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Kobayashi K, Hata A, Imoto W, Kakuno S, Shibata W, Yamada K, Kawaguchi H, Sakurai N, Ito T, Uenoyama K, Takahashi T, Ueda S, Katayama T, Onoue M, Kakeya H. Evaluation of predictors of third-generation cephalosporin non-susceptibility and factors affecting recurrence or death in bacteremia caused by Citrobacter freundii complex , Enterobacter cloacae complex, and Klebsiella aerogenes. J Chemother 2024:1-11. [PMID: 38451087 DOI: 10.1080/1120009x.2024.2323326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
Factors involved in the susceptibility of third-generation cephalosporins (3GCs) to bacteremia caused by Citrobacter freundii complex, Enterobacter cloacae complex, and Klebsiella aerogenes were investigated based on a case-case-control design. Antimicrobial therapy administered 30 days prior to bacteremia and hospitalization within 90 days were common risk factors for the 3GC susceptible and 3GC non-susceptible groups, while hospitalization from an institution or another hospital was a specific risk factor for the 3GC non-susceptible group. We also attempted to examine the factors affecting the clinical outcome of bacteremia. Hospitalization more than 14 days before the onset of bacteremia was an independent factor indicating poor clinical outcome. In contrast, the implementation of source control was an independent predictor of successful treatment. Although a longer hospital stay before the onset of bacteremia was associated with worse clinical outcomes, implementation of source control may have contributed to improved treatment outcomes for bacteremia.
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Affiliation(s)
- Kazuhiro Kobayashi
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Infection Diseases, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Atsuko Hata
- Department of Infection Diseases, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Waki Imoto
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Kakuno
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Wataru Shibata
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kawaguchi
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Norihiro Sakurai
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toshikazu Ito
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazuya Uenoyama
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tamotsu Takahashi
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Infection Diseases, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Satoru Ueda
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
- Department of Infection Diseases, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Toshiro Katayama
- Department of Medical Engineering, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Masahide Onoue
- Department of Pharmacy, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Research Centre for Infectious Disease Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research Centre for Infectious Disease, Osaka Metropolitan University, Osaka, Japan
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Stuurman RA, Jong E, Godschalk PCR, Corsten MF, Nagtegaal JE. Evaluating the Use of Meropenem in Hematologic Patients with Febrile Neutropenia: A Retrospective Observational Single-Cohort Study. Mediterr J Hematol Infect Dis 2023; 15:e2023067. [PMID: 38028398 PMCID: PMC10631713 DOI: 10.4084/mjhid.2023.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Abstract
Objectives
The Antibiotic Stewardship Team of Meander Medical Centre (Meander MC) instigated a revaluation of its treatment protocol for hematologic patients admitted with febrile neutropenia. The current hospital protocol advises administering meropenem for 72 hours, followed by antibiotic therapy guided by microbiological cultures. In order to responsibly adjust the current empiric regimen, this study aimed to determine the frequency of bacteria resistant to alternative antibiotics, namely ceftazidime and piperacillin/tazobactam, in both surveillance and diagnostic cultures.
Methods
This retrospective, observational, single-centre study included adult patients with a hematologic malignancy and febrile neutropenia admitted between October 2018 and June 2021. Collected metadata included patient characteristics, surveillance and diagnostic culture results, and antibiotic use.
Results
A total of 100 patients were included. One or more bacteria resistant to ceftazidime or piperacillin/tazobactam were identified in blood and urine cultures in seven (7%) and one (1%) patients respectively.
Conclusions
Our results support the safe reduction of the use of meropenem by changing the empiric treatment protocol for patients with hematologic malignancy and febrile neutropenia. As this study showed a lower resistance frequency to piperacillin/tazobactam than to ceftazidime, this antibiotic is the recommended alternative.
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Affiliation(s)
- R A Stuurman
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - E Jong
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
| | - P C R Godschalk
- Department of Clinical Microbiology, Meander Medical Centre, Amersfoort, The Netherlands
| | - M F Corsten
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
| | - J E Nagtegaal
- Department of Hospital Pharmacy, Meander Medical Centre, Amersfoort, The Netherlands
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Vossius G, Meex C, Moerman F, Thys M, Ernst M, Bourgeois ME, Wagner L, Delahaye T, Darcis G. Clinical Outcomes of Third-Generation Cephalosporin Definitive Therapy for Bloodstream Infections Due to Enterobacterales with Potential AmpC Induction: A Single-Center Retrospective Study. Pathogens 2023; 12:1152. [PMID: 37764960 PMCID: PMC10537439 DOI: 10.3390/pathogens12091152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The recommended therapy for severe infections caused by AmpC-inducible Enterobacterales (AmpC-E) typically involves cefepime or carbapenems. In an era of emerging resistance to these antimicrobials, we aim to assess the impact of third-generation cephalosporins (3GCs) vs. alternative antibiotics on clinical outcomes in bloodstream infections (BSIs) due to AmpC-E. We retrospectively included hospitalized adult patients with BSIs caused by 3GC-susceptible AmpC-E between 2012 and 2022, comparing the outcomes of 3GC and non-3GC definitive therapies. The primary outcome was overall treatment failure (OTF), encompassing 90-day all-cause mortality, 90-day reinfection, and 90-day readmission. Secondary outcomes comprised components of the OTF, in-hospital all-cause mortality, and length-of-stay. Within a total cohort of 353 patients, OTF occurred in 46.5% and 41.5% in the 3GC- and non-3GC-therapy groups, respectively (p = 0.36). The 3GC-therapy group exhibited a longer length-of-stay (38 vs. 21 days, p = 0.0003) and higher in-hospital mortality (23.3% vs. 13.4%, p = 0.019). However, the 90-day mortality, 90-day reinfection, and 90-day readmission were comparable between the therapy groups. Subgroup analyses involving high-risk AmpC-E and 3GC vs. standard-of-care yielded similar conclusions. Overall, our findings suggest that 3GC definitive therapy may not result in poorer clinical outcomes for the treatment of BSIs caused by AmpC-E.
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Affiliation(s)
- Gilles Vossius
- Département des Maladies Infectieuses, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
| | - Cécile Meex
- Service de Microbiologie Clinique, Université de Liège, 4000 Liège, Belgium
| | - Filip Moerman
- Département des Maladies Infectieuses, Hôpital de la Citadelle, 4000 Liège, Belgium
| | - Marie Thys
- Service des Informations Médico-Économiques, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
| | - Marie Ernst
- Biostatistics and Research Method Center (B-STAT), Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
| | | | - Léa Wagner
- Faculté de Médecine, Université de Liège, 4000 Liège, Belgium
| | | | - Gilles Darcis
- Département des Maladies Infectieuses, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
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Stewart AG, Paterson DL, Young B, Lye DC, Davis JS, Schneider K, Yilmaz M, Dinleyici R, Runnegar N, Henderson A, Archuleta S, Kalimuddin S, Forde BM, Chatfield MD, Bauer MJ, Lipman J, Harris-Brown T, Harris PNA. Meropenem Versus Piperacillin-Tazobactam for Definitive Treatment of Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: A Pilot Multicenter Randomized Controlled Trial (MERINO-2). Open Forum Infect Dis 2021; 8:ofab387. [PMID: 34395716 PMCID: PMC8361238 DOI: 10.1093/ofid/ofab387] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenems are recommended treatment for serious infections caused by AmpC-producing gram-negative bacteria but can select for carbapenem resistance. Piperacillin-tazobactam may be a suitable alternative. Methods We enrolled adult patients with bloodstream infection due to chromosomal AmpC producers in a multicenter randomized controlled trial. Patients were assigned 1:1 to receive piperacillin-tazobactam 4.5 g every 6 hours or meropenem 1 g every 8 hours. The primary efficacy outcome was a composite of death, clinical failure, microbiological failure, and microbiological relapse at 30 days. Results Seventy-two patients underwent randomization and were included in the primary analysis population. Eleven of 38 patients (29%) randomized to piperacillin-tazobactam met the primary outcome compared with 7 of 34 patients (21%) in the meropenem group (risk difference, 8% [95% confidence interval {CI}, –12% to 28%]). Effects were consistent in an analysis of the per-protocol population. Within the subcomponents of the primary outcome, 5 of 38 (13%) experienced microbiological failure in the piperacillin-tazobactam group compared to 0 of 34 patients (0%) in the meropenem group (risk difference, 13% [95% CI, 2% to 24%]). In contrast, 0% vs 9% of microbiological relapses were seen in the piperacillin-tazobactam and meropenem arms, respectively. Susceptibility to piperacillin-tazobactam and meropenem using broth microdilution was found in 96.5% and 100% of isolates, respectively. The most common AmpC β-lactamase genes identified were blaCMY-2, blaDHA-17, blaCMH-3, and blaACT-17. No ESBL, OXA, or other carbapenemase genes were identified. Conclusions Among patients with bloodstream infection due to AmpC producers, piperacillin-tazobactam may lead to more microbiological failures, although fewer microbiological relapses were seen. Clinical Trials Registration NCT02437045.
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Affiliation(s)
- Adam G Stewart
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Barnaby Young
- National Centre for Infectious Disease, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Disease, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua S Davis
- Infectious Disease Department, John Hunter Hospital, Newcastle, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Kellie Schneider
- Infectious Disease Department, John Hunter Hospital, Newcastle, Australia
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol, Turkey
| | - Rumeysa Dinleyici
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol, Turkey
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrew Henderson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Sophia Archuleta
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore
| | - Brian M Forde
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia.,Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, Australia
| | - Mark D Chatfield
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Michelle J Bauer
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - Jeffrey Lipman
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Scientific Consultant, Nimes University Hospital, University of Montpellier, Nimes, France
| | | | - Patrick N A Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
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