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Xie M, Ye L, Chen K, Xu Q, Yang C, Chen X, Chan EWC, Li F, Chen S. Clinical use of tigecycline may contribute to the widespread dissemination of carbapenem-resistant hypervirulent Klebsiella pneumoniae strains. Emerg Microbes Infect 2024; 13:2306957. [PMID: 38240375 PMCID: PMC10829843 DOI: 10.1080/22221751.2024.2306957] [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: 10/22/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
The emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) poses grave threats to human health. These strains increased dramatically in clinical settings in China in the past few years but not in other parts of the world. Four isogenic K. pneumoniae strains, including classical K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), hypervirulent K. pneumoniae (hvKP) and CR-hvKP, were created and subjected to phenotypic characterization, competition assays, mouse sepsis model and rat colonization tests to investigate the mechanisms underlying the widespread nature of CR-hvKP in China. Acquisition of virulence plasmid led to reduced fitness and abolishment of colonization in the gastrointestinal tract, which may explain why hvKP is not clinically prevalent after its emergence for a long time. However, tigecycline treatment facilitated the colonization of hvKP and CR-hvKP and reduced the population of Lactobacillus spp. in animal gut microbiome. Feeding with Lactobacillus spp. could significantly reduce the colonization of hvKP and CR-hvKP in the animal gastrointestinal tract. Our data implied that the clinical use of tigecycline to treat carbapenem-resistant K. pneumoniae infections facilitated the high spread of CR-hvKP in clinical settings in China and demonstrated that Lactobacillus spp. was a potential candidate for anticolonization strategy against CR-hvKP.
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Affiliation(s)
- Miaomiao Xie
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
- Department of Food Science and Nutrition, Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lianwei Ye
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Kaichao Chen
- Department of Food Science and Nutrition, Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qi Xu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Chen Yang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Xiangnan Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Edward Wai-Chi Chan
- State Key Lab of Chemical Biology and Drug Discovery, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Fuyong Li
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Sheng Chen
- Department of Food Science and Nutrition, Faculty of Science, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Ishikawa K, Nakamura T, Kawai F, Ota E, Mori N. Systematic Review of Beta-Lactam vs. Beta-Lactam plus Aminoglycoside Combination Therapy in Neutropenic Cancer Patients. Cancers (Basel) 2024; 16:1934. [PMID: 38792012 DOI: 10.3390/cancers16101934] [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: 05/06/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
We performed a systematic review of studies that compared beta-lactams vs. beta-lactams plus aminoglycosides for the treatment of febrile neutropenia in cancer patients. METHOD We searched CENTRAL, MEDLINE, and Embase for studies published up to October 2023, and randomized controlled trials (RCTs) that compared anti-Pseudomonas aeruginosa beta-lactam monotherapy with any combination of an anti-Pseudomonas aeruginosa beta-lactam and an aminoglycoside were included. RESULT The all-cause mortality rate of combination therapy showed no significant differences compared with that of monotherapy (RR 0.99, 95% CI 0.84 to 1.16, high certainty of evidence). Infection-related mortality rates showed that combination therapy had a small positive impact compared with the intervention with monotherapy (RR 0.83, 95% CI 0.66 to 1.05, high certainty of evidence). Regarding treatment failure, combination therapy showed no significant differences compared with monotherapy (RR 0.99, 95% CI 0.94 to 1.03, low certainty of evidence). In the sensitivity analysis, the treatment failure data published between 2010 and 2019 showed better outcomes in the same beta-lactam group (RR 1.10 [95% CI, 1.01-1.19]). Renal failure was more frequent with combination therapy of any daily dosing regimen (RR 0.46, 95% CI 0.36 to 0.60, high certainty of evidence). CONCLUSION We found combining aminoglycosides with a narrow-spectrum beta-lactam did not spare the use of broad-spectrum antibiotics. Few studies included antibiotic-resistant bacteria and a detailed investigation of aminoglycoside serum levels, and studies that combined the same beta-lactams showed only a minimal impact with the combination therapy. In the future, studies that include the profile of antibiotic-resistant bacteria and the monitoring of serum aminoglycoside levels will be required.
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Affiliation(s)
- Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo 104-8560, Japan
| | - Fujimi Kawai
- Library, Department of Academic Resources, St. Luke's International University, Tokyo 104-0044, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, Tokyo 104-0044, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-0032, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan
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Strich JR, Mishuk A, Diao G, Lawandi A, Li W, Demirkale CY, Babiker A, Mancera A, Swihart BJ, Walker M, Yek C, Neupane M, De Jonge N, Warner S, Kadri SS. Assessing Clinician Utilization of Next-Generation Antibiotics Against Resistant Gram-Negative Infections in U.S. Hospitals : A Retrospective Cohort Study. Ann Intern Med 2024; 177:559-572. [PMID: 38639548 DOI: 10.7326/m23-2309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The U.S. antibiotic market failure has threatened future innovation and supply. Understanding when and why clinicians underutilize recently approved gram-negative antibiotics might help prioritize the patient in future antibiotic development and potential market entry rewards. OBJECTIVE To determine use patterns of recently U.S. Food and Drug Administration (FDA)-approved gram-negative antibiotics (ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, plazomicin, eravacycline, imipenem-relebactam-cilastatin, and cefiderocol) and identify factors associated with their preferential use (over traditional generic agents) in patients with gram-negative infections due to pathogens displaying difficult-to-treat resistance (DTR; that is, resistance to all first-line antibiotics). DESIGN Retrospective cohort. SETTING 619 U.S. hospitals. PARTICIPANTS Adult inpatients. MEASUREMENTS Quarterly percentage change in antibiotic use was calculated using weighted linear regression. Machine learning selected candidate variables, and mixed models identified factors associated with new (vs. traditional) antibiotic use in DTR infections. RESULTS Between quarter 1 of 2016 and quarter 2 of 2021, ceftolozane-tazobactam (approved 2014) and ceftazidime-avibactam (2015) predominated new antibiotic usage whereas subsequently approved gram-negative antibiotics saw relatively sluggish uptake. Among gram-negative infection hospitalizations, 0.7% (2551 [2631 episodes] of 362 142) displayed DTR pathogens. Patients were treated exclusively using traditional agents in 1091 of 2631 DTR episodes (41.5%), including "reserve" antibiotics such as polymyxins, aminoglycosides, and tigecycline in 865 of 1091 episodes (79.3%). Patients with bacteremia and chronic diseases had greater adjusted probabilities and those with do-not-resuscitate status, acute liver failure, and Acinetobacter baumannii complex and other nonpseudomonal nonfermenter pathogens had lower adjusted probabilities of receiving newer (vs. traditional) antibiotics for DTR infections, respectively. Availability of susceptibility testing for new antibiotics increased probability of usage. LIMITATION Residual confounding. CONCLUSION Despite FDA approval of 7 next-generation gram-negative antibiotics between 2014 and 2019, clinicians still frequently treat resistant gram-negative infections with older, generic antibiotics with suboptimal safety-efficacy profiles. Future antibiotics with innovative mechanisms targeting untapped pathogen niches, widely available susceptibility testing, and evidence demonstrating improved outcomes in resistant infections might enhance utilization. PRIMARY FUNDING SOURCE U.S. Food and Drug Administration; NIH Intramural Research Program.
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Affiliation(s)
- Jeffrey R Strich
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Ahmed Mishuk
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, George Washington University, Washington, DC (G.D.)
| | - Alexander Lawandi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland (A.L., N.D.J.)
| | - Willy Li
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Department of Pharmacy, Clinical Center, National Institutes of Health, Bethesda, Maryland (W.L.)
| | - Cumhur Y Demirkale
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Ahmed Babiker
- Division of Infectious Diseases, Emory University, Atlanta, Georgia (A.B.)
| | - Alex Mancera
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Bruce J Swihart
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Morgan Walker
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Christina Yek
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Maniraj Neupane
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Nathaniel De Jonge
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland (A.L., N.D.J.)
| | - Sarah Warner
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
| | - Sameer S Kadri
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda; and Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland (J.R.S., A.Mishuk, C.Y.D., A.Mansera, B.J.S., M.W., C.Y., M.N., S.W., S.S.K.)
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Li D, Rao H, Xu Y, Zhang M, Zhang J, Luo J. Monotherapy vs combination therapy in patients with Klebsiella pneumoniae bloodstream infection: A systematic review and meta-analysis. J Infect Chemother 2024; 30:372-378. [PMID: 38369125 DOI: 10.1016/j.jiac.2024.02.007] [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: 10/22/2023] [Revised: 12/24/2023] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To determine whether mortality is lower in patients with Klebsiella pneumoniae bloodstream infection (BSI) who receive combination antimicrobial therapy than in those who receive monotherapy. METHODS Two authors independently searched for relevant articles in the PubMed, Embase, Web of Science, and Cochrane Library databases through to August 10, 2023. Risk of bias was evaluated using the ROBINS-I tool. Possible sources of heterogeneity were evaluated by meta-regression using a mixed-effects model. RESULTS Among 8044 articles screened, there were 23 studies (3443 patients) that were eligible for meta-analysis. Meta-regression analysis identified the proportion of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI to be a potential source of heterogeneity. Subgroup analysis showed that mortality on monotherapy was significantly higher when the proportion of patients with CRKP BSI was ≥50% (OR 1.75, 95% CI 1.33-2.30) and significantly lower when this proportion was <50% (OR 0.55, 95% CI 0.24-1.24). Overall mortality was significantly higher on tigecycline monotherapy (OR 2.86, 95% CI 1.46-5.59) than on combination therapy containing both these agents. There was a trend in favor of colistin/polymyxin B-containing combination therapy (OR 1.37, 95% CI 0.83-2.28). CONCLUSIONS Combination antimicrobial therapy can lower mortality in patients with CRKP but may not show a survival advantage over monotherapy when the proportion of patients with CRKP BSI is <50%. High-quality prospective observational studies are needed because of the high risk of bias and limited data in the studies performed to date.
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Affiliation(s)
- Dan Li
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Huayun Rao
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Yi Xu
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Min Zhang
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China
| | - Jie Zhang
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jianrong Luo
- Department of Laboratory Medicine, Qionglai Medical Center Hospital , Chengdu, Sichuan, China.
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Gottesdiener LS, Satlin MJ. Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients. Transpl Infect Dis 2023; 25 Suppl 1:e14169. [PMID: 37864309 PMCID: PMC10844985 DOI: 10.1111/tid.14169] [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: 08/01/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
Patients with hematologic malignancies and hematopoietic cell transplant (HCT) recipients are at high risk of developing bacterial infections. These patients may suffer severe consequences from these infections if they do not receive immediate effective therapies, and thus are uniquely threatened by antimicrobial-resistant bacteria. Here, we outline how the emergence of specific resistant bacteria threatens the effectiveness of established approaches to prevent and treat infections in this population. The emergence of fluoroquinolone resistance among Enterobacterales and viridans group streptococci may decrease the effectiveness of fluoroquinolone prophylaxis during neutropenia. The emergence of Enterobacterales that produce extended-spectrum β-lactamases or carbapenemases and of increasingly resistant Pseudomonas aeruginosa may result in neutropenic patients experiencing delayed time to active antibacterial therapy, and consequently worse clinical outcomes. The ability to select targeted antibacterial therapies after the availability of susceptibility data may be limited in patients infected with metallo-β-lactamase-producing Enterobacterales and difficult-to-treat P. aeruginosa. Vancomycin-resistant enterococci and Stenotrophomonas maltophilia can cause breakthrough infections in patients already being treated with broad-spectrum β-lactam antibiotics. Resistance can also limit the ability to provide oral stepdown antibacterial therapy for patients who could otherwise be discharged from hospitalization. We also outline strategies that have the potential to mitigate the negative impact of antimicrobial resistance, including interventions based on active screening for colonization with resistant bacteria and the use of novel rapid diagnostic assays. Additional research is needed to better understand how these strategies can be leveraged to combat the emerging crisis of antimicrobial resistance in patients with hematologic malignancies and HCT recipients.
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Affiliation(s)
- Lee S. Gottesdiener
- Division of Infectious Diseases, Weill Cornell Medicine,
New York, NY, USA
- NewYork-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, USA
| | - Michael J. Satlin
- NewYork-Presbyterian Hospital, Weill Cornell Medical
Center, New York, NY, USA
- Transplantation-Oncology Infectious Diseases Program,
Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
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Meng H, Yang J, Niu M, Zhu H, Zhou Y, Lu J. Risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae bacteraemia in children: a retrospective study. Int J Antimicrob Agents 2023; 62:106933. [PMID: 37500022 DOI: 10.1016/j.ijantimicag.2023.106933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Carbapenem-resistant Klebsiella pneumoniae (CRKP) is increasingly being identified in children, but data on the clinical outcomes in this population are limited. This study aimed to characterise the risk factors for 30-day mortality with CRKP bloodstream infection (BSI) in children. METHODS A retrospective study was performed from January 2018 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Patients aged < 18 years and with CRKP BSI were included. Multivariable Cox and logistic regression were performed to determine risk factors for death and the development of septic shock following CRKP infection, respectively. RESULTS This study identified 33 neonates aged 0-4 weeks and 37 older children. The 30-day mortality rate was 39.4% in neonates and 43.2% in older children. In the neonatal population, a higher Pitt bacteremia score (HR 1.694; 95% CI 1.313-2.186; P < 0.001) was an independent risk factor for 30-day mortality. In the non-neonatal population, higher platelet count (HR 0.990; 95% CI 0.982-0.998; P = 0.010), the use of carbapenems (HR 0.212; 95% CI 0.064-0.702; P = 0.011) and appropriately targeted antimicrobial treatment (HR 0.327; 95% CI 0.111-0.969; P = 0.044) were associated with decreased 30-day mortality. Monocyte count < 0.1 × 109 cells/L (OR 3.615; 95% CI 1.165-11.444; P = 0.026) and a higher Pitt bacteremia score (OR 1.330; 95% CI 1.048-1.688; P = 0.019) were identified as risk factors for the development of septic shock. CONCLUSIONS Carbapenem-resistant Klebsiella pneumoniae BSI was associated with high mortality in children. Appropriate antimicrobial treatment is important to improve survival, but more work is needed to assess the efficacy of specific treatment regimens in children.
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Affiliation(s)
- Haiyang Meng
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Mengxia Niu
- Department of Pharmacy, The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Han Zhu
- Department of Pharmacy, Anyang Maternal and Child Health Care Hospital, Anyang Children's Hospital, Anyang, China
| | - Yuke Zhou
- Department of Pharmacy, The First People's Hospital of Yiyang, Luoyang, China
| | - Jingli Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China.
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Geßner D, Berisha M, Esser T, Schalk E. Tigecycline as salvage treatment of febrile neutropenia in patients with haematological malignancies-a retrospective single-centre analysis of 200 cases. Ann Hematol 2023; 102:2607-2616. [PMID: 37186157 PMCID: PMC10444688 DOI: 10.1007/s00277-023-05222-5] [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: 12/12/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Tigecycline has been used to treat patients with febrile neutropenia (FN). This study aims to analyse the effectiveness of tigecycline as salvage treatment of FN. Patients records from 09/2004 to 04/2019 were reviewed. Cases were eligible if fever persisted/recurred (p/r-FN) after 3 days of second-line treatment with a carbapenem, and were divided into three groups: switch to tigecycline (TGC group), switch to other antibiotics (OAB group), and no switch (W&W group). The primary endpoint was response rate (defervescence for ≥ 7 days or at least until discharge); the key secondary endpoint was 30-day mortality rate. Two hundred cases from 176 patients (median 59 years; 53.5% men) treated were included, mostly acute myeloid leukaemias (61.0%). 45.5% of cases were in the TGC group (in combination with an anti-pseudomonal antibiotic, mostly ceftazidime [95.6%]); 35.5% were in the OAB and 19.0% in the W&W group. There was no significant difference in response rates (TGC, 73.6%; OAB, 62.0%; W&W, 78.9%; p = 0.12) or 30-day mortality rates (TGC, 7.7%; OAB, 7.0%; W&W, 5.3%; p = 0.94). Tigecycline plus an anti-pseudomonal antibiotic does not improve response or 30-day mortality rate compared to other antibiotics in patients with p/r-FN. Also, in some cases, no switch in antibiotics may be necessary at all.
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Affiliation(s)
- Daniel Geßner
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mirjeta Berisha
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Torben Esser
- Institute of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke University Magdeburg, Medical Centre, Magdeburg, Germany
| | - Enrico Schalk
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Galvidis IA, Surovoy YA, Tsarenko SV, Burkin MA. Tigecycline Immunodetection Using Developed Group-Specific and Selective Antibodies for Drug Monitoring Purposes. BIOSENSORS 2023; 13:343. [PMID: 36979555 PMCID: PMC10046529 DOI: 10.3390/bios13030343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Tigecycline (TGC), a third-generation tetracycline, is characterized by a more potent and broad antibacterial activity, and the ability to overcome different mechanisms of tetracycline resistance. TGC has proven to be of value in treatment of multidrug-resistant infections, but therapy can be complicated by multiple dangerous side effects, including direct drug toxicity. Given that, a TGC immunodetection method has been developed for therapeutic drug monitoring to improve the safety and efficacy of therapy. The developed indirect competitive ELISA utilized TGC selective antibodies and group-specific antibodies interacting with selected coating TGC conjugates. Both assay systems showed high sensitivity (IC50) of 0.23 and 1.59 ng/mL, and LOD of 0.02 and 0.05 ng/mL, respectively. Satisfactory TGC recovery from the spiked blood serum of healthy volunteers was obtained in both assays and laid in the range of 81-102%. TGC concentrations measured in sera from COVID-19 patients with secondary bacterial infections were mutually confirmed by ELISA based on the other antibody-antigen interaction and showed good agreement (R2 = 0.966). A TGC pharmacokinetic (PK) study conducted in three critically ill patients proved the suitability of the test to analyze the therapeutic concentrations of TGC. Significant inter-individual PK variability revealed in this limited group supports therapeutic monitoring of TGC in individual patients and application of the test for population pharmacokinetic modelling.
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Affiliation(s)
- Inna A. Galvidis
- I. Mechnikov Research Institute for Vaccines and Sera, Moscow 105064, Russia
| | - Yury A. Surovoy
- I. Mechnikov Research Institute for Vaccines and Sera, Moscow 105064, Russia
- Faculty of Medicine, M.V. Lomonosov Moscow State University, Moscow 119991, Russia
| | - Sergei V. Tsarenko
- Faculty of Medicine, M.V. Lomonosov Moscow State University, Moscow 119991, Russia
- Federal Center for Treatment and Rehabilitation Ministry of Health, Moscow 125367, Russia
| | - Maksim A. Burkin
- I. Mechnikov Research Institute for Vaccines and Sera, Moscow 105064, Russia
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Tigecycline Pharmacokinetic and Pharmacodynamic Profile in Patients with Chronic Obstructive Pulmonary Disease Exacerbation. Antibiotics (Basel) 2023; 12:antibiotics12020307. [PMID: 36830217 PMCID: PMC9952492 DOI: 10.3390/antibiotics12020307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We aimed to evaluate the pharmacokinetic profile of tigecycline in plasma and its penetration to sputum in moderately ill patients with an infectious acute exacerbation of chronic obstructive pulmonary disease (COPD). METHODS Eleven patients hospitalized with acute respiratory failure due to an acute COPD exacerbation with clinical evidence of an infectious cause received tigecycline 50 mg twice daily after an initial loading dose of 100 mg. Blood and sputum samples were collected at steady state after dose seven. RESULTS In plasma, mean Cmax pl was 975.95 ± 490.36 ng/mL and mean Cmin pl was 214.48 ±140.62 ng/mL. In sputum, mean Cmax sp was 641.91 ± 253.07 ng/mL and mean Cmin sp was 308.06 ± 61.7 ng/mL. In plasma, mean AUC 0-12 pl was 3765.89 ± 1862.23 ng*h/mL, while in sputum mean AUC 0-12 sp was 4023.27 ± 793.37 ng*h/mL. The mean penetration ratio for the 10/11 patients was 1.65 ± 1.35. The mean Free AUC0-24 pl/MIC ratio for Streptococcus pneumoniae and Haemophilus influenzae was 25.10 ± 12.42 and 6.02 ± 2.97, respectively. CONCLUSIONS Our findings support the clinical effectiveness of tigecycline against commonly causative bacteria in COPD exacerbations and highlight its sufficient lung penetration in pulmonary infections of moderate severity.
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Johnson TM, Byrd TF, Drummond WK, Childs-Kean LM, Mahoney MV, Pearson JC, Rivera CG. Contemporary Pharmacotherapies for Nontuberculosis Mycobacterial Infections: A Narrative Review. Infect Dis Ther 2023; 12:343-365. [PMID: 36609820 PMCID: PMC9925655 DOI: 10.1007/s40121-022-00750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 01/08/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) are a group of atypical bacteria that may cause a spectrum of clinical manifestations, including pulmonary, musculoskeletal, skin and soft tissue, and cardiac infections. Antimycobacterial medication regimens for NTM infections require multiple agents with prolonged treatment courses and are often associated with poor tolerance in patients and suboptimal clinical outcomes. This review summarizes NTM pharmacotherapy, including treatment concepts, preferred medication regimens according to NTM species and site of infection, and emerging treatment methods for difficult-to-treat species.
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Affiliation(s)
| | - Thomas F Byrd
- Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA
| | - Wendi K Drummond
- Division of Infectious Diseases, Providence Portland Medical Center, Portland, OR, USA
| | | | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey C Pearson
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA, USA
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11
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Abdel Halim RM, Saber SM, Fahim NAE. Evaluation of synergistic activity of antibiotic combinations in extensive drug-resistant Acinetobacter species using checkerboard assay. J Med Microbiol 2023; 72. [PMID: 36762530 DOI: 10.1099/jmm.0.001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction. Acinetobacter is one of the challenging drug-resistant organisms that can endanger patients' lives if not treated properly.Aim. This study was designed to investigate the activity of three synergistic antimicrobial combinations against extensive drug-resistant Acinetobacter isolates; ampicillin/sulbactam plus amikacin, ampicillin/sulbactam plus ciprofloxacin, and meropenem plus amikacin.Methodology. Minimum inhibitory concentrations of 100 XDR-Acinetobacter isolates were determined using the Vitek2 system. The broth micro-dilution method was performed to determine tigecycline MIC. Checkerboard assay was used to evaluate in vitro activity of the three antibiotic combinations.Results. MIC results by the Vitek 2C system revealed that all Acinetobacter isolates were resistant to all tested antibiotics except for colistin against which no resistance was reported. As for tigecycline, all isolates were susceptible. Regarding MIC results of each antibiotic, all isolates were resistant to meropenem and ciprofloxacin. While 95 % of isolates were resistant to both ampicillin/sulbactam and amikacin. The activities of antibiotic combinations by checkerboard assay were as follows: ampicillin/sulbactam plus amikacin was synergic in 52 %, additive 40 % and indifferent in 8 % of isolates, ampicillin/sulbactam plus ciprofloxacin was synergic in 40 %, additive 46 % and indifferent in 14 % of isolates, meropenem/amikacin combination was synergic in 22 %, additive in 49 % of isolates and indifferent in 29 % of isolates. No antagonistic activity was detected against any of the tested antibiotic combinations.Conclusion. Ampicillin/sulbactam plus amikacin showed the highest synergistic activity followed by ampicillin/sulbactam plus ciprofloxacin. This reflects the value of adding aminoglycosides to either of a β-lactam or quinolone. The tested antibiotic combinations are promising treatment options for XDR-Acinetobacter.
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Affiliation(s)
- Rania M Abdel Halim
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Sally M Saber
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Noha Alaa Eldin Fahim
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
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12
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Gu S, Xiong J, Peng S, Hu L, Zhu H, Xiao Y, Luo H, Hang Y, Chen Y, Fang X, Cao X, Fang Y, Li F, Zhu J, Zhong Q. Assessment of Effective Antimicrobial Regimens and Mortality-Related Risk Factors for Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii. Infect Drug Resist 2023; 16:2589-2600. [PMID: 37152405 PMCID: PMC10154582 DOI: 10.2147/idr.s408927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Objective This study aimed to determine the clinical features, risk factors, and effective antimicrobial therapy for Carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). Methods This was a retrospective analysis of data from patients with CRAB bacteremia in a Chinese tertiary hospital between January 2012 and October 2021. Risk factors, predictors of 30-day mortality, and effective antimicrobial therapy for CRAB BSI were identified using logistic and cox regression analyses. Results Data from 276 patients with Acinetobacter baumannii (AB) BSI were included, of whom 157 (56.9%) had CRAB BSI. The risk factors that were significantly associated with CRAB BSI included previous intensive care unit (ICU) stay (P < 0.001), immunocompromised status (P < 0.001), cephalosporin use (P = 0.014), and fluoroquinolone use (P = 0.007). The 30-day mortality of the CRAB BSI group was 49.7% (78/157). ICU stay after BSI (P = 0.047), sequential organ failure assessment (SOFA) score ≥10 (P < 0.001), and multiple organ failure (MOF) (P = 0.037) were independent predictors of 30-day mortality. Among antibiotic strategies for the treatment of patients with CRAB BSI, we found that definitive regimens containing cefoperazone/sulbactam were superior to those without cefoperazone/sulbactam in reducing the 30-day mortality rate (25.4% vs 53.4%, P = 0.005). After propensity score matching, we observed a significant increase in the 30-day mortality (77.8%vs 33.3%, P = 0.036) in patients receiving tigecycline monotherapy compared to those receiving cefoperazone/sulbactam monotherapy. The mortality rate of patients receiving tigecycline with cefoperazone/sulbactam was also higher than that of patients receiving cefoperazone-sulbactam monotherapy; however, the difference was not significant (28.6%vs 19.0%, P = 0.375). Conclusion The severity of patient conditions was significantly associated with mortality in patients with CRAB BSI. Those Patients treated with cefoperazone/sulbactam had better clinical prognoses, and tigecycline should be used with caution.
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Affiliation(s)
- Shumin Gu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Jianqiu Xiong
- Departmentof Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Suqin Peng
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Longhua Hu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Hongying Zhu
- Clinical Laboratory of Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
| | - Yanping Xiao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Hong Luo
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yaping Hang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yanhui Chen
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Xueyao Fang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Xingwei Cao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Youling Fang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Fuxing Li
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Junqi Zhu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Qiaoshi Zhong
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- Correspondence: Qiaoshi Zhong, Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Email
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13
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Haddad N, Carr M, Balian S, Lannin J, Kim Y, Toth C, Jarvis J. The Blood-Brain Barrier and Pharmacokinetic/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults. Antibiotics (Basel) 2022; 11:antibiotics11121843. [PMID: 36551500 PMCID: PMC9774927 DOI: 10.3390/antibiotics11121843] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial central nervous system (CNS) infections are serious and carry significant morbidity and mortality. They encompass many syndromes, the most common being meningitis, which may occur spontaneously or as a consequence of neurosurgical procedures. Many classes of antimicrobials are in clinical use for therapy of CNS infections, some with established roles and indications, others with experimental reporting based on case studies or small series. This review delves into the specifics of the commonly utilized antibacterial agents, updating their therapeutic use in CNS infections from the pharmacokinetic and pharmacodynamic perspectives, with a focus on the optimization of dosing and route of administration that have been described to achieve good clinical outcomes. We also provide a concise synopsis regarding the most focused, clinically relevant information as pertains to each class and subclass of antimicrobial therapeutics. CNS infection morbidity and mortality remain high, and aggressive management is critical in ensuring favorable patient outcomes while averting toxicity and upholding patient safety.
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Affiliation(s)
- Nicholas Haddad
- College of Medicine, Central Michigan University (CMU), Mt Pleasant, MI 48859, USA
- Correspondence: ; Tel.: +1-(989)-746-7860
| | | | - Steve Balian
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | | | - Yuri Kim
- CMU Medical Education Partners, Saginaw, MI 48602, USA
| | - Courtney Toth
- Ascension St. Mary’s Hospital, Saginaw, MI 48601, USA
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14
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Pinchera B, Buonomo AR, Schiano Moriello N, Scotto R, Villari R, Gentile I. Update on the Management of Surgical Site Infections. Antibiotics (Basel) 2022; 11:1608. [PMID: 36421250 PMCID: PMC9686970 DOI: 10.3390/antibiotics11111608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 10/29/2023] Open
Abstract
Surgical site infections are an increasingly important issue in nosocomial infections. The progressive increase in antibiotic resistance, the ever-increasing number of interventions and the ever-increasing complexity of patients due to their comorbidities amplify this problem. In this perspective, it is necessary to consider all the risk factors and all the current preventive and prophylactic measures which are available. At the same time, given multiresistant microorganisms, it is essential to consider all the possible current therapeutic interventions. Therefore, our review aims to evaluate all the current aspects regarding the management of surgical site infections.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
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15
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Ellis RC, Roberts EK, Grier JT, Fiester SE. Acinetobacter baumannii infections resistant to treatment: warning signs from the COVID-19 pandemic. Future Microbiol 2022; 17:1345-1347. [PMID: 36200659 DOI: 10.2217/fmb-2022-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ryan C Ellis
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Elena K Roberts
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Jennifer T Grier
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Steven E Fiester
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA.,Department of Pathology, Prisma Health Upstate, Greenville, SC 29605, USA
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16
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Meng R, Guan X, Sun L, Fei Z, Li Y, Luo M, Ma A, Li H. The efficacy and safety of eravacycline compared with current clinically common antibiotics in the treatment of adults with complicated intra-abdominal infections: A Bayesian network meta-analysis. Front Med (Lausanne) 2022; 9:935343. [PMID: 36186801 PMCID: PMC9524542 DOI: 10.3389/fmed.2022.935343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Eravacycline is a novel, fully synthetic fluorocycline antibiotic for the treatment of adults with complicated intra-abdominal infections (cIAIs). However, the efficacy and safety of eravacycline compared with current clinically common antibiotics remain unknown. Objective This study aims to compare the efficacy and safety of eravacycline and other clinically common antibiotics in China, including tigecycline, meropenem, ertapenem, ceftazidime/avibactam+metronidazole, piperacillin/tazobactam, imipenem/cilastatin, and ceftriaxone+metronidazole, for the treatment of adults with cIAIs and to provide a reference for clinical choice. Methods The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were electronically searched to collect clinical randomized controlled studies (RCTs) comparing different antibiotics in the treatment of patients with cIAIs from inception to June 1, 2021. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Results A total of 4050 articles were initially retrieved, and 25 RCTs were included after screening, involving eight treatment therapies and 9372 patients. The results of network meta-analysis showed that in the intention-to-treat (ITT) population, the clinically evaluable (CE) population, and the microbiologically evaluable (ME) population, the clinical response rate of eravacycline was not significantly different from that of the other 7 therapies (P > 0.05). In terms of microbiological response rate, eravacycline was significantly better than tigecycline [tigecycline vs. eravacycline: RR = 0.82, 95%CI (0.65,0.99)], and there was no significant difference between the other 6 regimens and eravacycline (P > 0.05). In terms of safety, the incidence of serious adverse events, discontinuation rate, and all-cause mortality of eravacycline were not significantly different from those of the other 7 treatment therapies (P > 0.05). Conclusion Based on the evidence generated by the current noninferiority clinical trial design, the efficacy and safety of eravacycline for the treatment of adults with cIAIs are not significantly different from those of the other 7 commonly used clinical antibiotics in China. In terms of microbiological response rate, eravacycline was significantly better than tigecycline. In view of the severe multidrug-resistant situation in China, existing drugs have difficulty meeting the needs of clinical treatment, and the new antibacterial drug eravacycline may be one of the preferred options for the treatment of cIAIs in adults.
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Affiliation(s)
- Rui Meng
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Xin Guan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Lei Sun
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Zhengyang Fei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Yuxin Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Mengjie Luo
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
- *Correspondence: Aixia Ma
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
- Hongchao Li
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17
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Rando E, Giovannenze F, Murri R, Sacco E. A review of recent advances in the treatment of adults with complicated urinary tract infection. Expert Rev Clin Pharmacol 2022; 15:1053-1066. [PMID: 36062485 DOI: 10.1080/17512433.2022.2121703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Complicated urinary tract infections (cUTIs) entail diverse clinical conditions that could be managed differently and not necessarily with premature empiric therapy. Since multidrug-resistant organisms (MDROs) are widely spreading worldwide, the possibility of encountering these resistant bacteria is inevitably part of the daily life of physicians who manage cUTIs. AREAS COVERED The advances in the management of cUTIs are explored, illustrating: 1) a proposed therapeutical approach to cUTIs within the antimicrobial stewardship context; 2) evidence regarding novel antibiotics targeting MDROs. Evidence research has been performed through MEDLINE/PubMed using appropriate keywords and terms regarding cUTIs published before June 2022. EXPERT OPINION Novel antimicrobial drugs are available in the clinicians' armamentarium. Selecting the optimal therapy for suitable patients may be challenging given the multifaceted group of cUTIs. Carbapenems use is widely increasing, the role of old β-lactam/β-lactamase inhibitors is constantly revised, and novel drugs lack real-life studies. Understanding the different ranges of the complexity of patients affected by cUTIs may help select the most suitable antibiotic for every single case. More multicentric observational studies targeting cUTIs are needed to elucidate the appropriate drug based on patient characteristics and presentations, providing stronger recommendations for cases encountered in everyday clinical practice.
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Affiliation(s)
- Emanuele Rando
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Giovannenze
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Emilio Sacco
- Urology Dept., Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Cefiderocol and the Need for Higher-Quality Evidence: Methods Matter for Patients. Antimicrob Agents Chemother 2022; 66:e0076622. [PMID: 35862749 PMCID: PMC9380567 DOI: 10.1128/aac.00766-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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19
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Extraction Methods, Quantitative and Qualitative Phytochemical Screening of Medicinal Plants for Antimicrobial Textiles: A Review. PLANTS 2022; 11:plants11152011. [PMID: 35956489 PMCID: PMC9370299 DOI: 10.3390/plants11152011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Medicinal plants are the product of natural drug discoveries and have gained traction due to their pharmacological activities. Pathogens are everywhere, and they thrive in ideal conditions depending on the nutrients, moisture, temperature, and pH that increase the growth of harmful pathogens on surfaces and textiles. Thus, antimicrobial agents and finishes may be the solution to the destruction of pathogens. This review article presents an analysis of various aspects of producing antimicrobial finishings, the microorganisms, their mechanism of attachment to natural and synthetic fibre, the effect of microbial growth, and the principle and mechanism of the microbial activity of the medicinal plants. Furthermore, the extraction methods, qualitative and quantitative phytochemical evaluations of antimicrobial efficacy, and developments of antimicrobial treated textiles using various agents are covered in this review.
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20
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Chang K, Wang H, Zhao J, Yang X, Wu B, Sun W, Huang M, Cheng Z, Chen H, Song Y, Chen P, Chen X, Gan X, Ma W, Xing L, Wang Y, Gu X, Zou X, Cao B. Polymyxin B/Tigecycline Combination vs. Polymyxin B or Tigecycline Alone for the Treatment of Hospital-Acquired Pneumonia Caused by Carbapenem-Resistant Enterobacteriaceae or Carbapenem-Resistant Acinetobacter baumannii. Front Med (Lausanne) 2022; 9:772372. [PMID: 35755062 PMCID: PMC9226555 DOI: 10.3389/fmed.2022.772372] [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: 09/08/2021] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction It is not clear whether polymyxin B/tigecycline (PMB/TGC) combination is better than PMB or TGC alone in the treatment of hospital-acquired pneumonia (HAP) caused by carbapenem-resistant organisms (CROs). Methods We conducted a multicenter, retrospective cohort study in patients with HAP caused by CROs. The primary outcome was 28-day mortality, and the secondary outcomes included clinical success and the incidence of acute kidney injury (AKI). Multivariate Cox regression analysis was performed to examine the relationship between antimicrobial treatments and 28-day mortality by adjusting other potential confounding factors. Results A total of 364 eligible patients were included in the final analysis, i.e., 99 in the PMB group, 173 in the TGC group, and 92 in the PMB/TGC combination group. The 28-day mortality rate was 28.3% (28/99) in the PMB group, 39.3% (68/173) in the TGC group, and 48.9% (45/92) in the PMB/TGC combination group (p = 0.014). The multivariate Cox regression model showed that there was a statistically significant lower risk of 28-day mortality among participants in the PMB group when compared with the PMB/TGC combination group [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31–0.81, p = 0.004] and that participants in the TGC group had a lower risk of 28-day mortality than in the PMB/TGC combination group but without statistical significance. The incidence of AKI in the PMB group (52.5%) and the PMB/TGC combination group (53.3%) was significantly higher than that in the TGC group (33.5%, p = 0.001). Conclusion The appropriate PMB/TGC combination was not superior to appropriate PMB therapy in the treatment of HAP caused by carbapenem-resistant Enterobacteriaceae/carbapenem-resistant Acinetobacter baumannii (CRE/CRAB) in terms of 28-day mortality.
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Affiliation(s)
- Kang Chang
- National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xianghong Yang
- Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Bo Wu
- Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wenkui Sun
- Department of Respirology and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Man Huang
- Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenshun Cheng
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Chen
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangqi Chen
- Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xin Gan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanli Ma
- Department of Respiratory and Critical Care Medicine, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lihua Xing
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, China Centre of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, China Centre of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohui Zou
- National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Bin Cao
- National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, China-Japan Friendship Hospital, Capital Medical University, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China Centre of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
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21
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Impact of Tigecycline on C. difficile Outcomes: Case Series and Propensity-Matched Retrospective Study. Antimicrob Agents Chemother 2022; 66:e0000122. [PMID: 35647645 PMCID: PMC9211400 DOI: 10.1128/aac.00001-22] [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] [Indexed: 11/20/2022] Open
Abstract
This case series and propensity-matched cohort study on the use of tigecycline in Clostridioides difficile infection (CDI) evaluated the effect of tigecycline on 30-day mortality. Adjusted for ATLAS Score, hypotension, treatment time period, and serum lactate, tigecycline did not significantly improve 30-day mortality (odds ratio: 0.89; 95% confidence interval: 0.25–3.12; P = 0.853). A randomized controlled trial is needed to determine efficacy and safety of tigecycline in severe or refractory CDI.
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Zhou CC, Huang F, Zhang JM, Zhuang YG. Population Pharmacokinetics of Tigecycline: A Systematic Review. Drug Des Devel Ther 2022; 16:1885-1896. [PMID: 35747442 PMCID: PMC9211078 DOI: 10.2147/dddt.s365512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022] Open
Abstract
Although tigecycline is widely used in clinical practice, its efficiency and optimal dosage regimens remain controversial. The purpose of this article was to help guide tigecycline dosing in different patient subpopulations through comparing the published population pharmacokinetic models of tigecycline, as well as summarizing and determining the potential covariates that markedly influence tigecycline pharmacokinetics. In this review, literature was systematically searched from the PubMed database from inception to March 2022. The articles focusing on population pharmacokinetics for tigecycline in healthy volunteers or patients were included; finally, a total of eight studies were included in this review. NONMEM methods were used in five studies to generate the population pharmacokinetic models. Tigecycline pharmacokinetics were mostly described by a two-compartment model in these included studies. Estimated clearance and volumes of distribution of tigecycline at steady state (Vss) varied widely in different target patient populations, with a range of 7.5–23.1 L/h and 212.7–1087.7 L, respectively. Body-weight and creatinine clearance were the most important predictors of clearance in these studies, while other predictors include age, gender, bilirubin and aspartate aminotransferase. In conclusion, this review showed the large variability of tigecycline population pharmacokinetics, which can provide guide dosing in different target populations. For clinicians, the individual dosing adjustment should be based not only on the indication and pathogen susceptibility but also on the potential important predictors. However, more studies were needed to confirm the necessity of modified dosage regimens in different patient subpopulations.
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Affiliation(s)
- Can-Can Zhou
- Department of Pharmacy, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, People’s Republic of China
| | - Fang Huang
- Department of Pharmacy, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, People’s Republic of China
| | - Jing-Ming Zhang
- Department of Pharmacy, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, People’s Republic of China
| | - Yu-Gang Zhuang
- Department of Emergency Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, People’s Republic of China
- Correspondence: Yu-Gang Zhuang, Email
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Falcone M, Tiseo G, Leonildi A, Della Sala L, Vecchione A, Barnini S, Farcomeni A, Menichetti F. Cefiderocol- Compared to Colistin-Based Regimens for the Treatment of Severe Infections Caused by Carbapenem-Resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2022; 66:e0214221. [PMID: 35311522 PMCID: PMC9112922 DOI: 10.1128/aac.02142-21] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Cefiderocol may represent a therapeutic option for carbapenem-resistant Acinetobacter baumannii (CRAB) infections, but clinical data are limited. This is an observational retrospective study conducted in the University Hospital of Pisa including consecutive patients with CRAB infections (January 2020 to August 2021). Patients were divided in two study groups according to the antibiotic treatment received: cefiderocol- and colistin-containing regimens. The primary outcome was the 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. A total of 124 patients were included: 47 (37.9%) received cefiderocol, while 77 (62.1%) colistin-containing regimens. Overall, 79 (63.7%) patients had a bloodstream infection (BSI), 35 (28.5%) a ventilator-associated pneumonia (VAP) and 10 (8.1%) other infections. Thirty-day mortality was higher in patients receiving colistin- compared to those who received cefiderocol-containing regimens (55.8% versus 34%, P = 0.018). This difference was confirmed in patients with BSI, but not in those with VAP. On multivariable analysis, septic shock, SOFA score, and age were independently associated with 30-day mortality, while cefiderocol therapy was protective in an IPTW analysis (Hazard ratio 0.44, 95% confidence interval 0.22-0.66, P < 0.001). Nephrotoxicity was more common in the colistin group. Microbiological failure occurred in 17.4% of patients receiving cefiderocol versus 6.8% of those receiving colistin (P = 0.079). Among 8 cases in the cefiderocol group who experienced microbiological failure, 4 (50%) developed resistance to cefiderocol. Cefiderocol represents a promising therapeutic option in patients with severe CRAB infections. Randomized clinical trial in this specific patient population should confirm our findings.
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Affiliation(s)
- Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Leonardo Della Sala
- Department of Clinical and Experimental Medicine, University of Pisa, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome “Tor Vergata,” Rome, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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24
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Scott CJ, Zhu E, Jayakumar RA, Shan G, Viswesh V. Efficacy of Eravacycline Versus Best Previously Available Therapy for Adults With Pneumonia Due to Difficult-to-Treat Resistant (DTR) Acinetobacter baumannii. Ann Pharmacother 2022; 56:1299-1307. [PMID: 35511209 DOI: 10.1177/10600280221085551] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii remains challenging to treat. Although eravacycline has in vitro activity against this pathogen, there are no studies evaluating outcomes. OBJECTIVE To assess the efficacy of eravacycline compared with best previously available therapy in adults with difficult-to-treat resistant (DTR) A. baumannii pneumonia. METHODS This was a retrospective study of adults hospitalized for pneumonia with DTR A. baumannii. Patients receiving eravacycline were compared with those receiving best previously available therapy. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included clinical cure at Day 14, hospital and intensive care unit (ICU) length of stay, microbiologic cure, and readmission within 90 days with a positive A. baumannii respiratory culture. RESULTS Ninety-three patients were included, with 27 receiving eravacycline. Eravacycline was associated with higher 30-day mortality (33% vs 15%; P = 0.048), lower microbiologic cure (17% vs 59%; P = 0.004), and longer durations of mechanical ventilation (10.5 vs 6.5 days; P = 0.016). At baseline, eravacycline patients had more A. baumannii bacteremia and coinfection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Among bacteremic patients, all 4 receiving eravacycline died by Day 30 and both patients receiving best previously available therapy survived. Upon exclusion of patients with bacteremia and SARS-CoV-2, there were no differences between the groups across any outcomes. CONCLUSIONS Eravacycline-based combination therapy had similar outcomes to best previously available combination therapy for adults with DTR A. baumannii pneumonia. However, eravacycline should be used with caution in the setting of bacteremia as outcomes were poor in this population.
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Affiliation(s)
- Courtney J Scott
- Department of Pharmacy, Valley Hospital Medical Center, Las Vegas, NV, USA
| | - Elizabeth Zhu
- Department of Pharmacy, Henderson Hospital, Henderson, NV, USA
| | | | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Velliyur Viswesh
- College of Pharmacy, Roseman University of Health Sciences, Henderson, NV, USA
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25
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Lynch JP, Clark NM, Zhanel GG. Infections Due to Acinetobacter baumannii-calcoaceticus Complex: Escalation of Antimicrobial Resistance and Evolving Treatment Options. Semin Respir Crit Care Med 2022; 43:97-124. [PMID: 35172361 DOI: 10.1055/s-0041-1741019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bacteria within the genus Acinetobacter (principally A. baumannii-calcoaceticus complex [ABC]) are gram-negative coccobacilli that most often cause infections in nosocomial settings. Community-acquired infections are rare, but may occur in patients with comorbidities, advanced age, diabetes mellitus, chronic lung or renal disease, malignancy, or impaired immunity. Most common sites of infections include blood stream, skin/soft-tissue/surgical wounds, ventilator-associated pneumonia, orthopaedic or neurosurgical procedures, and urinary tract. Acinetobacter species are intrinsically resistant to multiple antimicrobials, and have a remarkable ability to acquire new resistance determinants via plasmids, transposons, integrons, and resistance islands. Since the 1990s, antimicrobial resistance (AMR) has escalated dramatically among ABC. Global spread of multidrug-resistant (MDR)-ABC strains reflects dissemination of a few clones between hospitals, geographic regions, and continents; excessive antibiotic use amplifies this spread. Many isolates are resistant to all antimicrobials except colistimethate sodium and tetracyclines (minocycline or tigecycline); some infections are untreatable with existing antimicrobial agents. AMR poses a serious threat to effectively treat or prevent ABC infections. Strategies to curtail environmental colonization with MDR-ABC require aggressive infection-control efforts and cohorting of infected patients. Thoughtful antibiotic strategies are essential to limit the spread of MDR-ABC. Optimal therapy will likely require combination antimicrobial therapy with existing antibiotics as well as development of novel antibiotic classes.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology; Department of Medicine; The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nina M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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26
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Karlsson M, Lutgring JD, Ansari U, Lawsin A, Albrecht V, McAllister G, Daniels J, Lonsway D, McKay S, Beldavs Z, Bower C, Dumyati G, Gross A, Jacob J, Janelle S, Kainer MA, Lynfield R, Phipps EC, Schutz K, Wilson L, Witwer ML, Bulens SN, Walters MS, Duffy N, Kallen AJ, Elkins CA, Rasheed JK. Molecular Characterization of Carbapenem-Resistant Enterobacterales Collected in the United States. Microb Drug Resist 2022; 28:389-397. [PMID: 35172110 DOI: 10.1089/mdr.2021.0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) are a growing public health concern due to resistance to multiple antibiotics and potential to cause health care-associated infections with high mortality. Carbapenemase-producing CRE are of particular concern given that carbapenemase-encoding genes often are located on mobile genetic elements that may spread between different organisms and species. In this study, we performed phenotypic and genotypic characterization of CRE collected at eight U.S. sites participating in active population- and laboratory-based surveillance of carbapenem-resistant organisms. Among 421 CRE tested, the majority were isolated from urine (n = 349, 83%). Klebsiella pneumoniae was the most common organism (n = 265, 63%), followed by Enterobacter cloacae complex (n = 77, 18%) and Escherichia coli (n = 50, 12%). Of 419 isolates analyzed by whole genome sequencing, 307 (73%) harbored a carbapenemase gene; variants of blaKPC predominated (n = 299, 97%). The occurrence of carbapenemase-producing K. pneumoniae, E. cloacae complex, and E. coli varied by region; the predominant sequence type within each genus was ST258, ST171, and ST131, respectively. None of the carbapenemase-producing CRE isolates displayed resistance to all antimicrobials tested; susceptibility to amikacin and tigecycline was generally retained.
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Affiliation(s)
- Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Uzma Ansari
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Valerie Albrecht
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Daniels
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susannah McKay
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Chris Bower
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- New York Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York, USA
| | | | - Jesse Jacob
- Georgia Emerging Infections Program, Atlanta, Georgia, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Janelle
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Marion A Kainer
- Tennessee Department of Public Health, Nashville, Tennessee, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA
| | - Kyle Schutz
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Lucy Wilson
- Maryland Department of Health, Baltimore, Maryland, USA
| | | | - Sandra N Bulens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nadezhda Duffy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander J Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Kamile Rasheed
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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27
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1476-1480. [DOI: 10.1093/jac/dkac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
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28
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The Development of Third-Generation Tetracycline Antibiotics and New Perspectives. Pharmaceutics 2021; 13:pharmaceutics13122085. [PMID: 34959366 PMCID: PMC8707899 DOI: 10.3390/pharmaceutics13122085] [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: 10/29/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 01/04/2023] Open
Abstract
The tetracycline antibiotic class has acquired new valuable members due to the optimisation of the chemical structure. The first modern tetracycline introduced into therapy was tigecycline, followed by omadacycline, eravacycline, and sarecycline (the third generation). Structural and physicochemical key elements which led to the discovery of modern tetracyclines are approached. Thus, several chemical subgroups are distinguished, such as glycylcyclines, aminomethylcyclines, and fluorocyclines, which have excellent development potential. The antibacterial spectrum comprises several resistant bacteria, including those resistant to old tetracyclines. Sarecycline, a narrow-spectrum tetracycline, is notable for being very effective against Cutinebacterium acnes. The mechanism of antibacterial action from the perspective of the new compound is approached. Several severe bacterial infections are treated with tigecycline, omadacycline, and eravacycline (with parenteral or oral formulations). In addition, sarecycline is very useful in treating acne vulgaris. Tetracyclines also have other non-antibiotic properties that require in-depth studies, such as the anti-inflammatory effect effect of sarecycline. The main side effects of modern tetracyclines are described in accordance with published clinical studies. Undoubtedly, this class of antibiotics continues to arouse the interest of researchers. As a result, new derivatives are developed and studied primarily for the antibiotic effect and other biological effects.
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29
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Dimopoulos G, Almyroudi MP, Kapralos I, Apostolopoulou O, Flevari A, Nicolau DP, Dokoumetzidis A. Intrapulmonary pharmacokinetics of high doses of tigecycline in patients with ventilator-associated pneumonia. Int J Antimicrob Agents 2021; 59:106487. [PMID: 34843925 DOI: 10.1016/j.ijantimicag.2021.106487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022]
Abstract
Tigecycline is commonly used for infections by multidrug-resistant bacteria. However, it is not approved for ventilator-associated pneumonia (VAP) as increased mortality has been reported in VAP patients treated with conventional doses. The purpose of this study was to prospectively evaluate the intrapulmonary pharmacokinetics of off-label high-dose tigecycline in patients with VAP. Nine mechanically ventilated patients received tigecycline intravenously (loading dose 200 mg followed by 100 mg every 12 h). After ≥5 doses, two bronchoscopies were performed in each patient on consecutive days and eight blood samples were collected. Tigecycline concentrations in plasma and bronchoalveolar lavage fluid were determined by liquid chromatography. The urea dilution method was used to calculate epithelial lining fluid (ELF) concentrations. A two-compartmental pharmacokinetic (PK) model with linear elimination was used to estimate PK parameters. Mean patient age was 69 ± 11.86 years and mean APACHE II score was 21. The estimated population mean PK parameters (relative standard error) were: clearance, 11.64 L/h (54%); volume of distribution in central compartment, 79.01 L (37%); volume of distribution in peripheral compartment, 92.95 L (17%); intercompartmental clearance, 62.81 L/h (34%); and ELF penetration ratio, 2.41 (40%). Cmax, Cmin, plasma AUC0-12, plasma fAUC0-12 and ELF AUC0-12 were 1.99 ± 1.82 μg/mL, 0.81 ± 1.27 μg/mL, 12.89 ± 17.25 μg•h/mL, 3.24 ± 3.09 μg•h/mL and 7.13 ± 2.61 μg•h/mL, respectively. The increased plasma and ELF AUC0-12 achieved with a 200 mg daily tigecycline dose, combined with high ELF penetration, support the effectiveness of off-label high-dose tigecycline in VAP.
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Affiliation(s)
- G Dimopoulos
- Department of Critical Care, University Hospital ATTIKON at Haidari-Athens, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Greece
| | - M P Almyroudi
- Department of Critical Care, University Hospital ATTIKON at Haidari-Athens, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Greece.
| | - I Kapralos
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - O Apostolopoulou
- Department of Critical Care, University Hospital ATTIKON at Haidari-Athens, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Greece
| | - A Flevari
- Department of Critical Care, University Hospital ATTIKON at Haidari-Athens, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Greece
| | - D P Nicolau
- Center for Anti-Infective Research & Development at Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - A Dokoumetzidis
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
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30
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Bassetti M, Garau J. Current and future perspectives in the treatment of multidrug-resistant Gram-negative infections. J Antimicrob Chemother 2021; 76:iv23-iv37. [PMID: 34849997 PMCID: PMC8632738 DOI: 10.1093/jac/dkab352] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Microbial resistance is a serious threat to human health worldwide. Among the World Health Organisation's list of priority resistant bacteria, three are listed as critical-the highest level of concern-and all three are Gram-negative. Gram-negative resistance has spread worldwide via a variety of mechanisms, the most problematic being via AmpC enzymes, extended-spectrum β-lactamases, and carbapenemases. A combination of older drugs, many with high levels of toxicity, and newer agents are being used to combat multidrug resistance, with varying degrees of success. This review discusses the current treatments for multidrug-resistant Gram-negative bacteria, including new agents, older compounds, and new combinations of both, and some new treatment targets that are currently under investigation.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino—IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Javier Garau
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
- Clínica Rotger Quironsalud, Palma de Mallorca, Spain
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31
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Xu X, Xu C, Salisu RB, Xu W. Beta-Lactamase Gene Expression Level of Hospital-Acquired CRAB Isolated from Children in Picu. Infect Drug Resist 2021; 14:3195-3205. [PMID: 34429619 PMCID: PMC8378911 DOI: 10.2147/idr.s322604] [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: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Acinetobacter baumannii is a major cause of hospital-acquired infections. Studies showed that carbapenem resistance was related to mortality. Carbapenem resistance depends on expression of β-lactamase in adults. The present study explores the relationship between β-lactamase gene expression and carbapenem resistance and outcomes in children with A. baumannii infections. Patients and Methods We gathered clinical data of 131 children diagnosed with hospital-associated A. baumannii infections from the pediatrics unit of Shengjing Hospital of China Medical University. We obtained 131 isolates of A. baumannii, determined the minimal inhibitory concentrations (MICs) for common antibiotics, and measured carbapenemase-encoding genes expression using real-time PCR. Results We isolated 131 strains, 89 of which were carbapenem-resistant (MIC ≥ 8 µg/mL), and 42 carbapenem-sensitive strains. Univariate analysis identified statistically significant differences between the carbapenem-resistant group and the carbapenem-sensitive group for in-hospital days before infection, previous deep vein catheterization, previous urinary catheterization, previous treatment with a carbapenem (meropenem/imipenem), and expression of oxa-51 and oxa-23. Logistic regression analysis of factors associated with carbapenem-resistant A. baumannii infections found significant associations with oxa-23 expression (hazard ratio [HR] 0.005, confidence interval [CI] 95% 0-0.153, P = 0.002) and previous carbapenem treatment (HR 0.031 CI 95% 0.1-0.959, P = 0.042). Of 131 patients, 27 died within 30 days. Cox regression analysis of factors associated with 30-day mortality from A. baumannii infections showed that cephalosporin combined with sulbactam (HR 0.271, CI 95% 0.101-0.723, P = 0.009) was associated with 30-day survival. Conclusion The expression of oxa-23 and the use of carbapenems were independent risk factors for carbapenem resistance. The use of cephalosporins combined with sulbactam was independently associated with 30-day survival. We recommend using cephalosporins combined with sulbactam in children infected with A. baumannii.
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Affiliation(s)
- Xiao Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Caifang Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Rabiu Bilya Salisu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Wei Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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32
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Ji Z, Sun K, Li Z, Cheng W, Yang J. Carbapenem-Resistant Klebsiella pneumoniae Osteomyelitis Treated with Ceftazidime-Avibactam in an Infant: A Case Report. Infect Drug Resist 2021; 14:3109-3113. [PMID: 34408454 PMCID: PMC8364839 DOI: 10.2147/idr.s320056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
Increasing cases of carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections have been observed globally where multi-drug resistance to CR-KP can make the infection difficult to treat. In recent years, the β-lactam/β-lactamase inhibitor, ceftazidime-avibactam (CAZ-AVI), has been developed to treat complicated urinary tract infections and complicated intra-abdominal infections. CAZ-AVI is approved for children over 3-month old but has yet to be investigated for cases of osteomyelitis. Only three case reports exist in literature on the use of CAZ-AVI for CR-KP osteomyelitis in adults. In this report, we present an infant with primary hematogenous osteomyelitis and septic arthritis in the right shoulder following surgical treatment for a heart murmur. Bacterial isolation revealed a strain of CR-KP, which was successfully treated with CAZ-AVI after initial administration of imipenem-based treatments.
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Affiliation(s)
- Zejuan Ji
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Keming Sun
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Zhenwei Li
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Weyland Cheng
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China.,Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Junwen Yang
- Microbiology Laboratory, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, People's Republic of China
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33
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Zha L, Zhang D, Pan L, Ren Z, Li X, Zou Y, Li S, Luo S, Yang G, Tefsen B. Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study. Infect Dis Ther 2021; 10:2415-2429. [PMID: 34374953 PMCID: PMC8354101 DOI: 10.1007/s40121-021-00516-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. Methods This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. Results Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. Conclusions The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00516-5.
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Affiliation(s)
- Lei Zha
- Emergency and Critical Care Unit, Conch Hospital of Anhui Medical University, Wuhu, 241000, Anhui, China.
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China.
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.
| | - Dayan Zhang
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Lingling Pan
- Cardiology Department, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Zhichu Ren
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Xiang Li
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Yi Zou
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Shirong Li
- Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Shuangqi Luo
- Intensive Care Unit, The First People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Gang Yang
- Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Boris Tefsen
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China.
- Ronin Institute, Montclair, NJ, 07043, USA.
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Perletti G, Trinchieri A, Stamatiou K, Magri V. Safety considerations with new antibacterial approaches for chronic bacterial prostatitis. Expert Opin Drug Saf 2021; 21:171-182. [PMID: 34260337 DOI: 10.1080/14740338.2021.1956459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Chronic bacterial prostatitis (CBP) is a difficult-to-eradicate infection. Antibacterial therapy with currently licensed agents is hindered due to the increasing emergence of pathogen resistance worldwide and to frequent infection relapse. With limited treatment options, physicians are investigating new agents, which, however, may raise safety concerns.Areas covered: Antibacterial agents currently licensed for CBP were not considered. Available reports about the safety and efficacy of antibacterial agents that have been clinically tested or tentatively used to treat CBP in single cases were evaluated. This review also focused on agents targeting Gram-positive pathogens, whose prevalence as causative agents of CBP is increasing.Expert opinion: (i) Most antibacterial agents considered in this review have been administered off-label in the interest of patients, and their use requires particular caution. (ii) Reports describing the usage of many of the drugs reviewed here are still scant, and readers should be warned of the limited published evidence supporting therapy for CBP with these agents. (iii) As treatment must extend over several weeks, medium-term adverse events may occur and therapy should be individualized, taking into account the dosage and the potential toxicity of each specific antibiotic. Regarding dangerous drug-drug interactions, particular attention should be paid to the risk of ECG-QT-interval elongation.
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Affiliation(s)
- Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy.,Department of Human Function and Repair, Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium
| | - Alberto Trinchieri
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
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35
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Alrahmany D, Omar AF, Harb G, El Nekidy WS, Ghazi IM. Acinetobacter baumannii Infections in Hospitalized Patients, Treatment Outcomes. Antibiotics (Basel) 2021; 10:antibiotics10060630. [PMID: 34070398 PMCID: PMC8229601 DOI: 10.3390/antibiotics10060630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background Acinetobacter baumannii (AB), an opportunistic pathogen, could develop into serious infections with high mortality and financial burden. The debate surrounding the selection of effective antibiotic treatment necessitates studies to define the optimal approach. This study aims to compare the clinical outcomes of commonly used treatment regimens in hospitalized patients with AB infections to guide stewardship efforts. Material and methods: Ethical approval was obtained, 320 adult patients with confirmed AB infections admitted to our tertiary care facility within two years were enrolled. The treatment outcomes were statistically analyzed to study the relation between antibiotic regimens and 14, 28, and 90-day mortality as the primary outcomes using binary logistic regression—using R software—in addition to the length of hospitalization, adverse events due to antibiotic treatment, and 90-day recurrence as secondary outcomes. Results: Among 320 patients, 142 (44%) had respiratory tract, 105 (33%) soft tissue, 42 (13%) urinary tract, 22 (7%) bacte iemia, and other infections 9 (3%). Nosocomial infections were 190 (59%) versus community-acquired. Monotherapy was significantly associated with lower 28-day (p < 0.05, OR:0.6] and 90-day (p < 0.05, OR:0.4) mortality rates, shorter length of stay LOS (p < 0.05, Median: −12 days] and limited development of adverse events (p < 0.05, OR:0.4). Subgroup analysis revealed similar results ranging from lower odds of mortality, adverse events, and shorter LOS to statistically significant correlation to monotherapy. Meropenem (MEM) and piperacillin/tazobactam (PIP/TAZ) monotherapies showed non-significant high odd ratios of mortalities, adverse events, and disparate LOS. There was a statistical correlation between most combined therapies and adverse events, and longer LOS. Colistin based and colistin/meropenem (CST/MEM) combinations were superior in terms of 14-day mortality (p = 0.05, OR:0.4) and (p < 0.05, OR:0.4) respectively. Pip/Taz and MEM-based combined therapies were associated with statistically non-significant high odd ratios of mortalities. Tigecycline (TGC)-based combinations showed a significant correlation to mortalities (p < 0.05, OR:2.5). Conclusion: Monotherapy was associated with lower mortality rates, shorter LOS, and limited development of adverse events compared to combined therapies. Colistin monotherapy, colistin/meropenem, and other colistin combinations showed almost equivalent mortality outcomes. Patients on combined therapy were more susceptible to adverse events and comparable LOS. The possible adverse outcomes of PIP/TAZ and MEM-based therapies in the treatment of MDRAB infections and the association of TGC with a higher mortality rate raise doubts about their treatment role.
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Affiliation(s)
| | - Ahmed F. Omar
- General Medicine Department, Sohar Hospital, Sohar 311, Oman;
| | - Gehan Harb
- Gehan Harb Statistics, Cairo 11511, Egypt;
| | - Wasim S. El Nekidy
- Cleveland Clinic Abu Dhabi, Abu-Dhabi P.O. Box 112412, United Arab Emirates;
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA
| | - Islam M. Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA 19104, USA
- Correspondence: ; Tel.: +1-215-596-7121; Fax: +1-215-596-8586
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36
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Key Takeaways From the U.S. CDC's 2019 Antibiotic Resistance Threats Report for Frontline Providers. Crit Care Med 2021; 48:939-945. [PMID: 32282351 PMCID: PMC7176261 DOI: 10.1097/ccm.0000000000004371] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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37
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Satlin MJ. Languid Uptake of Ceftazidime-Avibactam for Carbapenem-Resistant Gram-Negative Infections and Continued Reliance on Polymyxins. Clin Infect Dis 2021; 72:622-625. [PMID: 32107528 DOI: 10.1093/cid/ciaa065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Satlin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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38
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Huh K, Chung DR, Ha YE, Ko JH, Kim SH, Kim MJ, Huh HJ, Lee NY, Cho SY, Kang CI, Peck KR, Song JH. Impact of Difficult-to-Treat Resistance in Gram-negative Bacteremia on Mortality: Retrospective Analysis of Nationwide Surveillance Data. Clin Infect Dis 2021; 71:e487-e496. [PMID: 31994704 DOI: 10.1093/cid/ciaa084] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinically relevant categorization of antimicrobial resistance is critical to mitigating the threat it poses. Difficult-to-treat resistance (DTR) is a recently proposed category defined as nonsusceptibility to all first-line antibiotic agents. METHODS A retrospective study was conducted with nonduplicate cases of gram-negative bloodstream infection (GNBSI) caused by 4 major taxa (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species) identified from a nationwide surveillance database. DTR was defined as nonsusceptibility to all the β-lactams and fluoroquinolones tested. Patient characteristics and mortality were compared between DTR GNBSI and GNBSI caused by carbapenem-resistant but not DTR and extended-spectrum cephalosporin-resistant but not DTR isolates using Centers for Disease Control and Prevention definitions. Adjusted odds ratios (aORs) for 30-day in-hospital mortality were examined for DTR in overall and in propensity score-matched cohorts. RESULTS A total of 1167 episodes of monomicrobial GNBSI were identified, and 147 (12.6%) of the isolates were DTR. The majority of DTR isolates were Acinetobacter species (79.6%) and P. aeruginosa (17.7%). DTR infections were associated with previous antibiotic use, healthcare contact, ventilator use, and lower respiratory tract infection. Crude mortality for GNBSI caused by DTR was 50.3%. A multivariable model showed that only DTR, but not other categories, was significantly associated with mortality (adjusted odds ratio [aOR], 3.58 [95% confidence interval {CI}, 1.27-10.19]). DTR was also a significant predictor for mortality in the analysis of propensity score-matched cohorts (aOR, 3.48 [95% CI, 1.82-6.79]). CONCLUSIONS In patients with GNBSI, DTR was associated with higher mortality than those in other resistance categories. Our findings suggest that DTR could be useful for surveillance and prognostication.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Department of Medicine, Sejong Hospital, Bucheon, Republic of Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Si-Ho Kim
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
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39
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Liu B, Li S, Li HT, Wang X, Tan HY, Liu S, Pan PH, Li XG, Li XM. Outcomes and prognostic factors of tigecycline treatment for hospital-acquired pneumonia involving multidrug-resistant Acinetobacter baumannii. J Int Med Res 2021; 48:300060520910917. [PMID: 32339001 PMCID: PMC7218464 DOI: 10.1177/0300060520910917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: To compare outcomes and prognostic factors of tigecycline (TC)-based treatment with those of other antibiotic-based treatments in the treatment of hospital-acquired pneumonia caused by multidrug-resistant Acinetobacter baumannii (MDRAB). Methods: A retrospective analysis of data was performed from all patients ≥18 years who were treated in the ICU at Xiangya Hospital, Changsha, China (January 2016 to June 2017) with hospital-acquired pneumonia involving monomicrobial MDRAB. Patients were separated into TC and non-TC groups. Results: Of 86 MDRAB-positive patients, 59 were in the TC group and 27 were in the non-TC group. The 28-day death rates were not significantly different between the two groups, but the TC group had significantly more patients with a good clinical prognosis than the non-TC group. Although prognostic markers for a poor clinical response were sepsis, procalcitonin concentration and APACHE II scores, TC therapy was found to be a protective factor. Conclusions: TC based therapy was associated with a positive clinical response in the treatment of MDRAB caused hospital-acquired pneumonia. Further studies are required to confirm our results.
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Affiliation(s)
- Ben Liu
- Emergency Department, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sha Li
- Radiology Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hai-Tao Li
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaokai Wang
- Emergency Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong-Yi Tan
- Department of Respiratory Medicine, Changsha Central Hospital, University of South China, Changsha, China
| | - Shuai Liu
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Pin-Hua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Gang Li
- Emergency Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang-Min Li
- Emergency Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
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40
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Kimmig A, Hagel S, Weis S, Bahrs C, Löffler B, Pletz MW. Management of Staphylococcus aureus Bloodstream Infections. Front Med (Lausanne) 2021; 7:616524. [PMID: 33748151 PMCID: PMC7973019 DOI: 10.3389/fmed.2020.616524] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.
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Affiliation(s)
- Aurelia Kimmig
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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41
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Moso MA, Macesic N. Peritoneal Dialysis-Related Peritonitis With Carbapenem-Resistant Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus faecium. Open Forum Infect Dis 2021; 8:ofaa525. [PMID: 33511220 PMCID: PMC7817076 DOI: 10.1093/ofid/ofaa525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael A Moso
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
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42
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Kuzucan A, Powers JH, Doshi P. Antibiotics Approved for Marketing in Populations Specifically Excluded From Premarketing Trials, 1999-2018. Mayo Clin Proc 2020; 95:2699-2703. [PMID: 33276841 PMCID: PMC8080959 DOI: 10.1016/j.mayocp.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/13/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
Approval by the US Food and Drug Administration (FDA) of a drug for a given indication is thought to reassure clinicians, other health care providers, and patients that substantial evidence of effectiveness exists for specific indicated populations (patients and diseases). This study examines whether FDA approval of certain antibiotics should be so reassuring for all patient populations identified in the FDA-approved labels. Specifically, this study compared patient populations covered by FDA-approved labels for 21 novel antibiotics approved between 1999 and 2018 to the patient exclusion and inclusion criteria of pivotal trials that supported those approvals. We found that every FDA-approved label for these antibiotics included at least one identifiable patient population that was explicitly excluded from enrolling in the supporting pivotal trials. Two antibiotics, bedaquiline and ceftazidime-avibactam, were approved for use in populations that were fully excluded from enrolling in registration trials.
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Affiliation(s)
- Aida Kuzucan
- Pharmaceutical Health Services Research Department, University of Maryland- Baltimore, Baltimore, MD.
| | - John H Powers
- George Washington University School of Medicine and Health Sciences Medicine, Washington, DC
| | - Peter Doshi
- Pharmaceutical Health Services Research Department, University of Maryland- Baltimore, Baltimore, MD
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43
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Clark JA, Kulengowski B, Burgess DS. In vitro activity of eravacycline compared with tigecycline against carbapenem-resistant Enterobacteriaceae. Int J Antimicrob Agents 2020; 56:106178. [PMID: 32980393 DOI: 10.1016/j.ijantimicag.2020.106178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 01/19/2023]
Abstract
Eravacycline has been shown to have broad-spectrum activity against Gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). We compared the activity of eravacycline with that of tigecycline in CRE isolates cultured from patients at an academic medical centre. Eravacycline was more potent than tigecycline [mean minimum inhibitory concentration (MIC) ratio = 0.76, 95% confidence interval 0.66-0.87]; however, the MIC90 observed for eravacycline was higher than previously reported at 4 μg/mL. Future studies are necessary to elucidate the mechanism driving this difference.
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Affiliation(s)
- Justin A Clark
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Brandon Kulengowski
- University of Kentucky College of Pharmacy, Lexington, KY, USA; Albert B. Chandler Hospital, UK Healthcare, Lexington, KY, USA
| | - David S Burgess
- University of Kentucky College of Pharmacy, Lexington, KY, USA.
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44
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Ruiz J, Ramirez P, Villarreal E, Gordon M, Sánchez MÁ, Martín M, Castellanos-Ortega Á. Effect of pharmacokinetic/pharmacodynamic ratio on tigecycline clinical response and toxicity in critically ill patients with multidrug-resistant Gram-negative infections. SAGE Open Med 2020; 8:2050312120958897. [PMID: 32999720 PMCID: PMC7506777 DOI: 10.1177/2050312120958897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: The information about the pharmacokinetics and optimal dose of tigecycline in
critically ill patients with severe underlying diseases is limited and
controversial. In this study, we evaluate the pharmacokinetic parameters of
tigecycline in critically ill patients with multidrug-resistant
Gram-negative infection and explore the association between the
pharmacokinetic/pharmacodynamic ratio and treatment response. Methods: A prospective study was designed including critically ill patients treated
with tigecycline for multidrug-resistant Gram-negative infections. Blood
samples were collected at day 3–5 of treatment, and pharmacokinetics
parameters were evaluated using NONMEM® software. Relationship
between area under the free concentration–time curve and minimum inhibitory
concentration ratio (fAUC/MIC) and treatment failure was evaluated.
Association between tigecycline fAUC and hepatobiliary toxicity was also
investigated. Results: Twenty-five critically ill patients were included in the study. In the
pharmacokinetic model, weight and total bilirubin level were found to be
significant predictors of tigecycline clearance. Fifteen (60.0%) patients
achieved an fAUC/MIC ratio >4.5, seven (28.0%) an fAUC/MIC > 6.96 and
only three (12.0%) an fAUC/MIC > 17.9. No differences in fAUC/MIC ratio
were obtained between those patients with and without clinical failure (5.28
(IC95%: 2.57–7.94) vs 8.71 (3.57–13.84)). fAUC values were higher in those
patients who suffered hepatobiliary disorders (7.63 (3.93–11.34) vs 17.63
(7.85–26.28) mg/L/h). Conclusion: An important percentage of critically ill patients with multidrug-resistant
Gram-negative infection treated with tigecycline do not achieve an
appropriate pharmacokinetic/pharmacodynamic value. Tigecycline fAUC seems to
be associated with hepatobiliary disorders in this study population. The
effect of fAUC/MIC ratio on clinical response remains unclear.
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Affiliation(s)
- Jesus Ruiz
- Intensive Care Unit, IIS La Fe, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | - Paula Ramirez
- Intensive Care Unit, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | - Esther Villarreal
- Intensive Care Unit, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | - Mónica Gordon
- Intensive Care Unit, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | | | - María Martín
- Pharmacy Department, IIS La Fe, Hospital Universitario y Politecnico de La Fe, Valencia, Spain
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Antibiotic Susceptibility of NDM-Producing Enterobacterales Collected in the United States in 2017 and 2018. Antimicrob Agents Chemother 2020; 64:AAC.00499-20. [PMID: 32540972 DOI: 10.1128/aac.00499-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/07/2020] [Indexed: 12/29/2022] Open
Abstract
The treatment of infections caused by carbapenem-resistant Enterobacterales, especially New Delhi metallo-β-lactamase (NDM)-producing bacteria, is challenging. Although less common in the United States than some other carbapenemase producers, NDM-producing bacteria are a public health threat due to the limited treatment options available. Here, we report on the antibiotic susceptibility of 275 contemporary NDM-producing Enterobacterales collected from 30 U.S. states through the Centers for Disease Control and Prevention's Antibiotic Resistance Laboratory Network. The aims of the study were to determine the susceptibility of these isolates to 32 currently available antibiotics using reference broth microdilution and to explore the in vitro activity of 3 combination agents that are not yet available. Categorical interpretations were determined using Clinical and Laboratory Standards Institute (CLSI) interpretive criteria. For agents without CLSI criteria, Food and Drug Administration (FDA) interpretive criteria were used. The percentage of susceptible isolates did not exceed 90% for any of the FDA-approved antibiotics tested. The antibiotics with breakpoints that had the highest in vitro activity were tigecycline (86.5% susceptible), eravacycline (66.2% susceptible), and omadacycline (59.6% susceptible); 18.2% of isolates were susceptible to aztreonam. All NDM-producing isolates tested were multidrug resistant, and 116 isolates were extensively drug resistant (42.2%); 207 (75.3%) isolates displayed difficult-to-treat resistance. The difficulty in treating infections caused by NDM-producing Enterobacterales highlights the need for containment and prevention efforts to keep these infections from becoming more common.
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Shen L, Lian C, Zhu B, Yao Y, Yang Q, Zhou J, Zhou H. Bloodstream Infections due to Carbapenem-Resistant Klebsiella pneumoniae: A Single-Center Retrospective Study on Risk Factors and Therapy Options. Microb Drug Resist 2020; 27:227-233. [PMID: 32584202 DOI: 10.1089/mdr.2019.0455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We aimed to compare efficacy of different patterns of antibiotics and explore the risk factors related to mortality in patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP). This study retrospectively included 89 patients with BSIs due to CRKP with complete data during the year of 2018 in the First Affiliated Hospital of Zhejiang University School of Medicine. Overall, the 28-day mortality was 47.2% (42/89). Multivariate analysis of Cox regression revealed that hematological malignancy (hazard ratio [HR] 5.698; 95% confidence interval [CI], 2.405-13.504; p < 0.001) and Pitt bacteremia score (HR per unit increase, 1.303; 95% CI, 1.109-1.532; p = 0.001) were identified as independent predictors for 28-day mortality. Among 70 patients with appropriate therapy, 35 received tigecycline (TGC)-based therapy, 20 received polymyxin B (PMB)-based therapy, 9 received ceftazidime/avibactam-based therapy, and 6 patients had other kinds of antibiotics, including ciprofloxacin, amikacin, and cotrimoxazole. By adjusting variables selected by crude analysis, it showed that receiving PMB-based therapy provided a survival benefit comparing with TGC-based therapy (HR, 0.068; 95% CI, 0.018-0.260; p < 0.001). Hematological malignancy and Pitt bacteremia score were independent risk factors of death in patients with BSIs due to CRKP and PMB-based therapy improved survival rate compared with TGC-based therapy.
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Affiliation(s)
- Lisha Shen
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chan Lian
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bingquan Zhu
- Department of Child Health Care, Zhejiang University Children's Hospital, Hangzhou, China
| | - Yake Yao
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Yang
- State Key Lab for Diagnostic and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, Paterson DL, Walker MJ. Antimicrobial Resistance in ESKAPE Pathogens. Clin Microbiol Rev 2020; 23:788-99. [PMID: 32404435 DOI: 10.1111/imb.12124] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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Affiliation(s)
- David M P De Oliveira
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Brian M Forde
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Patrick N A Harris
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
| | - David L Paterson
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, QLD, Australia
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences, The University of Queensland, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, QLD, Australia
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Abstract
Antimicrobial-resistant ESKAPE ( Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens represent a global threat to human health. The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antimicrobial resistance surveillance. This looming health threat has restimulated interest in the development of new antimicrobial therapies, has demanded the need for better patient care, and has facilitated heightened governance over stewardship practices.
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Clinical characteristics and risk factors of tigecycline-associated hypofibrinogenaemia in critically ill patients. Eur J Clin Pharmacol 2020; 76:913-922. [PMID: 32355990 PMCID: PMC7224009 DOI: 10.1007/s00228-020-02860-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/26/2020] [Indexed: 12/18/2022]
Abstract
Purpose To analyze the clinical features and risk factors of tigecycline-associated hypofibrinogenaemia and study whether cefoperazone/sulbactam combined with tigecycline aggravates coagulopathy or hypofibrinogenaemia. Methods A retrospective case–control study of patients with severe infection who were treated with tigecycline was conducted. Patients were assigned to the hypofibrinogenaemia group (< 2.0 g/L) and normal fibrinogen (normal) group (≥ 2.0 g/L) to assess the clinical features of patients with tigecycline-associated hypofibrinogenaemia. The traits of patients treated with cefoperazone/sulbactam in the hypofibrinogenaemia group were also analyzed. Results In total, 127 patients were enrolled in the study, including 71 patients with hypofibrinogenaemia and 56 patients with normal fibrinogen levels. Hypofibrinogenaemia developed at a median of 6 (4–8) days after tigecycline treatment, and the fibrinogen level returned to normal at a median of 3 (3–5) days after tigecycline discontinuation. In the multivariate analysis, intra-abdominal infection (p = 0.005), fibrinogen level at tigecycline initiation (p < 0.001), maintenance dose (p = 0.039), and treatment duration (p = 0.002) were found to be related to hypofibrinogenaemia. Treatment with cefoperazone/sulbactam was not associated with hypofibrinogenaemia (p = 0.681), but patients treated with cefoperazone/sulbactam had a higher incidence of coagulopathy (p = 0.009) and needed more blood products (p = 0.003) than those treated without cefoperazone/sulbactam. Conclusion Tigecycline-associated hypofibrinogenaemia often developed on the 6th (4th–8th) day of tigecycline use and was associated with intra-abdominal infection, fibrinogen level at tigecycline initiation, maintenance dose, and treatment duration of tigecycline but not cefoperazone/sulbactam.
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Real-World Experience with Ceftolozane-Tazobactam for Multidrug-Resistant Gram-Negative Bacterial Infections. Antimicrob Agents Chemother 2020; 64:AAC.02291-19. [PMID: 31932379 DOI: 10.1128/aac.02291-19] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/05/2020] [Indexed: 02/05/2023] Open
Abstract
Our objective was to describe the prescribing practices, clinical characteristics, and outcomes of patients treated with ceftolozane-tazobactam (C/T) for multidrug-resistant (MDR) Gram-negative infections. This was a multicenter, retrospective, cohort study at eight U.S. medical centers (2015 to 2019). Inclusion criteria were age ≥18 years and receipt of C/T (≥72 hours) for suspected or confirmed MDR Gram-negative infection. The primary efficacy outcome, evaluated among patients with MDR Pseudomonas aeruginosa infections, was composite clinical failure, namely, 30-day all-cause mortality, 30-day recurrence, and/or failure to resolve or improve infection signs or symptoms after C/T treatment. In total, 259 patients were included, and P. aeruginosa was isolated in 236 (91.1%). The MDR and extremely drug-resistant phenotypes were detected in 95.8% and 37.7% of P. aeruginosa isolates, respectively. The most common infection source was the respiratory tract (62.9%). High-dose C/T was used in 71.2% of patients with a respiratory tract infection (RTI) overall but in only 39.6% of patients with an RTI who required C/T renal dose adjustment. In the primary efficacy population (n = 226), clinical failure and 30-day mortality occurred in 85 (37.6%) and 39 (17.3%) patients, respectively. New C/T MDR P. aeruginosa resistance was detected in 3 of 31 patients (9.7%) with follow-up cultures. Hospital-acquired infection and Acute Physiological and Chronic Health Evaluation II (APACHE II) score were independently associated with clinical failure (adjusted odds ratio [aOR], 2.472 and 95% confidence interval [CI], 1.322 to 4.625; and aOR, 1.068 and 95% CI, 1.031 to 1.106, respectively). Twenty-five (9.7%) patients experienced ≥1 adverse effect (9 acute kidney injury, 13 Clostridioides difficile infection, 1 hepatotoxicity, 2 encephalopathy, and 2 gastrointestinal intolerance). C/T addresses an unmet medical need in patients with MDR Gram-negative infections.
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