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Bucataru A, Turcu-Stiolica A, Calina D, Balasoiu AT, Zlatian OM, Osman A, Balasoiu M, Ghenea AE. Systematic Review and Meta-Analysis of Clinical Efficacy and Safety of Meropenem-Vaborbactam versus Best-Available Therapy in Patients with Carbapenem-Resistant Enterobacteriaceae Infections. Int J Mol Sci 2024; 25:9574. [PMID: 39273526 PMCID: PMC11394724 DOI: 10.3390/ijms25179574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/28/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024] Open
Abstract
Antimicrobial resistance is increasingly concerning, causing millions of deaths and a high cost burden. Given that carbapenemase-producing Enterobacterales are particularly concerning due to their ability to develop structural modifications and produce antibiotic-degrading enzymes, leading to high resistance levels, we sought to summarize the available data on the efficacy and safety regarding the combination of meropenem-vaborbactam (MV) versus the best available therapy (BAT). Articles related to our objective were searched in the PubMed and Scopus databases inception to July 2024. To assess the quality of the studies, we used the Cochrane risk-of-bias tool, RoB2. The outcomes were pooled as a risk ratio (RR) and a 95% confidence interval (95%CI). A total of four published studies were involved: one retrospective cohort study and three phase 3 trials, including 432 patients treated with MV and 426 patients treated with BAT (mono/combination therapy with polymyxins, carbapenems, aminoglycosides, colistin, and tigecycline; or ceftazidime-avibactam; or piperacillin-tazobactam). No significant difference in the clinical response rate was observed between MV and the comparators at the TOC (RR = 1.29, 95%CI [0.92, 1.80], p = 0.14) and EOT (RR = 1.66, 95%CI [0.58, 4.76], p = 0.34) visits. MV was associated with a similar microbiological response as the comparators at TOC (RR = 1.63, 95%CI [0.85, 3.11], p = 0.14) and EOT assessment (RR = 1.16, 95%CI [0.88, 1.54], p = 0.14). In the pooled analysis of the four studies, 28-day all-cause mortality was lower for MV than the control groups (RR = 0.47, 95%CI [0.24, 0.92], p = 0.03). MV was associated with a similar risk of adverse events (AEs) as comparators (RR = 0.79, 95%CI [0.53, 1.17], p = 0.23). Additionally, MV was associated with fewer renal-related AEs than the comparators (RR = 0.32, 95%CI [0.15, 0.66], p = 0.002). MV was associated with a similar risk of treatment discontinuation due to AEs (RR = 0.76, 95%CI [0.38, 1.49], p = 0.42) or drug-related AEs (RR = 0.56, 95%CI [0.28, 1.10], p = 0.09) as the comparators. In conclusion, MV presents a promising therapeutic option for treating CRE infections, demonstrating similar clinical and microbiological responses as other comparators, with potential advantages in mortality outcomes and renal-related AEs.
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Affiliation(s)
- Alexandra Bucataru
- Medical Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Infectious Disease Department, Victor Babes University Hospital Craiova, 200515 Craiova, Romania
| | - Adina Turcu-Stiolica
- Pharmacoeconomics Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Theodor Balasoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ovidiu Mircea Zlatian
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Osman
- Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department ENT & Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Maria Balasoiu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alice Elena Ghenea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Tumbarello M, Raffaelli F, Giannella M, De Pascale G, Cascio A, De Rosa FG, Cattelan AM, Oliva A, Saracino A, Bassetti M, Mussini C, Luzzati R, Capone A, Signorini L, Bartoletti M, Sambo M, Sarmati L, Antinori S, Mularoni A, Tascini C, Corona A, Pascale R, Rubino R, Corcione S, Mazzitelli M, Giuliano G, Lovecchio A, Bavaro DF, Meschiari M, Montagnani F, Fabbiani M, De Benedetto I, Antonelli M, Venditti M, Viale P. Outcomes and Predictors of Mortality in Patients With KPC-Kp Infections Treated With Meropenem Vaborbactam: An Observational Multicenter Study. Open Forum Infect Dis 2024; 11:ofae273. [PMID: 38854388 PMCID: PMC11161898 DOI: 10.1093/ofid/ofae273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Background Meropenem-vaborbactam is a recent and promising option for the treatment of KPC-producing Klebsiella pneumoniae (KPC-Kp) infections, including those resistant to ceftazidime-avibactam. Methods We conducted a retrospective analysis of observational data from 19 Italian hospitals on use and outcomes of patients treated with meropenem-vaborbactam for at least ≥24 hours for KPC-Kp infections. Crude and propensity-weighted multiple Cox regression models were performed to ascertain risk factors independently associated with 30-day mortality. Results The cohort included 342 adults with bloodstream infections (n = 172) and nonbacteremic infections (n = 170), of which 107 were lower respiratory tract infections, 30 were complicated urinary tract infections, and 33 were infections involving other sites. Most infections (62.3%) were managed with meropenem-vaborbactam monotherapy, or in combination with at least 1 other active drug (usually fosfomycin, tigecycline, or gentamicin) (37.7%). The 30-day mortality rate was 31.6% (108/342). In multiple Cox regression model, 30-day mortality was independently associated with septic shock at infection onset, Charlson comorbidity index ≥ 3, dialysis, concomitant COVID-19, and INCREMENT score ≥ 8. Administration of meropenem-vaborbactam within 48 hours from infection onset was a negative predictor of mortality. All predictors, except administration of meropenem-vaborbactam within 48 hours, remained significant when the multiple Cox regression model was repeated after adjustment for the propensity score for receipt of combination therapy. Conclusions Despite the limits of a retrospective study, the data derived from this multicenter cohort provide additional evidence on the efficacy of meropenem-vaborbactam in treating severe KPC-Kp infections, even when used as monotherapy.
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Affiliation(s)
- Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienza dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D'Alessandro”, University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone” Palermo, Italy
| | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Alessandra Oliva
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy
| | - Annalisa Saracino
- Operative Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Bari, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Cristina Mussini
- Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Alessandro Capone
- Infezioni Sistemiche ed Immunodepresso, National Institute for Infectious Disease L. Spallanzani, Roma, Italy
| | - Liana Signorini
- UOC Malattie Infettive, Spedali Civili di Brescia, Brescia, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Margherita Sambo
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Roma Italy
| | - Spinello Antinori
- Dipartiment of Scienze Biomediche e Cliniche L. Sacco, Università degli Studi di Milano Polo Universitario, Milano, Italy
| | - Alessandra Mularoni
- Infectious Diseases Unit, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Carlo Tascini
- Infectious Disease Clinic, DAME (Department of Medicine) University of Udine, Udine Italy
| | - Alberto Corona
- ICU, Surgical Theatre & Emergency Department, ASST Valcamonica, Breno Italy
| | - Renato Pascale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Raffaella Rubino
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone” Palermo, Italy
| | - Silvia Corcione
- Infectious diseases, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Gabriele Giuliano
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Antonio Lovecchio
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Davide Fiore Bavaro
- Operative Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Bari, Italy
| | - Marianna Meschiari
- Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | - Francesca Montagnani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Massimiliano Fabbiani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Ilaria De Benedetto
- Infectious diseases, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienza dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Mario Venditti
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Rodríguez A, Moreno G, Bodi M, Martín-Loeches I. Antibiotics in development for multiresistant gram-negative bacilli. Med Intensiva 2022; 46:630-640. [PMID: 36302707 DOI: 10.1016/j.medine.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/26/2022] [Indexed: 06/16/2023]
Abstract
The rapid increase in antibiotic(ATB) resistance among Gram-negative bacilli(BGN), especially in strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii, with high resistance patterns (XDR), poses a huge threat to health systems worldwide. In the last decade, different ATBs have been developed against XDR, some of which combine a lactam β along with a β-lactamase inhibitor, while others use non-β-lactam inhibitors. Most of them have adequate "in vitro" activity on several β-lactamases of class A, C and D of Ambler. However, combinations such as Ceftazidime/avibactam, Ceftolozane/Tazobactam and Meropenem/vaborbactam have no activity against metallo-β-lactamases(MβL). New combinations such as Aztreonan/AVI, Cefepime/Zidebactam, or new cephalosporins such as Cefiderocol, have efficacy against MβL enzymes. Although some of these combinations are already approved and in the commercialization phase, many of them have yet to define their place within the treatment of microorganisms with high resistance through clinical studies.
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Affiliation(s)
- A Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; IISPV/CIBERES, Tarragona, Spain.
| | - G Moreno
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - M Bodi
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; IISPV/CIBERES, Tarragona, Spain
| | - I Martín-Loeches
- Trinity College Dublin, School of Medicine, Intensive Care Medicine St James's Hospital, Dublín, Ireland
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