scholarly journals Carbapenem-Resistant Enterobacteriaceae Bloodstream Infection Treated Successfully With High-Dose Meropenem in a Preterm Neonate

2020 ◽  
Vol 11 ◽  
Author(s):  
Yue-E Wu ◽  
Hai-Yan Xu ◽  
Hai-Yan Shi ◽  
John van den Anker ◽  
Xiao-Yu Chen ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Preterm Neonate ◽  
High Dose ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Emergency Combination of Four Drugs for Bloodstream Infection Caused by Carbapenem-Resistant Enterobacteriaceae in Severe Agranulocytosis Patients with Hematologic Malignancies after Hematopoietic Stem Cell Transplantation

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Xiaofan Li ◽  
Yaqun Hong ◽  
Xianling Chen ◽  
Ping Chen ◽  
Nainong Li
Keyword(s):  
Bloodstream Infection ◽  
Combination Treatment ◽  
Drug Combination ◽  
Conventional Treatment ◽  
Hematologic Malignancies ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant

Bloodstream infection (BSI) caused by multidrug-resistant (MDR) bacteria or extensively drug-resistant (XDR) bacteria is a global threat. However, an effective treatment regimen is still controversial and inadequate due to the rapid deterioration caused by the bacteria. In immunocompromised and neutropenic patients, MDR-BSI is an emergency, which causes treatment-related mortality. In this study, four agranulocytosis patients with hematologic malignancies after HSCT receiving treatment for carbapenem-resistant Enterobacteriaceae- (CRE-) BSI were included. Conventional treatment using two to three combined antibiotics was administered in the first and second patients. Combination treatment using four drugs, polymyxin B, high-dose tigecycline, fosfomycin, and double-dose carbapenem, was administered in the third and fourth patients. None of the patients receiving conventional treatment survived. Both patients receiving combination treatment using four drugs survived. Therefore, four-drug combination therapy may be needed in CRE-BSI patients who experienced severe agranulocytosis after HSCT. The efficacy of the four-drug combination treatment for CRE-BSI patients as well as the adverse effects need to be further studied.

scholarly journals Effect of combination therapy containing a high-dose carbapenem on mortality in patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection

2018 ◽  
Vol 51 (2) ◽  
pp. 244-248 ◽  
Author(s):  
Maddalena Giannella ◽  
Enrico Maria Trecarichi ◽  
Daniele Roberto Giacobbe ◽  
Francesco Giuseppe De Rosa ◽  
Matteo Bassetti ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
High Dose ◽  
Carbapenem Resistant

scholarly journals PREDICTORS OF MORTALITY AND CLINICAL CHARACTERISTICS AMONG CARBAPENEM-RESISTANT OR CARBAPENEMASE-PRODUCING ENTEROBACTERIACEAE BLOODSTREAM INFECTION IN SPANISH CHILDREN

2020 ◽  
Author(s):  
Maria Fatima Ara Montojo ◽  
Luis Escosa Garcia ◽  
Marina Alguacil ◽  
Nieves Seara ◽  
Carlos Zozaya ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Pediatric Population ◽  
Empiric Therapy ◽  
Carbapenem Resistant ◽  
Crude Mortality ◽  
Single Center Study ◽  
Sources Of Infection ◽  
Underlying Diseases ◽  
Hospital Acquired ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in pediatric population worldwide with high mortality rates (18.5-52%) in bloodstream infection (BSI). Objectives: The aim of this study is to evaluate predictors of 30-day mortality in CRE BSI in a pediatric cohort. Methods: Retrospective observational single-center study (December 2005 - August 2018) was conducted. CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2 and MicroScan panel NBC44) according to current EUCAST breakpoints were performed. PCR OXVIKP was used to confirm carbapenemases genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteremia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day-mortality was performed. Results: Thirty-eight cases were included, 76.3% hospital-acquired infections and 23.7% related to healthcare. All patients had underlying comorbidity and 52.6% had received a transplant. VIM-carbapenemase was the predominant mechanism (92%). Previous CRE colonization or infection rate was 52.6%. Gut (26%) and vascular catheter (21%) were the predominant sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30-day mortality was 10.5%. Conditions associated with an increment in 30-day mortality were intensive care admission and inadequate empiric therapy (p<0.05). Combination antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. Conclusions: CRE BSI mortality rate is high. The most important factor related to 30-day survival in our CRE BSI cohort in children was success in empiric treatment with at least one active antibiotic.

scholarly journals The Synergistic Activity and Optimizing Doses of Tigecycline in Combination with Aminoglycosides Against Clinical Carbapenem-Resistant Klebsiella Pneumoniae Isolates

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 736
Author(s):  
Parnrada Nulsopapon ◽  
Worapong Nasomsong ◽  
Manat Pongchaidecha ◽  
Dhitiwat Changpradub ◽  
Piraporn Juntanawiwat ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Treatment Options ◽  
High Dose ◽  
Combination Regimen ◽  
Synergistic Activity ◽  
Chain Reaction ◽  
Carbapenem Resistant ◽  
Polymerase Chain ◽  
Combination Regimens ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE), especially carbapenem-resistant Klebsiella pneumoniae (CRKP), are among the largest pathogenic threats to humans. The available antibiotic treatment options for combating CRKP are limited. Colistin-resistant Enterobacteriaceae (CoRE) have also been reported worldwide, including in Thailand. Therefore, this study aimed 1) to determine minimum inhibitory concentrations (MICs) and synergistic activities of antibiotics of CRKP, and 2) to determine the probability target of attainment (PTA) and cumulative fraction of response (CFR) using pharmacokinetic/pharmacodynamic (PK/PD) data. Clinical CRKP isolates were obtained from Phramongkutklao Hospital (June to November 2020). Broth microdilution and checkerboard techniques were used to determine the mono- and synergistic activities of antibiotics. Carbapenemase and mcr-1 genes were also identified by polymerase chain reaction (PCR). The optimal antibiotic regimens were evaluated using Monte Carlo simulations. Forty-nine CRKP isolates were collected, 40 of which were CoRKP strains. The MIC50 and MIC90 of tigecycline, amikacin, and gentamicin were 1 and 2 µg/mL, 4 and 16 µg/mL, and 0.25 and 4 µg/mL, respectively. None of any isolates expressed the mcr-1 gene, whereas blaOXA-48 (53.1%) and blaOXA-48 plus blaNDM (42.9%) were detected. The synergy of tigecycline combined with amikacin or gentamicin was 8.2%. Additive activity was observed in 75.5% of isolates for tigecycline-amikacin and 69.4% for tigecycline-gentamicin, and no antagonism was observed. High-dose antibiotic regimens achieved the PTA target. The general recommended dose of combination regimens began with 200 mg tigecycline and 25 mg/kg amikacin, or 7 mg/kg gentamicin, followed by 100 mg tigecycline every 12 h and 15 mg/kg amikacin or 5 mg/kg gentamicin every 24 h. In conclusion, tigecycline plus aminoglycosides might be a potential regimen against CRKP and CoRKP. The appropriate combination regimen based on MIC-based dose adjustment can improve optimal antibiotic dosing. Further research via clinical studies will be necessary to confirm these results.

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