dependent Decrease

ABSTRACT Cysticercosis is a parasitic disease that frequently involves the human central nervous system (CNS), and current treatment options are limited. Oxfendazole, a veterinary medicine belonging to the benzimidazole family of anthelmintic drugs, has demonstrated substantial activity against the tissue stages of Taenia solium and has potential to be developed as an effective therapy for neurocysticercosis. To accelerate the transition of oxfendazole from veterinary to human use, the pharmacokinetics, safety, and tolerability of oxfendazole were evaluated in healthy volunteers in this phase 1 first-in-human (FIH) study. Seventy subjects were randomly assigned to receive a single oral dose of oxfendazole (0.5, 1, 3, 7.5, 15, 30, or 60 mg oxfendazole/kg body weight) or placebo and were followed for 14 days. Blood and urine samples were collected, and the concentrations of oxfendazole were measured using a validated ultraperformance liquid chromatography mass spectrometry method. The pharmacokinetic parameters of oxfendazole were estimated using noncompartmental analysis. Oxfendazole was rapidly absorbed with a mean plasma half-life ranging from 8.5 to 11 h. The renal excretion of oxfendazole was minimal. Oxfendazole exhibited significant nonlinear pharmacokinetics with less than dose-proportional increases in exposure after single oral doses of 0.5 mg/kg to 60 mg/kg. This nonlinearity of oxfendazole is likely due to the dose-dependent decrease in bioavailability that is caused by its low solubility. Oxfendazole was found to be well tolerated in this study at different escalating doses without any serious adverse events (AEs) or deaths. There were no significant differences in the distributions of hematology, biochemistry, or urine parameters between oxfendazole and placebo recipients. (This study has been registered at ClinicalTrials.gov under identifier NCT02234570.)

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Combination Regimens for Treatment of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03007-15 ◽

2016 ◽

Vol 60 (6) ◽

pp. 3601-3607 ◽

Cited By ~ 47

Author(s):

A. Gomez-Simmonds ◽

B. Nelson ◽

D. P. Eiras ◽

A. Loo ◽

S. G. Jenkins ◽

...

Keyword(s):

Combination Therapy ◽

Klebsiella Pneumoniae ◽

Active Agent ◽

Bloodstream Infections ◽

Individual Treatment ◽

Beta Lactam ◽

Content Type ◽

Carbapenem Resistant ◽

Extended Spectrum

Previous studies reported decreased mortality in patients with carbapenemase-producingKlebsiella pneumoniaebloodstream infections (BSIs) treated with combination therapy but included carbapenem-susceptible and -intermediate isolates, as per revised CLSI breakpoints. Here, we assessed outcomes in patients with BSIs caused by phenotypically carbapenem-resistantK. pneumoniae(CRKP) according to the number ofin vitroactive agents received and whether an extended-spectrum beta-lactam (BL) antibiotic, including meropenem, or an extended-spectrum cephalosporin was administered. We retrospectively reviewed CRKP BSIs at two New York City hospitals from 2006 to 2013, where all isolates had meropenem or imipenem MICs of ≥4 μg/ml. Univariate and multivariable models were created to identify factors associated with mortality. Of 141 CRKP BSI episodes, 23% were treated with a single active agent (SAA), 26% were treated with an SAA plus BL, 28% were treated with multiple active agents (MAA), and 23% were treated with MAA plus BL. Ninety percent of isolates had meropenem MICs of ≥16 μg/ml. Thirty-day mortality was 33% overall and did not significantly differ across the four treatment groups in a multivariable model (P= 0.4); mortality was significantly associated with a Pitt bacteremia score of ≥4 (odds ratio [OR], 7.7; 95% confidence interval [CI], 3.2 to 18.1;P= 0.1), and immunosuppression was protective (OR, 0.4; 95% CI, 0.2 to 1.0;P= 0.04). Individual treatment characteristics were also not significantly associated with outcome, including use of SAAs versus MAA (26% versus 38%,P= 0.1) or BL versus no BL (26% versus 39%,P= 0.1). In summary, in patients with CRKP BSIs caused by isolates with high carbapenem MICs, the role of combination therapy remains unclear, highlighting the need for prospective studies to identify optimal treatment regimens.

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1114. Oral β-lactams for the Treatment of Escherichia coli Bacteremia Secondary to Complicated Urinary Tract Infections Including Pyelonephritis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.978 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S396-S396

Author(s):

Nicole Harrington ◽

Megan Doran ◽

Stephen May ◽

Julianne Care ◽

Jillian Laude ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Clinical Success ◽

Clinical Success Rate ◽

Bloodstream Infections ◽

E Coli ◽

Definitive Therapy ◽

Days Of Therapy ◽

Step Down ◽

Tract Infections

Abstract Background Complicated urinary tract infections (cUTI) including pyelonephritis may result in bacteremia, increasing the rate of morbidity and mortality. The Infectious Diseases Society of America recommends a fluoroquinolone as empiric therapy or trimethoprim/sulfamethoxazole as definitive therapy for acute pyelonephritis (AP). Oral β-lactams (BL) are considered sub-optimal based on historical efficacy data with aminopenicillins and variable bioavailability. Increasing resistance and toxicity with preferred agents, justifies further evaluation of oral BL for E. coli bacteremia secondary to urinary source. Methods This was a single-center, retrospective cohort study of patients with E. coli bacteremia secondary to AP or cUTI who received oral step-down therapy with a BL or non-BL. The primary outcome was the rate of clinical success defined by microbiological cure, clinical cure, and infection-related readmission. Secondary outcomes were time to oral step-down, total days of therapy, length of hospital stay, incidence of therapy escalation, 30-day readmissions, and antibiotic-associated adverse events. Results A total of 46 patients were included, with 23 patients in each group. The difference in clinical success between the BL and non-BL groups was not statistically significant (91.3% vs. 100%, P = 0.489). The most frequent oral step-down agents prescribed were cephalexin and ciprofloxacin. The median time to oral step-down was significantly lower in the non-BL group (4.39 vs. 3.41 days, P = 0.038), and the median duration of therapy in each group was 15 days. No patients required therapy escalation after oral step-down or had infection-related readmission within 30 days of discharge. Conclusion The observed clinical success rate of 91.3% remains consistent with previous studies evaluating oral BL as step-down therapy for Enterobacteriaceae bloodstream infections. The results of this study support the safety and efficacy of oral BL as step-down therapy for E. coli bacteremia due to cUTI, although larger studies may be beneficial. Disclosures All authors: No reported disclosures.

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Multicenter Observational Study of Ceftaroline Fosamil for Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02015-16 ◽

2016 ◽

Vol 61 (2) ◽

Cited By ~ 29

Author(s):

Evan J. Zasowski ◽

Trang D. Trinh ◽

Kimberly C. Claeys ◽

Anthony M. Casapao ◽

Noor Sabagha ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Combination Therapy ◽

Observational Study ◽

Clinical Success ◽

Bloodstream Infections ◽

Interquartile Range ◽

Ceftaroline Fosamil ◽

Methicillin Resistant ◽

Content Type ◽

Multicenter Observational Study

ABSTRACT Novel therapies for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) are needed in the setting of reduced antibiotic susceptibilities and therapeutic failure. Ceftaroline is a cephalosporin antibiotic with MRSA activity. Although not FDA approved for MRSA BSI, ceftaroline has generated much interest as a potential treatment option. However, detailed descriptions of its use in this setting remain limited. To address this, we conducted a retrospective, multicenter, observational study of adult patients with MRSA BSI treated with at least 72 h of ceftaroline from 2011 to 2015. Safety outcomes were examined in the overall cohort, while efficacy outcomes were examined among patients who had not cleared their BSI prior to ceftaroline initiation. Data were also stratified by ceftaroline monotherapy or combination therapy. Predictors of clinical failure on ceftaroline treatment were also sought. Overall, 211 patients were included in the safety population; Clostridium difficile infection, rash, and neutropenia occurred in 6 patients (2.8%), 7 patients (3.3%), and 3 patients (1.4%), respectively. Clinical success was observed in 86 (68.3%) of the 126 patients included in the efficacy population. The monotherapy and combination therapy subgroups had similar proportions of patients experiencing success (69.7 and 64.9%, respectively). The median BSI durations post-ceftaroline treatment were 2 days (interquartile range, 1 to 4 days) for monotherapy and 3 days (interquartile range, 1.5 to 5 days) for combination therapy. Higher acute physiology and chronic health evaluation II scores and comorbid malignancy independently predicted treatment failure. Ceftaroline appears effective for MRSA BSI as both monotherapy and combination therapy. However, comparative studies are needed to further delineate the role of ceftaroline in MRSA BSI treatment.

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277. Comparison of Oral Beta-Lactams and Fluoroquinolones for Step-Down in Uncomplicated Enterobacterales Blood Stream Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.321 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S139-S139

Author(s):

Nichol Ngo ◽

Lionel Sielatchom-Noubissie ◽

Kyle Molina ◽

Tanner M Johnson ◽

Misha Huang ◽

...

Keyword(s):

Urinary Tract ◽

Multivariable Analysis ◽

Bloodstream Infections ◽

Blood Stream ◽

Causative Organism ◽

Clinical Failure ◽

Salmonella Spp ◽

Antibiotic Duration ◽

Step Down ◽

Tract Infections

Abstract Background Bloodstream infections (BSI) with Enterobacterales (formerly Enterobacteriaceae) group organisms are a frequently encountered complication, often stemming from urinary tract infections. Recent studies have demonstrated similar outcomes among patients transitioned to oral antibiotics compared to those managed solely with parenteral routes; however, most transitions utilize highly bioavailable agents such as fluoroquinolones (FQ). With limited comparative evidence on oral b-lactams (OBL) and mounting concerns over FQ safety and resistance, we sought to compare outcomes of FQ vs. OBL for Enterobacterales BSI step-down. Methods Single-center, retrospective cohort of adults at University of Colorado Hospital from 2015–2017 with uncomplicated Enterobacterales BSI who stepped down to OBL or FQ after initial parenteral therapy. Exclusions were: pregnant or incarcerated, causative organism identified as Salmonella spp., Enterobacter spp., Citrobacter freundii, Serratia spp. and/or Klebsiella aerogenes, parenteral antibiotic duration ≥ 5 days, death before day 5, total antibiotic duration < 5 days or > 21 days. Primary outcome was clinical failure, a composite of any of the following within 30-days of antibiotic completion: death, recurrence or antibiotic change for presumed failure, or readmission for original infection. Results Overall, 74 patients were included (n=36 OBL, n=38 FQ). Baseline characteristics were not different between groups, with overall mean age (SD) 60 (17) years and 62% female. E. coli was most commonly identified (65%), with 70% originating from the urinary tract. ICU admission was present in 18%, and median (IQR) Pitt Bacteremia Score was 2 (1–3). Treatment failure occurred in 25% OBL vs. 24% FQ recipients, p=0.55. No deaths were identified in either group within 30-days, and adverse events were rarely reported in either group. Multivariable analysis identified presence of nephrostomy tubes (OR 8.1; 95% CI: 1.1–61) but not OBL (OR 1.5; 95% CI: 0.3–7.2) as associated with clinical failure. Conclusion In a cohort of uncomplicated Enterobacterales BSIs there does not appear to be a difference in clinical failure associated with OBLs compared to FQs. Additional studies with a larger cohort, or prospective trials are needed to confirm these findings. Disclosures matthew miller, PharmD, Allergan (Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

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Multiple-Ascending-Dose Phase 1 Clinical Study of the Safety, Tolerability, and Pharmacokinetics of CRS3123, a Narrow-Spectrum Agent with Minimal Disruption of Normal Gut Microbiota

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01395-19 ◽

2019 ◽

Vol 64 (1) ◽

Cited By ~ 4

Author(s):

Barbara K. Lomeli ◽

Hal Galbraith ◽

Jared Schettler ◽

George A. Saviolakis ◽

Wael El-Amin ◽

...

Keyword(s):

Adverse Events ◽

Gut Microbiota ◽

Phase 1 ◽

Toxin Production ◽

Trna Synthetase ◽

Serious Adverse Events ◽

Content Type ◽

Clostridioides Difficile ◽

Clinically Significant ◽

Microbiome Data

ABSTRACT CRS3123 is a novel small molecule that potently inhibits methionyl-tRNA synthetase of Clostridioides difficile, inhibiting C. difficile toxin production and spore formation. CRS3123 has been evaluated in a multiple-ascending-dose placebo-controlled phase 1 trial. Thirty healthy subjects, ages 18 to 45 years, were randomized into three cohorts of 10 subjects each, receiving either 200, 400, or 600 mg of CRS3123 (8 subjects per cohort) or placebo (2 subjects per cohort) by oral administration twice daily for 10 days. CRS3123 was generally safe and well tolerated, with no serious adverse events (SAEs) or severe treatment-emergent adverse events (TEAEs) reported. All subjects completed their assigned treatment and follow-up visits, and there were no trends in systemic, vital sign, or laboratory TEAEs. There were no QTcF interval changes or any clinically significant changes in other electrocardiogram (ECG) intervals or morphology. CRS3123 showed limited but detectable systemic uptake; although absorption increased with increasing dose, the increase was less than dose proportional. Importantly, the bulk of the oral dose was not absorbed, and fecal concentrations were substantially above the MIC90 value of 1 μg/ml at all dosages tested. Subjects receiving either of the two lower doses of CRS3123 exhibited minimal disruption of normal gut microbiota after 10 days of twice-daily dosing. CRS3123 was inactive against important commensal anaerobes, including Bacteroides, bifidobacteria, and commensal clostridia. Microbiome data showed favorable differentiation compared to other CDI therapeutics. These results support further development of CRS3123 as an oral agent for the treatment of CDI. (This study has been registered at Clinicaltrials.gov under identifier NCT02106338.)

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Daptomycin Improves Outcomes Regardless of Vancomycin MIC in a Propensity-Matched Analysis of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00227-16 ◽

2016 ◽

Vol 60 (10) ◽

pp. 5841-5848 ◽

Cited By ~ 25

Author(s):

Kimberly C. Claeys ◽

Evan J. Zasowski ◽

Anthony M. Casapao ◽

Abdalhamid M. Lagnf ◽

Jerod L. Nagel ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Logistic Regression ◽

Bloodstream Infections ◽

Attributable Mortality ◽

Stepwise Logistic Regression ◽

Clinical Failure ◽

Methicillin Resistant ◽

Content Type ◽

Vancomycin Mics ◽

Significant Difference

ABSTRACTVancomycin remains the mainstay treatment for methicillin-resistantStaphylococcus aureus(MRSA) bloodstream infections (BSIs) despite increased treatment failures. Daptomycin has been shown to improve clinical outcomes in patients with BSIs caused by MRSA isolates with vancomycin MICs of >1 mg/liter, but these studies relied on automated testing systems. We evaluated the outcomes of BSIs caused by MRSA isolates for which vancomycin MICs were determined by standard broth microdilution (BMD). A retrospective, matched cohort of patients with MRSA BSIs treated with vancomycin or daptomycin from January 2010 to March 2015 was completed. Patients were matched using propensity-adjusted logistic regression, which included age, Pitt bacteremia score, primary BSI source, and hospital of care. The primary endpoint was clinical failure, which was a composite endpoint of the following metrics: 30-day mortality, bacteremia with a duration of ≥7 days, or a change in anti-MRSA therapy due to persistent or worsening signs or symptoms. Secondary endpoints included MRSA-attributable mortality and the number of days of MRSA bacteremia. Independent predictors of failure were determined through conditional backwards-stepwise logistic regression with vancomycin BMD MIC forced into the model. A total of 262 patients were matched. Clinical failure was significantly higher in the vancomycin cohort than in the daptomycin cohort (45.0% versus 29.0%;P= 0.007). All-cause 30-day mortality was significantly higher in the vancomycin cohort (15.3% versus 6.1%;P= 0.024). These outcomes remained significant when stratified by vancomycin BMD MIC. There was no significant difference in the length of MRSA bacteremia. Variables independently associated with treatment failure included vancomycin therapy (adjusted odds ratio [aOR] = 2.16, 95% confidence interval [CI] = 1.24 to 3.76), intensive care unit admission (aOR = 2.46, 95% CI = 1.34 to 4.54), and infective endocarditis as the primary source (aOR = 2.33, 95% CI = 1.16 to 4.68). Treatment of MRSA BSIs with daptomycin was associated with reduced clinical failure and 30-day mortality; these findings were independent of vancomycin BMD MIC.

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A Retrospective Analysis of Treatment and Clinical Outcomes among Patients with Methicillin-Susceptible Staphylococcus aureus Bloodstream Isolates Possessing Detectable mecA by a Commercial PCR Assay Compared to Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Isolates

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01396-17 ◽

2017 ◽

Vol 62 (1) ◽

Cited By ~ 2

Author(s):

Dylan Jones ◽

Ramy H. Elshaboury ◽

Erik Munson ◽

Thomas J. Dilworth

Keyword(s):

Staphylococcus Aureus ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Methicillin Resistant Staphylococcus Aureus ◽

Bloodstream Infections ◽

Clinical Failure ◽

Pcr Assay ◽

Methicillin Resistant ◽

Content Type ◽

Persistent Bacteremia

ABSTRACT mecA-positive Staphylococcus aureus isolates phenotypically susceptible to cefoxitin (mecA-methicillin-sensitive S. aureus [MSSA]) have been identified. We describe the treatment and outcomes among patients with mecA-MSSA bloodstream infections (BSI) and MRSA BSI matched 1:1 for age, BSI origin, and BSI type (n = 17 per group). Compared to MRSA BSI patients, mecA-MSSA BSI patients more often experienced clinical failure (58.8% and 11.8%, P = 0.010), driven largely by persistent bacteremia (35.3% and 11.8%). mecA-MSSA BSI patients may be at higher risk for poor clinical outcomes.

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Ertapenem-Containing Double-Carbapenem Therapy for Treatment of Infections Caused by Carbapenem-Resistant Klebsiella pneumoniae

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01569-15 ◽

2015 ◽

Vol 60 (1) ◽

pp. 669-673 ◽

Cited By ~ 33

Author(s):

Jessica B. Cprek ◽

Jason C. Gallagher

Keyword(s):

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Clinical Success ◽

Treatment Options ◽

Bloodstream Infections ◽

Content Type ◽

Skin Structure ◽

Carbapenem Resistant ◽

Tract Infections ◽

Intraabdominal Infections

ABSTRACTWe describe outcomes of patients with infections with carbapenem-resistantKlebsiella pneumoniae(CRKP) who received ertapenem-containing double-carbapenem therapy (ECDCT). Clinical success was observed in 7/18 (39%) patients overall: bloodstream infections, 3/7 (43%); pneumonia, 1/5 (20%); intraabdominal infections, 0/2 (0%); urinary tract infections, 2/3 (67%); and a skin and skin structure infection, 1/1 (100%). Microbiologic success was observed in 11/14 (79%) evaluable patients; 5/18 (28%) patients died. ECDCT may be effective for CRKP infections with limited treatment options.

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