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Xu A, Li M, Hang Y, Zeng L, Zhang X, Hu Y, Guo Q, Wang M. Multicenter retrospective genomic characterization of carbapenemase-producing Acinetobacter baumannii isolates from Jiangxi patients 2021-2022: identification of a novel international clone, IC11. mSphere 2024; 9:e0027624. [PMID: 38832781 DOI: 10.1128/msphere.00276-24] [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: 04/08/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
This study aimed to characterize carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from Jiangxi patients using whole-genome sequencing (WGS). We subjected 100 clinical CRAB strains isolated from the three local largest teaching hospitals to WGS and antimicrobial susceptibility testing. Molecular epidemiology was investigated using multilocus sequence typing, core genome multilocus typing, core genome single-nucleotide polymorphism phylogeny, and pulsed-field gel electrophoresis. The most prevalent acquired carbapenemase was blaOXA-23, predominant in all isolates (100%). Isolates belonging to the dominating international clone IC2 accounted for 92% of all isolates. International IC11 (ST164Pas/ST1418Ox) clone was found in an additional 8% (eight isolates), with seven isolates (87.5%) carrying an acquired additional blaNDM-1 carbapenemase. The oxa23-associated Tn2009, either alone or in a tandem repeat structure containing four copies of blaOXA-23, was discovered in 62% (57 isolates) of IC2. The oxa23-associated Tn2006 was identified in 38% (35 isolates) of IC2 and all IC11 isolates. A putative conjugative RP-T1 (formerly RepAci6) plasmid with blaOXA-23 in Tn2006 within AbaR4, designated pSRM1.1, was found in IC2 A. baumannii strain SRM1. The blaNDM-1 gene found in seven IC11 isolates was located on a novel Tn6924-like transposon, a first-time report in IC11. These findings underscore the significant importance of real-time surveillance to prevent the further spread of CRAB. IMPORTANCE Carbapenem-resistant Acinetobacter baumannii (CRAB) is notorious for causing difficult-to-treat infections. To elucidate the molecular and clinical epidemiology of CRAB in Jiangxi, clinical CRAB isolates were collected and underwent whole-genome sequencing and antibiotic susceptibility phenotyping. Key findings included the predominance of OXA-23-producing IC2 A. baumannii, marked by the emergence of OXA-23 and NDM-1-producing IC11 strains.
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Affiliation(s)
- An Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China
| | - Min Li
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yaping Hang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lingbing Zeng
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xuefei Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China
| | - Yiyi Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai, China
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Miller AA, Moussa SH, McLeod SM. Characterization of Acinetobacter baumannii-calcoaceticus complex isolates and microbiological outcome for patients treated with sulbactam-durlobactam in a phase 3 trial (ATTACK). Antimicrob Agents Chemother 2024; 68:e0169823. [PMID: 38567976 PMCID: PMC11064521 DOI: 10.1128/aac.01698-23] [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: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 05/03/2024] Open
Abstract
Acinetobacter baumannii-calcoaceticus complex (ABC) causes severe, difficult-to-treat infections that are frequently antibiotic resistant. Sulbactam-durlobactam (SUL-DUR) is a targeted β-lactam/β-lactamase inhibitor combination antibiotic designed to treat ABC infections, including those caused by multidrug-resistant strains. In a global, pathogen-specific, randomized, controlled phase 3 trial (ATTACK), the efficacy and safety of SUL-DUR were compared to colistin, both dosed with imipenem-cilastatin as background therapy, in patients with serious infections caused by carbapenem-resistant ABC. Results from ATTACK showed that SUL-DUR met the criteria for non-inferiority to colistin for the primary efficacy endpoint of 28-day all-cause mortality with improved clinical and microbiological outcomes compared to colistin. This report describes the characterization of the baseline ABC isolates from patients enrolled in ATTACK, including an analysis of the correlation of microbiological outcomes with SUL-DUR MIC values and the molecular drivers of SUL-DUR resistance.
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Affiliation(s)
- Alita A. Miller
- Entasis Therapeutics Inc., an affiliate of Innoviva Specialty Therapeutics, Inc., Waltham, Massachusetts, USA
| | - Samir H. Moussa
- Entasis Therapeutics Inc., an affiliate of Innoviva Specialty Therapeutics, Inc., Waltham, Massachusetts, USA
| | - Sarah M. McLeod
- Entasis Therapeutics Inc., an affiliate of Innoviva Specialty Therapeutics, Inc., Waltham, Massachusetts, USA
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Hu Y, Li D, Zhang G, Dai Y, Chen M, Jiang H, Cui W. Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study. Eur J Clin Microbiol Infect Dis 2024; 43:875-884. [PMID: 38443737 PMCID: PMC11108910 DOI: 10.1007/s10096-024-04794-y] [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: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. METHODS A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan-Meier survival and multivariate logistic regression analyses were performed. RESULTS The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. CONCLUSIONS Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.
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Affiliation(s)
- Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Danyang Li
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yunjian Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Meng Chen
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Huifang Jiang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Dudoignon E, Caméléna F, Lafaurie M, Deniau B, Chaussard M, Coutrot M, Guillemet L, Cupaciu A, Pharaboz A, Boutin L, Benyamina M, Chaouat M, Mimoun M, Merimèche M, Mebazaa A, Plaud B, Berçot B, Dépret F, Mellon G. Evolution, control and success of combination therapy with Ampicilin-sulbactam/Ceftazidime-Avibactam during a Carbapenem-Resistant Acinetobacter baumannii outbreak in burn Intensive Care Unit. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04840-9. [PMID: 38676856 DOI: 10.1007/s10096-024-04840-9] [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: 12/01/2023] [Accepted: 04/25/2024] [Indexed: 04/29/2024]
Abstract
We present our findings on interpatient transmission, epidemic control measures, and the outcomes of a series of ten critically ill burn patients who were either colonized or infected with carbapenem-resistant Acinetobacter baumannii (CRAB). None of the five infected patients achieved clinical cure, and all experienced relapses. Microbiological failure was observed in 40% of the infected patients. The isolated CRAB strains were found to carry blaOXA-23 and armA resistance genes. Despite the lack of clinical cure, all five infected patients survived and were discharged from the Burn Intensive Care Unit.
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Affiliation(s)
- Emmanuel Dudoignon
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France.
- University of Paris Cité, Paris, France.
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France.
- INI-CRCT Network, Nancy, France.
- FHU PROMICE, Paris, France.
| | - Francois Caméléna
- University of Paris Cité, Paris, France
- Department of Bacteriology, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Paris, France
- INSERM 1137, IAME, Paris, France
| | - Matthieu Lafaurie
- Infectious Diseases Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France
| | - Benjamin Deniau
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
- University of Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- INI-CRCT Network, Nancy, France
- FHU PROMICE, Paris, France
| | - Maité Chaussard
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Maxime Coutrot
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Lucie Guillemet
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Alexandru Cupaciu
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Alexandre Pharaboz
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Louis Boutin
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
- University of Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
| | - Marc Chaouat
- University of Paris Cité, Paris, France
- Plastic Surgery, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France
| | - Maurice Mimoun
- University of Paris Cité, Paris, France
- Plastic Surgery, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France
| | - Manel Merimèche
- Department of Bacteriology, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Paris, France
- INSERM 1137, IAME, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
- University of Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- INI-CRCT Network, Nancy, France
- FHU PROMICE, Paris, France
| | - Benoit Plaud
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
- University of Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- FHU PROMICE, Paris, France
| | - Béatrice Berçot
- University of Paris Cité, Paris, France
- Department of Bacteriology, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Paris, France
- INSERM 1137, IAME, Paris, France
| | - François Dépret
- Department of Anesthesiology and Critical Care and Burn Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis- Lariboisière, 1, avenue Claude Vellefaux, Paris, 75010, France
- University of Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- INI-CRCT Network, Nancy, France
- FHU PROMICE, Paris, France
| | - Guillaume Mellon
- Infectious Disease Prevention and Control Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France
- DMU PRISME, Paris, France
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Franzone JP, Mackow N, van Duin D. Current treatment options for pneumonia caused by carbapenem-resistant Acinetobacter baumannii. Curr Opin Infect Dis 2024; 37:137-143. [PMID: 38179988 PMCID: PMC10922681 DOI: 10.1097/qco.0000000000001001] [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] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to briefly summarize the challenges associated with the treatment of pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB), discuss its carbapenem-resistance, and review the literature supporting the current treatment paradigm and therapeutic options. RECENT FINDINGS In a multicenter, randomized, and controlled trial the novel β-lactam-β-lactamase inhibitor sulbactam-durlobactam was compared to colistin, both in addition to imipenem-cilastatin. The drug met the prespecified criteria for noninferiority for 28-day all-cause mortality while demonstrating higher clinical cure rates in the treatment of CRAB pneumonia. In an international, randomized, double-blind, placebo controlled trial colistin monotherapy was compared to colistin combined with meropenem. In this trial, combination therapy was not superior to monotherapy in the treatment of drug-resistant gram-negative organisms including CRAB pneumonia. SUMMARY CRAB pneumonia is a preeminent public health threat without an agreed upon first line treatment strategy. Historically, there have been drawbacks to available treatment modalities without a clear consensus on the first-line treatment regimen. CRAB pneumonia is a top priority for the continued development of antimicrobials, adjuvant therapies and refinement of current treatment strategies.
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Affiliation(s)
- John P. Franzone
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Natalie Mackow
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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Iovleva A, McElheny CL, Fowler EL, Cober E, Herc ES, Arias CA, Hill C, Baum K, Fowler VG, Chambers HF, Greenwood-Quaintance KE, Patel R, van Duin D, Bonomo RA, Doi Y. In vitro activity of sulbactam-durlobactam against colistin-resistant and/or cefiderocol-non-susceptible, carbapenem-resistant Acinetobacter baumannii collected in U.S. hospitals. Antimicrob Agents Chemother 2024; 68:e0125823. [PMID: 38289078 PMCID: PMC10916374 DOI: 10.1128/aac.01258-23] [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: 09/30/2023] [Accepted: 12/30/2023] [Indexed: 03/07/2024] Open
Abstract
The activity of a novel β-lactamase inhibitor combination, sulbactam-durlobactam (SUL-DUR), was tested against 87 colistin-resistant and/or cefiderocol-non-susceptible carbapenem-resistant Acinetobacter baumannii clinical isolates collected from U.S. hospitals between 2017 and 2019. Among them, 89% and 97% were susceptible to SUL-DUR and imipenem plus SUL-DUR, with MIC50/MIC90 values of 2 µg/mL/8 µg/mL and 1 µg/mL/4 µg/mL, respectively. The presence of amino acid substitutions in penicillin-binding protein 3, including previously reported A515V or T526S, was associated with SUL-DUR non-susceptibility.
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Affiliation(s)
- Alina Iovleva
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christi L. McElheny
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Erin L. Fowler
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erica S. Herc
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Cesar A. Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Carol Hill
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Keri Baum
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Vance G. Fowler
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Henry F. Chambers
- Division of Infectious Diseases, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kerryl E. Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David van Duin
- Division of Infectious Diseases University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert A. Bonomo
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Cleveland, Ohio, USA
- Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Clinician Scientist Investigator, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Departments of Microbiology and Infectious Diseases, Fujita Health University, Toyoake, Japan
- Center for Innovative Antimicrobial Therapy, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Arns B, Horvath JDC, Rech GS, Sesin GP, Agani CAJO, da Rosa BS, Dos Santos TM, Brochier LSB, Cavalcanti AB, Tomazini BM, Pereira AJ, Veiga VC, Nascimento GM, Kalil AC, Zavascki AP. A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol. Infect Dis Ther 2024; 13:237-250. [PMID: 38102448 PMCID: PMC10828314 DOI: 10.1007/s40121-023-00897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).
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Affiliation(s)
- Beatriz Arns
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil
| | | | - Gabriela Soares Rech
- Responsabilidade Social-PROADI, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Alexandre P Zavascki
- Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS, 90035-000, Brazil.
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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