scholarly journals Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study

Hygiene ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 69-79
Author(s):  
Benoît Pilmis ◽  
Thibaud Delerue ◽  
Anna Belkacem ◽  
Pauline Caraux-Paz ◽  
Solen Kernéis ◽  
...  
Keyword(s):  
Rare Event ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Clinical Failure ◽  
First Line ◽  
Multicentric Study ◽  
First Line Therapy ◽  
Secondary Objective ◽  
Emergence Of Resistance

Background: Clinical and microbiological guidelines recommend treating infections caused by Enterobacter spp. with cefepime or carbapenems. The main objective of this study was to assess the risk of clinical failure with third generation cephalosporin (3GC) therapy compared to other β-lactams for infections caused by Enterobacter spp. Our secondary objective was to evaluate the risk of emergence of resistance during therapy. Methods: We conducted a prospective observational study in seven French hospitals over an 18-month period including all patients with a pulmonary and/or bloodstream infection due to Enterobacter spp. susceptible to 3GC. Results: Seventy-four patients were included in our study. Among them, 26 (35%) received a 3GC as a first-line treatment, and clinical improvements were observed for 13/21 (62%) of them. Four (5%) cases of emergence of 3GC resistance were observed during therapy including one in the 3GC group. 3GC therapy can be safely used as first-line therapy especially for non-severe patients suffering from pulmonary or bloodstream infections due to Enterobacter spp. Conclusions: Emergence of 3GC resistance remains a rare event, and there is a lack of evidence of the benefit of last-line antibiotics therapies.

scholarly journals Subacute Bacterial Endocarditis Caused byCardiobacterium hominis: A Case Report

2015 ◽  
Vol 26 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Davie Wong ◽  
Julie Carson ◽  
Andrew Johnson
Keyword(s):  
Susceptibility Testing ◽  
Medical Literature ◽  
Generation Cephalosporin ◽  
Bacterial Endocarditis ◽  
Clinical Microbiology Laboratory ◽  
Third Generation ◽  
First Line ◽  
Subacute Bacterial Endocarditis ◽  
First Line Therapy ◽  
Third Generation Cephalosporins

Cardiobacterium hominis, a member of the HACEK group of organisms, is an uncommon but important cause of subacute bacterial endocarditis. First-line therapy is a third-generation cephalosporin due to rare beta-lactamase production. The authors report a case involving endovascular infection due toC hoministhat initially tested resistant to third-generation cephalosporins using an antibiotic gradient strip susceptibility method (nitrocephin negative), but later proved to be susceptible using broth microdilution reference methods (a ‘major’ error). There are limited studies to guide susceptibility testing and interpretive breakpoints forC hominisin the medical literature, and the present case illustrates some of the issues that may arise when performing susceptibility testing for fastidious organisms in the clinical microbiology laboratory.

scholarly journals Use of Ceftaroline in Hospitalized Patients with and without COVID-19: A Descriptive Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 763
Author(s):  
Daniele Roberto Giacobbe ◽  
Chiara Russo ◽  
Veronica Martini ◽  
Silvia Dettori ◽  
Federica Briano ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Bloodstream Infections ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Sectional Study ◽  
Cross Sectional ◽  
First Line Therapy ◽  
Large Teaching Hospital ◽  
Secondary Objective ◽  
Medical Wards

A single-center cross-sectional study was conducted to describe the use of ceftaroline in a large teaching hospital in Northern Italy, during a period also including the first months of the coronavirus disease 2019 (COVID-19) pandemic. The primary objective was to describe the use of ceftaroline in terms of indications and characteristics of patients. A secondary objective was to describe the rate of favorable clinical response in patients with bloodstream infections (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA-BSI) receiving ceftaroline. Overall, 200 patients were included in the study. Most of them had COVID-19 (83%, 165/200) and were hospitalized in medical wards (78%, 155/200). Included patients with COVID-19 pneumonia were given empirical ceftaroline in the suspicion of bacterial co-infection or superinfection. Among patients with MRSA-BSI, ceftaroline was used as a first-line therapy and salvage therapy in 25% (3/12) and 75% (9/12) of cases, respectively, and as a monotherapy or in combination with daptomycin in 58% (7/12) and 42% (5/12) of patients, respectively. A favorable response was registered in 67% (8/12) of patients. Improving etiological diagnosis of bacterial infections is essential to optimize the use of ceftaroline in COVID-19 patients. The use of ceftaroline for MRSA-BSI, either as a monotherapy or in combination with other anti-MRSA agents, showed promising rates of favorable response.

Characterization of Third-Generation Cephalosporin-ResistantEscherichia colifrom Bloodstream Infections in Denmark

2014 ◽  
Vol 20 (4) ◽  
pp. 316-324 ◽  
Author(s):  
Frank Hansen ◽  
Stefan S. Olsen ◽  
Ole Heltberg ◽  
Ulrik S. Justesen ◽  
David Fuglsang-Damgaard ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation

scholarly journals Multifactorial Role of Mitochondria in Echinocandin Tolerance Revealed by Transcriptome Analysis of Drug-Tolerant Cells

mBio ◽  
2021 ◽  
Author(s):  
Rocio Garcia-Rubio ◽  
Cristina Jimenez-Ortigosa ◽  
Lucius DeGregorio ◽  
Christopher Quinteros ◽  
Erika Shor ◽  
...  
Keyword(s):  
Fungal Pathogen ◽  
Candida Glabrata ◽  
Clinical Failure ◽  
First Line ◽  
Content Type ◽  
First Line Therapy ◽  
Line Therapy ◽  
Resistant Strains ◽  
Opportunistic Fungal Pathogen

Echinocandin drugs are a first-line therapy to treat invasive candidiasis, which is a major source of morbidity and mortality worldwide. The opportunistic fungal pathogen Candida glabrata is a prominent bloodstream fungal pathogen, and it is notable for rapidly developing echinocandin-resistant strains associated with clinical failure.

scholarly journals Piperacillin-tazobactam should be preferred to third-generation cephalosporins to treat wild-type inducible AmpC-producing Enterobacteriaceae in critically ill patients with hospital or ventilator-acquired pneumonia. A propensity score-matched analysis

2019 ◽  
Author(s):  
Cédric Carrié ◽  
Guillaume Bardonneau ◽  
Laurent Petit ◽  
Alexandre Ouattara ◽  
Didier Gruson ◽  
...  
Keyword(s):  
Propensity Score ◽  
Antibiotic Therapy ◽  
Pulmonary Infection ◽  
Therapeutic Failure ◽  
Third Generation ◽  
Pulmonary Infections ◽  
Wild Type ◽  
First Line ◽  
Emergence Of Resistance ◽  
Third Generation Cephalosporins

Abstract BACKGROUND The aim of this study was to compare the rate of therapeutic failure and emergence of resistance in critically ill patients treated by third-generation cephalosporins (3GCs) or piperacillin-tazobactam (PTZ) for wild-type AmpC-producing Enterobacteriaceae pulmonary infections. METHODS In a multicenter retrospective cohort study over a 4-year period, all patients treated for a pulmonary infection related to wild-type AmpC-producing Enterobacteriaceae who received documented antibiotic therapy with 3GCs or PTZ after less than 48 hours of empirical antibiotic therapy were eligible. The main outcome was the rate of therapeutic failure, defined by an impaired clinical response under treatment and/or a relapse of pulmonary infection related to the same pathogen. The secondary outcome was a secondary acquisition of derepressed cephalosporinase-producing Enterobacteriaceae. RESULTS Over the study period, 244 patients were included; 56 (23%) experienced therapeutic failure and 19 (8%) experienced secondary acquisition of resistance. In the non-adjusted cohort, the rate of therapeutic failure and emergence of resistance were significantly higher in the 3GCs group (32 vs. 18%, p = 0.011 and 13 vs. 5%, p = 0.035, respectively). In the propensity score-matched population, the 3GCs group was associated with higher rates of therapeutic failure (HR = 1.61 [1.27 – 2.07]). The secondary de-escalation to 3GCs after 48h of PTZ as a first-line antibiotic therapy was not associated with increased rate of emergence of resistance. CONCLUSION Our study confirms that third-generation cephalosporins should be avoided as first-line antibiotic therapy in wild-type AmpC-producing Enterobacteriaceae pulmonary infections.

scholarly journals Risk Factors for Emergence of Resistance to Broad-Spectrum Cephalosporins among Enterobacterspp

2001 ◽  
Vol 45 (9) ◽  
pp. 2628-2630 ◽  
Author(s):  
Keith S. Kaye ◽  
Sara Cosgrove ◽  
Anthony Harris ◽  
George M. Eliopoulos ◽  
Yehuda Carmeli
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Broad Spectrum ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Independent Risk Factors ◽  
Emergence Of Resistance

ABSTRACT Among 477 patients with susceptible Enterobacter spp., 49 subsequently harbored third-generation cephalosporin-resistantEnterobacter spp. Broad-spectrum cephalosporins were independent risk factors for resistance (relative risk [OR] = 2.3, P = 0.01); quinolone therapy was protective (OR = 0.4, P = 0.03). There were trends toward decreased risk for resistance among patients receiving broad-spectrum cephalosporins and either aminoglycosides or imipenem. Of the patients receiving broad-spectrum cephalosporins, 19% developed resistance.

scholarly journals Artemisinin Combination Therapy Can Result in Clinical Failure If Oral Therapy Is Not Directly Observed

2013 ◽  
Vol 24 (4) ◽  
pp. 215-216
Author(s):  
Wilson W Chan ◽  
Divya Virmani ◽  
Dylan R Pillai
Keyword(s):  
Combination Therapy ◽  
Treatment Failure ◽  
Oral Therapy ◽  
Present Report ◽  
Artemisinin Combination Therapy ◽  
Clinical Failure ◽  
First Line ◽  
Early Administration ◽  
First Line Therapy ◽  
Line Therapy

Intravenous artesunate therapy is the first-line therapy for severe malaria, and is highly efficacious when used in combination with an oral partner drug such as doxycycline or atovaquone-proguanil. However, treatment failure occurs routinely with artesunate monotherapy due to the very short half-life of this drug. In North America, experience with artesunate is limited. With the pressure to discharge patients early, administration of the essential oral partner drug is often left to the discretion of the patient. Thus, treatment failure may be commonplace if nonadherence is a factor, as was observed in the case described in the present report.

scholarly journals Piperacillin–tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen)

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040210 ◽  
Author(s):  
Roni Bitterman ◽  
Fidi Koppel ◽  
Cristina Mussini ◽  
Yuval Geffen ◽  
Michal Chowers ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Control Group ◽  
Third Generation ◽  
Beta Lactam ◽  
Open Label ◽  
Randomised Controlled

IntroductionThe optimal treatment for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections has yet to be defined. Retrospective studies have shown conflicting results, with most data suggesting the non-inferiority of beta-lactam–beta-lactamase inhibitor combinations compared with carbapenems. However, the recently published MERINO trial failed to demonstrate the non-inferiority of piperacillin–tazobactam to meropenem. The potential implications of the MERINO trial are profound, as widespread adoption of carbapenem treatment will have detrimental effects on antimicrobial stewardship in areas endemic for ESBL and carbapenem-resistant bacteria. Therefore, we believe that it is justified to re-examine the comparison in a second randomised controlled trial prior to changing clinical practice.Methods and analysisPeterPen is a multicentre, investigator-initiated, open-label, randomised controlled non-inferiority trial, comparing piperacillin–tazobactam with meropenem for third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections. The study is currently being conducted in six centres in Israel and one in Canada with other centres from Israel, Italy and Canada expected to join. The two primary outcomes are all-cause mortality at day 30 from enrolment and treatment failure at day seven (death, fever above 38°C in the last 48 hours, continuous symptoms, increasing Sequential Organ Failure Assessment Score or persistent blood cultures with the index pathogen). A sample size of 1084 patients was calculated for the mortality endpoint assuming a 12.5% mortality rate in the control group with a 5% non-inferiority margin and assuming 100% follow-up for this outcome.Ethics and disseminationThe study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available.Trial registration numbersClinicalTrials.gov Registry (NCT03671967); Israeli Ministry of Health Trials Registry (MOH_2018-12-25_004857).

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