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Lemos-Luengas EV, Rentería-Valoyes S, Muñoz DMA, Gonzalez CKG, Guerrón-Gómez G, Ramos-Castaneda JA. In vitro activity of ceftazidime-avibactam against gram-negative bacteria in patients with bacteremia and skin and soft-tissue infections in Colombia 2019-2021. Diagn Microbiol Infect Dis 2024; 109:116235. [PMID: 38458096 DOI: 10.1016/j.diagmicrobio.2024.116235] [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: 11/09/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Ceftazidime-avibactam (CAZ-AVI) is an option for infections caused by MDR gram-negative bacilli. In this study, we aimed to analyze the in vitro antimicrobial activity of CAZ-AVI and other antimicrobial agents against gram-negative bacilli that were collected in Colombia between 2019 and 2021 from patients with bacteremia and skin and soft-tissue infections (SSTIs). METHODS A total of 600 Enterobacterales and 259 P. aeruginosa strains were analyzed. The phenotypic resistance of isolates, particularly non-susceptibility to meropenem, multidrug-resistant (MDR) isolates, and difficult-to-treat (DTR) P. aeruginosa, was evaluated according to CLSI breakpoints. RESULTS Enterobacterales had the most susceptibility to CAZ-AVI (96.5 %) and tigecycline (95 %). Tigecycline and CAZ-AVI were the antimicrobial agents with the most in vitro activity against carbapenem-resistant Enterobacterales (CRE). CAZ-AVI was the antimicrobial treatment with the most activity against P. aeruginosa. CONCLUSIONS Tigecycline and CAZ-AVI were the antimicrobial agents with the most activity against CRE and MDR Enterobacterales. For P. aeruginosa, CAZ-AVI was the antimicrobial treatment with the most in vitro activity.
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Affiliation(s)
- Elkin Vladimir Lemos-Luengas
- Medical Affairs Pfizer Colombia, Colombia; Foundation For Development And Support In International Health (FUDASAI), Miami, FL, USA.
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Dan MO, Tǎlǎpan D. Friends or foes? Novel antimicrobials tackling MDR/XDR Gram-negative bacteria: a systematic review. Front Microbiol 2024; 15:1385475. [PMID: 38800756 PMCID: PMC11116650 DOI: 10.3389/fmicb.2024.1385475] [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: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Gram-negative bacteria have been one of the most studied classes in the field of microbiology, especially in the context of globally alarming antimicrobial resistance levels to these pathogens over the course of the past decades. With high numbers of these microorganisms being described as multidrug-resistant (MDR), or even extended-drug-resistant (XDR) bacteria, specialists in the field have been struggling to keep up with higher prevalence of difficult-to-treat infections caused by such superbugs. The FDA approval of novel antimicrobials, such as cefiderocol (FDC), ceftolozane/tazobactam (C/T), ceftazidime/avibactam (CZA), imipenem/relebactam (IMR), sulbactam/durlobactam (SUL-DUR) and phase 3 clinical trials' results of aztreonam/avibactam (ATM-AVI) has proven that, while all these substances provide encouraging efficacy rates, antibiotic resistance keeps up with the pace of drug development. Microorganisms have developed more extensive mechanisms of resistance in order to target the threat posed by these novel antimicrobials, thus equiring researchers to be on a constant lookout for other potential drug candidates and molecule development. However, these strategies require a proper understanding of bacterial resistance mechanisms to gain a comprehensive outlook on the issue. The present review aims to highlight these six antibiotic agents, which have brought hope to clinicians during the past decade, discussing general properties of these substances, as well as mechanisms and patterns of resistance, while also providing a short overview on further directions in the field. Systematic review registration https://www.crd.york.ac.uk/prospero/#searchadvanced, Identifier CRD42024505832.
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Affiliation(s)
- Mihai Octavian Dan
- Department of Microbiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Tǎlǎpan
- Department of Microbiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Microbiology Laboratory, “Matei Bals” National Institute of Infectious Diseases, Bucharest, Romania
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3
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Tootla HD, Prentice E, Moodley C, Marais G, Nyakutira N, Reddy K, Bamford C, Niehaus A, Whitelaw A, Brink A. Carbapenem-resistant Enterobacterales among hospitalized patients in Cape Town, South Africa: clinical and microbiological epidemiology. JAC Antimicrob Resist 2024; 6:dlae051. [PMID: 38523732 PMCID: PMC10959510 DOI: 10.1093/jacamr/dlae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) are a substantial problem in Cape Town. CRE epidemiology is largely unknown and mortality remains high. Objectives To describe and characterize the clinical and microbiological epidemiology of CRE within Cape Town hospitals to better inform therapy with regard to current and novel antibiotics, as well as improve antimicrobial stewardship (AMS), and infection prevention and control (IPC). Methods This prospective, multicentre study performed between 1 November 2020 and 30 November 2022, across three public and three private hospitals included hospitalized participants with CRE from clinical cultures. Participant demographics, clinical information and microbiology results were collected and analysed. Results Ninety percent of participants were from public hospitals. The age distribution ranged from 7 days to 88 years. Notable risk factors for CRE infection included recent exposure to antibiotics, medical devices and surgery. The most prevalent species was Klebsiella pneumoniae. However, a higher proportion of Serratia marcescens compared with previous reports was identified. The detected carbapenemases were blaOXA-48-like (80%) and blaNDM (11%). With the exception of amikacin (63%), tigecycline (65%), colistin (95%) and ceftazidime/avibactam (87%), susceptibility to antibiotics was low. Conclusions This study identified common risk factors for CRE infection and generated a description of carbapenemase enzymes, species distribution and antibiograms, enabling a better understanding of CRE epidemiology. This provides insights into transmission patterns and resistance determinants of CREs, beneficial to informing data-driven regional patient management, AMS and IPC strategies.
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Affiliation(s)
- Hafsah Deepa Tootla
- Division of Medical Microbiology, National Health Laboratory Service, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gert Marais
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nyasha Nyakutira
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kessendri Reddy
- Division of Medical Microbiology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Colleen Bamford
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Medical Microbiology, Pathcare, Cape Town, South Africa
| | - Abraham Niehaus
- Division of Medical Microbiology, Ampath, Cape Town, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrian Brink
- Division of Medical Microbiology, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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4
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Collignon C, Benaboud S, Gana I, Bendavid M, Fournier B, Oualha M, de Marcellus C. Pharmacokinetic of ceftazidime-avibactam in a critically ill patient under high-volume continuous venovenous haemodiafiltration: A first paediatric case report. Br J Clin Pharmacol 2024; 90:890-894. [PMID: 38178624 DOI: 10.1111/bcp.15993] [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: 09/13/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 01/06/2024] Open
Abstract
Ceftazidime-avibactam is a novel cephalosporin/B-lactamase inhibitor developed in the context of increasing resistance. This case reports the pharmacokinetics of ceftazidime-avibactam in a critically ill child under continuous renal replacement (CRRT) therapy for fluid overload. The patient was a 6-month-old female with sepsis due to bloodstream infection to Stenotrophomonas maltophilia following stem cell transplantation for severe combined immunodeficiency. CRRT was started on Day 2. Concentrations have been monitored using liquid chromatography-tandem mass spectrometry. Treatment was given every 8 h with a 2 h infusion of 30-7,5 mg/kg and did not reach pharmacokinetic/pharmacodynamic targets. Total clearance was respectively 1.7 and 3.02 L/h, with CRRT clearance respectively 28.8%-60% for ceftazidime and 14%-33% for avibactam. Those clearances are higher than reported in adult literature leading to a risk of treatment failure and emerging resistance. This supports the benefit of monitoring antimicrobial therapy under CRRT and the necessity to assess higher dosing or continuous infusion of ceftazidime-avibactam.
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Affiliation(s)
- Charlotte Collignon
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Sihem Benaboud
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, Paris Descartes University, Paris, France
| | - Inès Gana
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, Paris Descartes University, Paris, France
| | - Matthieu Bendavid
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Benjamin Fournier
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
- Université de Paris, Paris, France
| | - Charles de Marcellus
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
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Torres-Castillo LC, Fandiño C, Ramos MP, Ramos-Castaneda JA, Rioseco ML, Juliet C. In vitro activity of ceftazidime-avibactam against Gram-negative strains in Chile 2015-2021. J Glob Antimicrob Resist 2023; 35:143-148. [PMID: 37714380 DOI: 10.1016/j.jgar.2023.09.004] [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: 04/11/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES Ceftazidime-avibactam (CAZ-AVI) combines ceftazidime and a reversible β-lactamase inhibitor that has shown activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa. Using data from the Antimicrobial Testing Leadership and Surveillance program (ATLAS), this study examined the in vitro antimicrobial activity of CAZ-AVI and other antibiotics against Gram-negative bacteria collected from Chilean hospitals between 2015 and 2021. METHODS Clinical isolates of Enterobacterales and P. aeruginosa were collected from three medical centres in Chile. Blood, abdominal fluid, urine, soft tissues, and respiratory tract samples were obtained from infected patients. Minimum inhibitory concentrations using the broth microdilution method were determined for susceptibility testing, and the Clinical and Laboratory Standards Institute (CLSI) breakpoints were used for interpreting the results. Extended-spectrum β-lactamases (ESBL) and carbapenemase genes were also detected through polymerase chain reaction. RESULTS A total of 2600 Enterobacterales and 836 P. aeruginosa were analysed. CAZ-AVI was the antibiotic with the highest in vitro activity against Enterobacterales (99.72%). The incidence of carbapenem-resistant Enterobacterales (CRE) was 1.5% (n = 39), and the antibiotics with the best in vitro activity were tigecycline (92.31%), CAZ-AVI (88.57%), and amikacin (79.49%). CAZ-AVI was the antibiotic with the best activity against ESBL-producing Enterobacterales (99.34%) and MDR Enterobacterales (99.31%). For KPC-producing Enterobacterales, susceptibility to amikacin was 100%, whereas susceptibility to CAZ-AVI was 91.67%. Regarding MDR and difficult-to-treat resistance P. aeruginosa, 44.83% and 38.99% were susceptible to CAZ-AVI, respectively. CONCLUSION CAZ-AVI shows excellent in vitro activity against Enterobacterales in general, CRE, ESBL-producing Enterobacterales, and KPC-producing Enterobacterales. CAZ-AVI is also an option against MDR P. aeruginosa.
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Affiliation(s)
| | - Cecil Fandiño
- Medical Affairs, Pfizer Andean Cluster, Santiago, Chile
| | | | - Jorge A Ramos-Castaneda
- Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia.
| | - María L Rioseco
- Medico Microbiólogo Hospital de Puerto Montt, Puerto Montt, Chile
| | - Chrystal Juliet
- Medico Microbiólogo Hospital del Salvador, Santiago de Chile, Chile
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6
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Albarrak M, Al Dabbagh M, Al Hashami H, Alzomor O, Ghatasheh G, Habashy N, Hassanien A, Pérez-López A. Urinary tract infections in children from the Gulf Cooperation Council countries: a literature review (2011-2022). Front Pediatr 2023; 11:1163103. [PMID: 37528872 PMCID: PMC10387756 DOI: 10.3389/fped.2023.1163103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Urinary tract infections (UTIs) are common healthcare-associated and community-acquired bacterial infections in children. Data on pediatric UTIs in the Gulf Cooperation Council (GCC) region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) have not been collated. Our aim is to review the published literature on the risk factors, etiology, antimicrobial susceptibility, and treatment of pediatric (aged <18 years) UTIs from healthcare and community settings in the GCC countries.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mona Al Dabbagh
- Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hilal Al Hashami
- Pediatric Infectious Diseases Department, Lean Healthcare Certification, Royal Hospital, Muscat, Oman
| | - Omar Alzomor
- Pediatric Infectious Diseases Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ghassan Ghatasheh
- Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | | | | | - Andrés Pérez-López
- Division of Microbiology, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine in Qatar, Doha, Qatar
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7
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Wang J, Lv Y, Yang W, Zhao P, Yin C. Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients. BMC Microbiol 2022; 22:177. [PMID: 35820815 PMCID: PMC9277881 DOI: 10.1186/s12866-022-02585-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to elucidate the epidemiological features of carbapenemase-producing Enterobacterales (CPE) in the pediatric and neonatal patients, to describe clinical characteristics of neonatal patients with CPE infections, and to assess risk factors for neonatal rectal colonization with CPE. Results A total of 439 carbapenem-resistant Enterobacterales (CRE) isolates recovered from 367 infant patients were characterised, including 397 isolates of Klebsiella pneumoniae (KP) and 42 isolates of Escherichia coli (EC). Carbapenemase gene blaNDM-1 was the most commonly detected, accounting for 86.56% (n = 380), followed by blaKPC-2 (9.11%, 40) and blaIMP-4 (4.33%, 19). MLST analysis showed 17 different STs detected within CPKP isolates, with ST20, ST2068, ST36 and ST17 being the most frequently isolated types. Eleven STs were identified within CPEC isolates, with ST325 being the dominant types. Eight isolates of NDM-1 producing KP, belonging to ST23, were identified as having hypervirulent traits. The main infections caused by CPE were pneumonia (n = 90) and sepsis (n = 16). All infected patients received monotherapy, with meropenem and ciprofloxacin being the most commonly used antibiotics. All pneumonia patients were cured or improved after treatment. Of the 16 patients with sepsis, 9 were cured or improved, 3 died, and 4 abandoned treatment without any clinical improvement. The rectal prevalences of CPE in the 0–3 days old (DO), the 4–28 DO, and the 29 DO-1 year old groups were decreased from 15.31%, 27.37% and 14.29% in the first stool screening period to 11.78%, 19.59% and 4.07% in the second stool screening period, respectively. Multivariate analysis showed that cesarean section, acidosis, respiration failure, gastric lavage and enema were independent risk factors for rectal colonization in the 0–3 DO group, whereas cesarean section, cephalosporins, gastric lavage and residence in rural area were independently associated with rectal colonization in the 4–28 DO group. The implementation of a series of evidence-based control measures eventually contained the CPE transmission. Conclusions Continued vigilance, epidemiological studies, and multimodal infection prevention strategies are urgently needed due to frequent importations.
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Affiliation(s)
- Jiansheng Wang
- Clinical Laboratory, Hebei General Hospital, 348 Hepingxi Road, Shijiazhuang, 050051, Hebei, China.
| | - Yuanpeng Lv
- Clinical Laboratory, Hebei General Hospital, 348 Hepingxi Road, Shijiazhuang, 050051, Hebei, China
| | - Weiwei Yang
- Clinical Laboratory, Hebei General Hospital, 348 Hepingxi Road, Shijiazhuang, 050051, Hebei, China
| | - Peng Zhao
- Clinical Laboratory, Hebei General Hospital, 348 Hepingxi Road, Shijiazhuang, 050051, Hebei, China
| | - Changfu Yin
- The Experimental Center, Clinic College of Hebei Medical University, 309 South Jianhua Street, Shijiazhuang, 050031, Hebei, China
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8
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Nascimento ADS, Passaro MF, Silva PSDS, Rodriguez SF, Martins MK, Oliveira SCP, Moriel P, Visacri MB. Off-Label Use of Ceftazidime-Avibactam in a Premature Infant With Multidrug-Resistant Klebsiella pneumoniae Infection: A Case Report. J Pharm Pract 2022:8971900221087131. [PMID: 35414301 DOI: 10.1177/08971900221087131] [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: 01/25/2023]
Abstract
PURPOSE The emergence of multidrug-resistant (MDR) Gram-negative bacterial infections in the neonatal intensive care unit (NICU) is a major public health threat. Ceftazidime-avibactam (CAZ-AVI) provides a new option for treating infections caused by most beta-lactamase- and carbapenemase-producing Gram-negative bacteria in infants older than three months. However, treatment options are extremely limited, with no safety data available for preterm neonates. Here, we describe our experience regarding the safety and efficacy of off-label use of CAZ-AVI in a NICU in Brazil. SUMMARY We report a case of a premature infant (born at 29 weeks gestational age) treated with CAZ-AVI due to a bloodstream infection caused by MDR Klebsiella pneumoniae. CONCLUSION Treatment with CAZ-AVI was safe and effective in our patient.
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Affiliation(s)
| | - Marcos F Passaro
- 592445Irmandade da Santa Casa de Misericórdia de Santos, Santos, Brazil
| | | | | | | | | | - Patricia Moriel
- Faculty of Pharmaceutical Sciences, 28132University of Campinas, Campinas, Brazil
| | - Marília B Visacri
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, 28132University of São Paulo, São Paulo, Brazil
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Lemos EV, Rentería SR, Cárdenas P, Ramos-Castaneda JA. IN VITRO ACTIVITY OF CEFTAZIDIME-AVIBACTAM AGAINST GRAM-NEGATIVE STRAINS IN COLOMBIA 2014-2018. J Glob Antimicrob Resist 2022; 29:141-146. [DOI: 10.1016/j.jgar.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022] Open
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Asfour SS, Alaklobi FA, Abdelrahim A, Taha MY, Asfour RS, Khalil TM, Al-Mouqdad MM. Intravenous Ceftazidime-Avibactam in Extremely Premature Neonates With Carbapenem-Resistant Enterobacteriaceae: Two Case Reports. J Pediatr Pharmacol Ther 2022; 27:192-197. [DOI: 10.5863/1551-6776-27.2.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
The increasing use of carbapenems has contributed to a notable distribution of carbapenem-resistant Enterobacteriaceae (CRE). Recently, the incidence of CRE-associated infections is increasing significantly in NICUs, which pose a grave challenge to clinical treatment. We report 2 cases of IV ceftazidimeavibactam use to treat CRE infections in extremely premature neonates. The first case was diagnosed with bacteraemia and meningitis and the second one was diagnosed with bacteraemia only. Due to the lack of neonatal-specific information for IV ceftazidime-avibactam, the usual pediatric dose (62.5 mg/kg/dose every 8 hours) was used in these patients. Clinical cure occurred in these 2 patients. Although blood cultures became sterile after starting ceftazidime-avibactam in the second case, the patient died, presumably owing to sepsis or various causes, such as prematurity and chronic lung disease. Large and randomized studies are necessary to ensure the safety and efficacy of IV ceftazidime-avibactam for the treatment of neonates with sepsis caused by multidrug resistant organisms.
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Affiliation(s)
- Suzan S. Asfour
- Clinical Pharmacy Department (SSA), King Saud Medical City, Riyadh, Saudi Arabia
| | - Faisal A. Alaklobi
- Pediatric Infectious Disease Department (FAA), King Saud Medical City, Riyadh, Saudi Arabia
| | - Adli Abdelrahim
- Neonatal Intensive Care Unit (AA), King Saud Medical City, Riyadh, Saudi Arabia
| | - Muhammed Y. Taha
- Pediatric Pharmacy Department (MYT), King Saud Medical City, Riyadh, Saudi Arabia
| | - Raneem S. Asfour
- Pharmacy College (RSA), Jordan University of Science and Technology, Irbid, Jordan
| | - Thanaa M. Khalil
- Obstetrics and Gynaecology Department (TMK), King Saud Medical City, Riyadh, Saudi Arabia
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11
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Castagnola E, Bagnasco F, Mesini A, Agyeman PKA, Ammann RA, Carlesse F, Santolaya de Pablo ME, Groll AH, Haeusler GM, Lehrnbecher T, Simon A, D’Amico MR, Duong A, Idelevich EA, Luckowitsch M, Meli M, Menna G, Palmert S, Russo G, Sarno M, Solopova G, Tondo A, Traubici Y, Sung L. Antibiotic Resistant Bloodstream Infections in Pediatric Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant: Factors Associated with Development of Resistance, Intensive Care Admission and Mortality. Antibiotics (Basel) 2021; 10:antibiotics10030266. [PMID: 33807654 PMCID: PMC8000765 DOI: 10.3390/antibiotics10030266] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 01/01/2023] Open
Abstract
Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
- Correspondence:
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Roland A. Ammann
- Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Kinderaerzte KurWerk, 3400 Burgdorf, Switzerland
| | - Fabianne Carlesse
- Pediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo 04023-062, Brazil;
| | | | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology and Oncology, University Children’s Hospital Muenster, 48149 Muenster, Germany;
| | - Gabrielle M. Haeusler
- The Paediatric Integrated Cancer Service, Parkville, VIC 3052, Australia;
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany; (T.L.); (M.L.)
| | - Arne Simon
- Pediatric Oncology and Hematology, Children’s Hospital Medical Center, University Clinics, 6642 Homburg, Germany;
| | - Maria Rosaria D’Amico
- Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy; (M.R.D.); (G.M.)
| | - Austin Duong
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Evgeny A. Idelevich
- Institute of Medical Microbiology, University Hospital Munster, 48149 Munster, Germany;
| | - Marie Luckowitsch
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany; (T.L.); (M.L.)
| | - Mariaclaudia Meli
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.M.); (G.R.)
| | - Giuseppe Menna
- Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy; (M.R.D.); (G.M.)
| | - Sasha Palmert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (M.M.); (G.R.)
| | - Marco Sarno
- Pediatric Unit, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, Pozzuoli, 80027 Napoli, Italy;
| | - Galina Solopova
- Dmitry Rogachev Federal Scientific-Clinical Center of Children’s Hematology, Oncology and Immunology, 117997 Moscow, Russia;
| | - Annalisa Tondo
- Paediatric Haematology/Oncology Department, Meyer Children’s University Hospital, 50134 Florence, Italy;
| | - Yona Traubici
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada; (A.D.); (S.P.); (Y.T.); (L.S.)
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