1
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Zhang S, Di L, Qi Y, Qian X, Wang S. Treatment of infections caused by carbapenem-resistant Acinetobacter baumannii. Front Cell Infect Microbiol 2024; 14:1395260. [PMID: 39081869 PMCID: PMC11287075 DOI: 10.3389/fcimb.2024.1395260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Patients with severe carbapenem-resistant Acinetobacter baumannii (CRAB) infections currently face significant treatment challenges. When patients display signs of infection and the clinical suspicion of CRAB infections is high, appropriate treatment should be immediately provided. However, current treatment plans and clinical data for CRAB are limited. Inherent and acquired resistance mechanisms, as well as host factors, significantly restrict options for empirical medication. Moreover, inappropriate drug coverage can have detrimental effects on patients. Most existing studies have limitations, such as a restricted sample size, and are predominantly observational or non-randomized, which report significant variability in patient infection severity and comorbidities. Therefore, a gold-standard therapy remains lacking. Current and future treatment options of infections due to CRAB were described in this review. The dose and considerable side effects restrict treatment options for polymyxins, and high doses of ampicillin-sulbactam or tigecycline appear to be the best option at the time of initial treatment. Moreover, new drugs such as durlobactam and cefiderocol have substantial therapeutic capabilities and may be effective salvage treatments. Bacteriophages and antimicrobial peptides may serve as alternative treatment options in the near future. The advantages of a combination antimicrobial regimen appear to predominate those of a single regimen. Despite its significant nephrotoxicity, colistin is considered a primary treatment and is often used in combination with antimicrobials, such as tigecycline, ampicillin-sulbactam, meropenem, or fosfomycin. The Infectious Diseases Society of America (IDSA) has deemed high-dose ampicillin-sulbactam, which is typically combined with high-dose tigecycline, polymyxin, and other antibacterial agents, the best option for treating serious CRAB infections. A rational combination of drug use and the exploration of new therapeutic drugs can alleviate or prevent the effects of CRAB infections, shorten hospital stays, and reduce patient mortality.
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Affiliation(s)
- Siqin Zhang
- Department of Clinical Laboratory, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingfang Di
- Department of Clinical Laboratory, Tongxiang First People’s Hospital, Tongxiang, Zhejiang, China
| | - Yan Qi
- Department of Clinical Laboratory, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiang Qian
- Department of Clinical Laboratory, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Siwei Wang
- Panvascular Diseases Research Center, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
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2
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Oliva A, Liguori L, Covino S, Petrucci F, Cogliati-Dezza F, Curtolo A, Savelloni G, Comi M, Sacco F, Ceccarelli G, Viscido A, Alessandri F, Raponi G, Pugliese F, Mastroianni CM, Venditti M. Clinical effectiveness of cefiderocol for the treatment of bloodstream infections due to carbapenem-resistant Acinetobacter baumannii during the COVID-19 era: a single center, observational study. Eur J Clin Microbiol Infect Dis 2024; 43:1149-1160. [PMID: 38634975 PMCID: PMC11178648 DOI: 10.1007/s10096-024-04833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND We assessed the clinical effectiveness of cefiderocol (CFDC) in comparison with colistin (COL) for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infections (BSI). MATERIALS/METHODS Retrospective cohort study including adults with CRAB-BSI. Outcomes were mortality, clinical cure and adverse events during therapy. The average treatment effect of CFDC compared to COL was weighted with the inverse-probability treatment weight (IPTW). RESULTS Overall, 104 patients were included (50 CFDC, 54 COL), median age 66.5 years, median Charlson Comorbidity Index 5, septic shock in 33.6% of patients. Primary BSI accounted for 43.3% of cases, followed by ventilator-associated pneumonia (VAP) (26%), catheter-related BSI (20.2%) and hospital-acquired pneumonia (HAP) (9.6%). Although not significantly, mortality at all time points was lower for CFDC than COL, while clinical cure was higher in CFDC than COL (66% vs. 44.4%, p = 0.027). Adverse events were more frequent in COL than CFDC-group (38.8% vs. 10%, p < 0.0001), primarily attributed to acute kidney injury (AKI) in the COL group. Patients with bacteremic HAP/VAP treated with CFDC had a significant lower 30-d mortality and higher clinical cure than COL (p = 0.008 and p = 0.0008, respectively). Increment of CCI (p = 0.005), ICU (p = 0.025), SARS-CoV2 (p = 0.006) and ECMO (p < 0.0001) were independently associated with 30-d mortality, while receiving CFDC was not associated with survival. CONCLUSIONS CFDC could represent an effective and safe treatment option for CRAB BSI, especially in patients with bacteremic HAP/VAP and frail patients where the risk of acute renal failure during therapy should be avoided.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy.
| | - L Liguori
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - S Covino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - F Petrucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - F Cogliati-Dezza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - A Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - G Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - M Comi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - F Sacco
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - G Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - A Viscido
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - F Alessandri
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - G Raponi
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - F Pugliese
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - C M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy
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3
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Serapide F, Guastalegname M, Gullì SP, Lionello R, Bruni A, Garofalo E, Longhini F, Trecarichi EM, Russo A. Antibiotic Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections in View of the Newly Developed β-Lactams: A Narrative Review of the Existing Evidence. Antibiotics (Basel) 2024; 13:506. [PMID: 38927173 PMCID: PMC11201171 DOI: 10.3390/antibiotics13060506] [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: 05/02/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
It is estimated that antimicrobial resistance (AMR) is responsible for nearly 5 million human deaths worldwide each year and will reach 10 million by 2050. Carbapenem-resistant Acinetobacter baumannii (CRAB) infections represent the fourth-leading cause of death attributable to antimicrobial resistance globally, but a standardized therapy is still lacking. Among the antibiotics under consideration, Sulbactam/durlobactam seems to be the best candidate to replace current back-bone agents. Cefiderocol could play a pivotal role within combination therapy regimens. Due to toxicity and the pharmacokinetics/pharmacodynamics (PK/PD) limitations, colistin (or polymyxin B) should be used as an alternative agent (when no other options are available). Tigecycline (or minocycline) and fosfomycin could represent suitable partners for both NBLs. Randomized clinical trials (RCTs) are needed to better evaluate the role of NBLs in CRAB infection treatment and to compare the efficacy of tigecycline and fosfomycin as partner antibiotics. Synergism should be tested between NBLs and "old" drugs (rifampicin and trimethoprim/sulfamethoxazole). Huge efforts should be made to accelerate pre-clinical and clinical studies on safer polymyxin candidates with improved lung activity, as well as on the iv rifabutin formulation. In this narrative review, we focused the antibiotic treatment of CRAB infections in view of newly developed β-lactam agents (NBLs).
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Affiliation(s)
- Francesca Serapide
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
| | - Maurizio Guastalegname
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
| | - Sara Palma Gullì
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
| | - Rosaria Lionello
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
| | - Andrea Bruni
- Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (A.B.); (E.G.); (F.L.)
| | - Eugenio Garofalo
- Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (A.B.); (E.G.); (F.L.)
| | - Federico Longhini
- Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (A.B.); (E.G.); (F.L.)
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
| | - Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, 88100 Catanzaro, Italy; (F.S.); (S.P.G.); (R.L.)
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4
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Nasrollahian S, Graham JP, Halaji M. A review of the mechanisms that confer antibiotic resistance in pathotypes of E. coli. Front Cell Infect Microbiol 2024; 14:1387497. [PMID: 38638826 PMCID: PMC11024256 DOI: 10.3389/fcimb.2024.1387497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
The dissemination of antibiotic resistance in Escherichia coli poses a significant threat to public health worldwide. This review provides a comprehensive update on the diverse mechanisms employed by E. coli in developing resistance to antibiotics. We primarily focus on pathotypes of E. coli (e.g., uropathogenic E. coli) and investigate the genetic determinants and molecular pathways that confer resistance, shedding light on both well-characterized and recently discovered mechanisms. The most prevalent mechanism continues to be the acquisition of resistance genes through horizontal gene transfer, facilitated by mobile genetic elements such as plasmids and transposons. We discuss the role of extended-spectrum β-lactamases (ESBLs) and carbapenemases in conferring resistance to β-lactam antibiotics, which remain vital in clinical practice. The review covers the key resistant mechanisms, including: 1) Efflux pumps and porin mutations that mediate resistance to a broad spectrum of antibiotics, including fluoroquinolones and aminoglycosides; 2) adaptive strategies employed by E. coli, including biofilm formation, persister cell formation, and the activation of stress response systems, to withstand antibiotic pressure; and 3) the role of regulatory systems in coordinating resistance mechanisms, providing insights into potential targets for therapeutic interventions. Understanding the intricate network of antibiotic resistance mechanisms in E. coli is crucial for the development of effective strategies to combat this growing public health crisis. By clarifying these mechanisms, we aim to pave the way for the design of innovative therapeutic approaches and the implementation of prudent antibiotic stewardship practices to preserve the efficacy of current antibiotics and ensure a sustainable future for healthcare.
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Affiliation(s)
- Sina Nasrollahian
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jay P. Graham
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, United States
| | - Mehrdad Halaji
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Medical Microbiology and Biotechnology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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5
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Lombardi A, Alagna L, Palomba E, Viero G, Tonizzo A, Mangioni D, Bandera A. New Antibiotics Against Multidrug-Resistant Gram-Negative Bacteria in Liver Transplantation: Clinical Perspectives, Toxicity, and PK/PD Properties. Transpl Int 2024; 37:11692. [PMID: 38362283 PMCID: PMC10867129 DOI: 10.3389/ti.2024.11692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
Antimicrobial resistance is a growing global health problem, and it is especially relevant among liver transplant recipients where infections, particularly when caused by microorganisms with a difficult-to-treat profile, are a significant cause of morbidity and mortality. We provide here a complete dissection of the antibiotics active against multidrug-resistant Gram-negative bacteria approved over the last years, focusing on their activity spectrum, toxicity profile and PK/PD properties, including therapeutic drug monitoring, in the setting of liver transplantation. Specifically, the following drugs are presented: ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, cefiderocol, and eravacycline. Overall, studies on the safety and optimal employment of these drugs in liver transplant recipients are limited and especially needed. Nevertheless, these pharmaceuticals have undeniably enhanced therapeutic options for infected liver transplant recipients.
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Affiliation(s)
- Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Laura Alagna
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Emanuele Palomba
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Giulia Viero
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Anna Tonizzo
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Davide Mangioni
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
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6
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Karruli A, Migliaccio A, Pournaras S, Durante-Mangoni E, Zarrilli R. Cefiderocol and Sulbactam-Durlobactam against Carbapenem-Resistant Acinetobacter baumannii. Antibiotics (Basel) 2023; 12:1729. [PMID: 38136764 PMCID: PMC10740486 DOI: 10.3390/antibiotics12121729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain a clinical challenge due to limited treatment options. Recently, cefiderocol, a novel siderophore cephalosporin, and sulbactam-durlobactam, a bactericidal β-lactam-β-lactamase inhibitor combination, have been approved by the Food and Drug Administration for the treatment of A. baumannii infections. In this review, we discuss the mechanisms of action of and resistance to cefiderocol and sulbactam-durlobactam, the antimicrobial susceptibility of A. baumannii isolates to these drugs, as well as the clinical effectiveness of cefiderocol and sulbactam/durlobactam-based regimens against CRAB. Overall, cefiderocol and sulbactam-durlobactam show an excellent antimicrobial activity against CRAB. The review of clinical studies evaluating the efficacy of cefiderocol therapy against CRAB indicates it is non-inferior to colistin/other treatments for CRAB infections, with a better safety profile. Combination treatment is not associated with improved outcomes compared to monotherapy. Higher mortality rates are often associated with prior patient comorbidities and the severity of the underlying infection. Regarding sulbactam-durlobactam, current data from the pivotal clinical trial and case reports suggest this antibiotic combination could be a valuable option in critically ill patients affected by CRAB infections, in particular where no other antibiotic appears to be effective.
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Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Antonella Migliaccio
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Athens, Greece
| | | | - Raffaele Zarrilli
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
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7
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Cai T, Novelli A, Tascini C, Stefani S. Rediscovering the value of fosfomycin trometamol in the era of antimicrobial resistance: A systematic review and expert opinion. Int J Antimicrob Agents 2023; 62:106983. [PMID: 37748624 DOI: 10.1016/j.ijantimicag.2023.106983] [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: 12/16/2022] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
The worldwide prevalence of uncomplicated lower urinary tract infections (uUTIs) caused by multidrug-resistant Escherichia coli is increasing. To address this emergency, international guidelines recommend reducing administration of fluoroquinolones, in the context of growing resistance and the long-lasting and potentially disabling side effects of these drugs. The favoured drug to replace fluoroquinolones is fosfomycin trometamol (FT), a well-known derivate of phosphonic acid with broad-spectrum activity against Gram-negative and Gram-positive bacteria, including multidrug-resistant (MDR) strains. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recently reduced the susceptibility breakpoint for E. coli from 32 mg/L to 8 mg/L regarding FT used for uUTIs. This might lead to increased appropriate use of oral fosfomycin target therapy against E. coli and other microorganisms, and may be associated with a high likelihood of success. For species such as Klebsiella spp, particularly MDR strains, the absence of clinical breakpoints might lead to reduced use of oral fosfomycin, particularly if minimum inhibitory concentration is not available. To address this issue, this review presents an overview of the preclinical evidence on the activity of FT, and a systematic review of the clinical activity of FT in uUTIs in women, and in the prevention of infectious complications after prostate biopsy. The findings indicate that the safety and microbiological and clinical effectiveness of a single oral dose of FT are similar to that for comparator regimens with longer treatment schedules in women with uUTI, and FT can be considered a viable alternative to fluoroquinolones for antimicrobial prophylaxis in prostate biopsy. These observations and a broad clinical experience support the empirical use of FT for treating uUTI and indicate that FT is a promising candidate to effectively counteract antibiotic-resistant uUTIs throughout Europe.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Carlo Tascini
- Department of Medicine (DAME), Infectious Diseases Clinic, University of Udine, Udine, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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8
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Gaibani P, Lazzarotto T, Viale P, Ambretti S. In vitro activity of cefiderocol in combination with new β-lactam/β-lactamase inhibitor combinations (βL-βLICs) against multidrug resistant KPC-producing Klebsiella pneumoniae. J Antibiot (Tokyo) 2023; 76:682-688. [PMID: 37648744 DOI: 10.1038/s41429-023-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/21/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Paolo Gaibani
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Tiziana Lazzarotto
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- University of Bologna, Bologna, Italy
| | - PierLuigi Viale
- University of Bologna, Bologna, Italy
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ambretti
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- University of Bologna, Bologna, Italy
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9
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Bavaro DF, Diella L, Pizzutilo P, Catino A, Signorile F, Pesola F, Belati A, Marech I, Garrisi V, Lamorgese N, Di Gennaro F, Saracino A, Galetta D. Incidence and predictors of infections in patients with advanced non-small cell lung cancer treated with checkpoint inhibitor immunotherapies: A monocentric retrospective cohort study. Scand J Immunol 2023; 98:e13303. [PMID: 38441223 DOI: 10.1111/sji.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 06/04/2023] [Indexed: 03/07/2024]
Abstract
Immune checkpoint inhibitors (ICIs) represent the cornerstone of the current treatment of non-small cell lung cancer (NSCLC). However, the occurrence of concomitant infections might hamper success. All consecutive patients with advanced NSCLC who started ICIs as a first- or second-line therapy from January 1, 2017 to June 30, 2020 were retrospectively evaluated. The occurrence of infectious events during ICIs was correlated with clinical characteristics, including previous Cytotoxic Chemotherapy (CC), occurrence of immune-related-adverse-events (irAEs). A total of 211 patients were included, 46 (22%) females, with a median (q1-q3) age of 69 (62-76) years. Overall, 85 patients (40%) received ICIs as a first treatment line and 126 (60%) as a second line; 40 patients (19%) had at least one infection during ICIs, and 17 (8%) more than one. Notably, autoimmune diseases (P < .005), neutropenia (P = .001) or infections during previous CC (P = .001), irAEs (P = .006), or steroid therapy for irAEs (P < .001) were associated with infection development. By multivariate Cox-regression, autoimmune diseases (aHR = 6.27; 95%CI = 2.38-16.48; P < .001) and steroid therapy for irAEs (aHR = 2.65; 95%CI = 1.27-5.52; P < .009) were associated with a higher risk of infection during ICIs. Interestingly, autoimmune diseases were confirmed as risk factors in patients treated with ICIs as a first line, while previous infections were the only independent predictor of infections in patients treated with ICIs as a second line. Patients with NSCLC treated with ICIs with concurrent autoimmune disease, receiving steroid therapy for management of irAEs, or having a history of previous infections during CC should be actively monitored for the risk of developing infectious complications.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Lucia Diella
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Fabio Signorile
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Francesco Pesola
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Alessandra Belati
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Ilaria Marech
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Vito Garrisi
- Clinical Pathology Laboratory, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Nino Lamorgese
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Galetta
- Thoracic Oncology Unit, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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10
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Cavallo I, Oliva A, Pages R, Sivori F, Truglio M, Fabrizio G, Pasqua M, Pimpinelli F, Di Domenico EG. Acinetobacter baumannii in the critically ill: complex infections get complicated. Front Microbiol 2023; 14:1196774. [PMID: 37425994 PMCID: PMC10325864 DOI: 10.3389/fmicb.2023.1196774] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Acinetobacter baumannii is increasingly associated with various epidemics, representing a serious concern due to the broad level of antimicrobial resistance and clinical manifestations. During the last decades, A. baumannii has emerged as a major pathogen in vulnerable and critically ill patients. Bacteremia, pneumonia, urinary tract, and skin and soft tissue infections are the most common presentations of A. baumannii, with attributable mortality rates approaching 35%. Carbapenems have been considered the first choice to treat A. baumannii infections. However, due to the widespread prevalence of carbapenem-resistant A. baumannii (CRAB), colistin represents the main therapeutic option, while the role of the new siderophore cephalosporin cefiderocol still needs to be ascertained. Furthermore, high clinical failure rates have been reported for colistin monotherapy when used to treat CRAB infections. Thus, the most effective antibiotic combination remains disputed. In addition to its ability to develop antibiotic resistance, A. baumannii is also known to form biofilm on medical devices, including central venous catheters or endotracheal tubes. Thus, the worrisome spread of biofilm-producing strains in multidrug-resistant populations of A. baumannii poses a significant treatment challenge. This review provides an updated account of antimicrobial resistance patterns and biofilm-mediated tolerance in A. baumannii infections with a special focus on fragile and critically ill patients.
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Affiliation(s)
- Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rebecca Pages
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Truglio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giorgia Fabrizio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Martina Pasqua
- Department of Biology and Biotechnology "C. Darwin" Sapienza University of Rome, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Enea Gino Di Domenico
- Department of Biology and Biotechnology "C. Darwin" Sapienza University of Rome, Rome, Italy
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11
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Viale P, Sandrock CE, Ramirez P, Rossolini GM, Lodise TP. Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence. Ann Intensive Care 2023; 13:52. [PMID: 37322293 DOI: 10.1186/s13613-023-01146-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Appropriate antibiotic treatment for critically ill patients with serious Gram-negative infections in the intensive care unit is crucial to minimize morbidity and mortality. Several new antibiotics have shown in vitro activity against carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistant Pseudomonas aeruginosa. Cefiderocol is the first approved siderophore beta-lactam antibiotic with potent activity against multidrug-resistant, carbapenem-resistant, difficult-to-treat or extensively drug-resistant Gram-negative pathogens, which have limited treatment options. The spectrum of activity of cefiderocol includes drug-resistant strains of Acinetobacter baumannii, P. aeruginosa, Stenotrophomonas maltophilia, Achromobacter spp. and Burkholderia spp. and CRE that produce serine- and/or metallo-carbapenemases. Phase 1 studies established that cefiderocol achieves adequate concentration in the epithelial lining fluid in the lung and requires dosing adjustment for renal function, including patients with augmented renal clearance and continuous renal-replacement therapy (CRRT); no clinically significant drug-drug interactions are expected. The non-inferiority of cefiderocol versus high-dose, extended-infusion meropenem in all-cause mortality (ACM) rates at day 14 was demonstrated in the randomized, double-blind APEKS-NP Phase 3 clinical study in patients with nosocomial pneumonia caused by suspected or confirmed Gram-negative bacteria. Furthermore, the efficacy of cefiderocol was investigated in the randomized, open-label, pathogen-focused, descriptive CREDIBLE-CR Phase 3 clinical study in its target patient population with serious carbapenem-resistant Gram-negative infections, including hospitalized patients with nosocomial pneumonia, bloodstream infection/sepsis, or complicated urinary tract infections. However, a numerically greater ACM rate with cefiderocol compared with BAT led to the inclusion of a warning in US and European prescribing information. Cefiderocol susceptibility results obtained with commercial tests should be carefully evaluated due to current issues regarding their accuracy and reliability. Since its approval, real-world evidence in patients with multidrug-resistant and carbapenem-resistant Gram-negative bacterial infections suggests that cefiderocol can be efficacious in certain critically ill patient groups, such as those requiring mechanical ventilation for COVID-19 pneumonia with subsequently acquired Gram-negative bacterial superinfection, and patients with CRRT and/or extracorporeal membrane oxygenation. In this article, we review the microbiological spectrum, pharmacokinetics/pharmacodynamics, efficacy and safety profiles and real-world evidence for cefiderocol, and look at future considerations for its role in the treatment of critically ill patients with challenging Gram-negative bacterial infections.
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Affiliation(s)
- Pierluigi Viale
- Infectious Disease Unit, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Science, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Christian E Sandrock
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
| | - Paula Ramirez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
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12
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Sajib MI, Monteforte M, Go R. Clinical Outcome of Cefiderocol for Infections with Carbapenem-Resistant Organisms. Antibiotics (Basel) 2023; 12:antibiotics12050936. [PMID: 37237839 DOI: 10.3390/antibiotics12050936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Cefiderocol is a novel cephalosporin recently approved by the FDA to aid clinicians in the fight against multidrug-resistant (including carbapenem-resistant) gram-negative organisms. The primary objective of this study is to evaluate the 14- and 28-day mortality associated with cefiderocol. We performed a retrospective chart review of all adult patients admitted at Stony Brook University Hospital between October 2020 and December 2021 and received cefiderocol for at least 3 days. Patients were excluded if they received more than one course of cefiderocol therapy or remained hospitalized at the time of this study. A total of 22 patients met the inclusion criteria. The all-cause mortality on day 28 for all patients was 13.6%, whereas this rate for patients with BSI was 0%, with cUTI was 0% and with LRTI was 16.7%. The all-cause mortality on day 28 for patients who received the dual antibiotics (in conjunction with cefiderocol) was 0%, compared to 25% for patients who only received cefiderocol (p = 0.25). We noted treatment failure in two patients (9.1%). Our findings suggest that cefiderocol could possibly be associated with lower all-cause mortality than previously thought. In our study, we did not find any significant difference between cefiderocol's use in combination with another antibacterial agent and its use as a monotherapy.
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Affiliation(s)
- Monirul I Sajib
- Division of Infectious Disease, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Melinda Monteforte
- Division of Infectious Disease, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Roderick Go
- Division of Infectious Disease, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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13
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de la Fuente C, Rodriguez M, Merino N, Carmona P, Machuca I, Córdoba-Fernández M, Guzmán-Puche J, Dominguez A, Viñau TL, García L, Vaquero JM, Robles JC, Martínez-Martínez L, Torre-Cisneros J. Real-life use of cefiderocol for salvage therapy of severe infections due to carbapenem-resistant Gram-negative bacteria. Int J Antimicrob Agents 2023; 62:106818. [PMID: 37062445 DOI: 10.1016/j.ijantimicag.2023.106818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
Treatment of infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) is challenging and new active antibiotics are urgently needed. This study describes the efficacy and safety of cefiderocol in a retrospective series of 13 patients with severe CR-GNB infection and limited treatment options. Pseudomonas aeruginosa was the predominant CR-GNB (n=8) followed by Burkholderia cepacia (n=3), Sthenotrophomona maltophilia (n=1) and KPC-producing Klebsiella pneumoniae (n=1). The source of infection was nosocomial pneumonia in 92.3% of cases (12/13), of which 11 cases were ventilator-associated pneumonia (VAP). Five patients were lung transplant recipients (38.5%). The median duration of treatment was 10 days (range, 6-21 days). No severe adverse effects required reducing the dose or interrupting the treatment. Clinical and microbiological cure was assessed 7 days after the end of treatment and achieved in 84.6% (11/13) of the patients. Crude mortality at day 28 was observed in 23.1% (3/13) of the cases. Cefiderocol is a valid alternative for the treatment of susceptible CR-GNB infections in patients with limited therapeutic options.
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Affiliation(s)
- Carmen de la Fuente
- Critical Care Service, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Rodriguez
- Critical Care Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Noemi Merino
- Critical Care Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Isabel Machuca
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - J Guzmán-Puche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Arantxa Dominguez
- Anesthesiology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Teresa-López Viñau
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Pharmacy Service. Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Lucrecia García
- Pharmacy Service. Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jose Manuel Vaquero
- Pulmonary Medicine Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan Carlos Robles
- Critical Care Service, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Luis Martínez-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain; Department of Agricultural Chemistry, Soil Sciences and Microbiology. Universidad de Córdoba, Córdoba, Spain.
| | - Julian Torre-Cisneros
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitario Reina Sofía, Córdoba, Spain; Department of Medical and Surgical Sciences. Universidad de Córdoba, Córdoba, Spain
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14
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Palermo G, Medaglia AA, Pipitò L, Rubino R, Costantini M, Accomando S, Giammanco GM, Cascio A. Cefiderocol Efficacy in a Real-Life Setting: Single-Centre Retrospective Study. Antibiotics (Basel) 2023; 12:antibiotics12040746. [PMID: 37107108 PMCID: PMC10135318 DOI: 10.3390/antibiotics12040746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The current carbapenem-resistant gram-negative bacteria (CR-GN) treatment guidelines lack strong evidence about cefiderocol (CFD) efficacy against CR-GN, especially CRAB. The study's purpose is to evaluate the effectiveness of CFD in a real-life setting. We made a single-center retrospective study of 41 patients who received CFD in our hospital for several CR-GN infections. Bloodstream infections (BSI) affected 43.9% (18/41) of patients, while CRAB affected 75.6% (31/41) of isolated CR-GN patients. Thirty-days (30-D) all-causes mortality affected 36.6% (15/41) of patients, while end-of-treatment (EOT) clinical cure affected 56.1% (23/41). Finally, microbiological eradication at EOT affected 56.1% (23/41) of patients. Univariate and multivariate analysis showed that septic shock is an independent factor associated with mortality. Subgroup analyses showed no difference in CFD effectiveness between monotherapy and combination therapy.
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Affiliation(s)
- Gabriele Palermo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Alice Annalisa Medaglia
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Raffaella Rubino
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | | | - Salvatore Accomando
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Giovanni Maurizio Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Microbiology and Virology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
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15
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Mazzitelli M, Gregori D, Sasset L, Trevenzoli M, Scaglione V, Lo Menzo S, Marinello S, Mengato D, Venturini F, Tiberio I, Navalesi P, Cattelan A. Cefiderocol-Based versus Colistin-Based Regimens for Severe Carbapenem-Resistant Acinetobacter baumannii Infections: A Propensity Score-Weighted, Retrospective Cohort Study during the First Two Years of the COVID-19 Pandemic. Microorganisms 2023; 11:microorganisms11040984. [PMID: 37110408 PMCID: PMC10146662 DOI: 10.3390/microorganisms11040984] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A large increase in multi-drug-resistant Acinetobacter baumannii, especially carbapenem-resistant strains, occurred during the first two years of the COVID-19 pandemic, posing important challenges in its treatment. Cefiderocol appeared to be a good option for the treatment of Carbapenem-resistant Acinetobacter baumannii (CR-Ab), but to date, the guidelines and evidence available are conflicting. METHODS We retrospectively included a group of patients with CR-Ab infections (treated with colistin- or cefiderocol-based regimens) at Padua University Hospital (August 2020-July 2022) and assessed predictors of 30-day mortality, and differences in microbiological and clinical treatment. To evaluate the difference in outcomes, accounting for the imbalance in antibiotic treatment allocation, a propensity score weighting (PSW) approach was adopted. RESULTS We included 111 patients, 68% males, with a median age of 69 years (IQR: 59-78). The median duration of antibiotic treatment was 13 days (IQR:11-16). In total, 60 (54.1%) and 51 (45.9%) patients received cefiderocol- and colistin-based therapy, respectively. Notably, 53 (47.7%) patients had bloodstream infections, while 58 (52.3%) had pneumonia. Colistin was combined in 96.1%, 80.4%, and 5.8% of cases with tigecycline, meropenem, and fosfomycin, respectively. Cefiderocol was combined in 13.3%, 30%, and 18.3% of cases with fosfomycin, tigecycline, and meropenem, respectively. At the baseline, the two treatment groups significantly differed in age (patients treated with colistin were significantly older), the prevalence of diabetes and obesity (more frequent in the group treated with colistin), length of stay (longer in the group receiving cefiderocol), and type of infection (BSI were more frequent in the group receiving cefiderocol). The proportion of patients who developed acute kidney injury was significantly higher in the colistin group. By using PSW, no statistically significant differences emerged for mortality or clinical and microbiological cure between the two groups. No independent predictors were detected for hospital mortality or clinical cure, while for the length of stay, the only selected predictor was age, with a non-linear effect (p-value 0.025 for non-linearity) on the prolongation of hospital stay of 0.25 days (95% CI 0.10-0.39) at increasing ages (calculated over the IQR). CONCLUSIONS Cefiderocol treatment did not differ in terms of main outcomes and safety profile from colistin-based regimens. More prospective studies with a larger number of patients are required to confirm our results.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Marco Trevenzoli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Sara Lo Menzo
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Unit, Padua University Hospital, 35128 Padua, Italy
| | | | - Ivo Tiberio
- Anesthesiology and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy
| | - Paolo Navalesi
- Department of Medicine (DIMED), Padua University Hospital, 35121 Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
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16
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Bavaro DF, De Gennaro N, Belati A, Diella L, Papagni R, Frallonardo L, Camporeale M, Guido G, Pellegrino C, Marrone M, Dell’Erba A, Gesualdo L, Brienza N, Grasso S, Columbo G, Moschetta A, Carpagnano GE, Daleno A, Minicucci AM, Migliore G, Saracino A. Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study. Antibiotics (Basel) 2023; 12:antibiotics12040712. [PMID: 37107073 PMCID: PMC10135160 DOI: 10.3390/antibiotics12040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Background: Antimicrobial and diagnostic stewardship (AS/DS) principles are crucial for the management of multidrug-resistant organisms (MDROs) infections. We evaluated the impact of a pro-active Infectious Disease (ID) consultation on the mortality risk of patients during an MDROs outbreak in a COVID-19 hospital. Methods: A quasi-experimental study was performed in a dedicated COVID-19 hospital, including patients with suspected/confirmed infection and/or colonization by MDROs, which were managed as follows: (i) according to the standard of care during the pre-phase and (ii) in collaboration with a dedicated ID team performing a pro-active bedside evaluation every 48–72 h in the post-phase. Results: Overall, 112 patients were included (pre-phase = 89 and post-phase = 45). The AS interventions included the following: therapy optimization (33%), de-escalation to narrow the spectrum (24%) or to lessen toxic drugs (20%), and discontinuation of antimicrobials (64%). DS included the request of additional microbiologic tests (82%) and instrumental exams (16%). With the Cox model, after adjusting for age, sex, COVID-19 severity, infection source, etiological agents, and post-phase attendance, only age predicted an increased risk of mortality, while attendance in the post-phase resulted in a decreased risk of mortality. Conclusions: Implementation of AS and DS intervention through a pro-active ID consultation may reduce the risk of 28-day mortality of COVID-19 patients with MDROs infections.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Nicolò De Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Roberta Papagni
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Michele Camporeale
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Maricla Marrone
- Interdisciplinary Department of Medicine, University of Bari–Section of Legal Medicine, Bari General Hospital, 70124 Bari, Italy
| | - Alessandro Dell’Erba
- Interdisciplinary Department of Medicine, University of Bari–Section of Legal Medicine, Bari General Hospital, 70124 Bari, Italy
| | - Loreto Gesualdo
- Precision and Regenerative Medicine and Ionian Area, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Nicola Brienza
- Precision and Regenerative Medicine and Ionian Area, Section of Anesthesia and Intensive Care, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Salvatore Grasso
- Precision and Regenerative Medicine and Ionian Area, Section of Anesthesia and Intensive Care, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giuseppe Columbo
- Precision and Regenerative Medicine and Ionian Area, Section of Anesthesia and Intensive Care, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Precision and Regenerative Medicine and Ionian Area, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Antonio Daleno
- Section of Health Management, Policlinico Hospital, 70124 Bari, Italy
| | | | | | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy
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17
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Fendian ÁM, Albanell-Fernández M, Tuset M, Pitart C, Castro P, Soy D, Bodro M, Soriano A, Del Río A, Martínez JA. Real-Life Data on the Effectiveness and Safety of Cefiderocol in Severely Infected Patients: A Case Series. Infect Dis Ther 2023; 12:1205-1216. [PMID: 36943617 PMCID: PMC10029777 DOI: 10.1007/s40121-023-00776-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Real-life data about cefiderocol use to treat extensively drug-resistant bacteria are scarce. We aim to report our early experience in patients with difficult-to-treat infections and limited therapeutic options. METHODS Patients treated with cefiderocol from March 2018 to April 2022 in a tertiary-care hospital in Spain were included. Demographic, clinical, and microbiological data were collected up to 90 days after the end of treatment or until death. Survival status was recorded at 30 and 90 days. RESULTS Ten patients were included, seven of them critically ill. Ventilator-associated pneumonia (40%) and bacteremia (40%) were the main infections. Multidrug-resistant or extensively drug-resistant P. aeruginosa was the most frequently isolated pathogen (70%, of which six patients were infected with bacteria with difficult-to-treat resistance), followed by A. baumannii, E. coli, and A. xylosoxidans (10% each). Seven patients received combination therapy. Clinical and microbiological cures were achieved in 90% and 80% of patients, respectively. Two previously susceptible strains (20%) developed resistance to cefiderocol. Overall, 30-day and 90-day mortality rates were 10% and 50%, respectively, although two out of five patients died due to the infection. No serious adverse events were reported, except for one patient who developed thrombocytopenia. CONCLUSION Cefiderocol seems to be an effective and safe rescue therapy for patients infected with difficult-to-treat pathogens, although there is a definite risk of the emergence of resistance.
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Affiliation(s)
- Ángel Marcos Fendian
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain.
| | | | - Montse Tuset
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Dolors Soy
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana Del Río
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Clinical Appraisal of Cefiderocol in the Treatment of Non-fermenting Gram-Negative Bacilli. Curr Infect Dis Rep 2023. [DOI: 10.1007/s11908-023-00800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Abstract
Purpose of Review
Cefiderocol has a potential role in the treatment of infections caused by increasingly resistant non-fermenting Gram-negative organisms.
Recent Findings
Non-fermenting Gram-negative organisms pose a unique threat to public health given their arsenal of inherent resistance mechanisms. High rates of intrinsic resistance to a wide array of agents, inducible adaptive resistance, and the ability to acquire resistance through horizontal transfer of resistance genes limit the utility of conventional antimicrobial treatment options against non-fermenting Gram-negative infections. Beta-lactams, one of the most reliable classes of antimicrobials, are often rendered inactive by the acquisition of beta-lactamases, with activity potentially restored by beta-lactamase inhibitors. Alteration of intrinsic mechanisms of resistance, porin channels, and efflux pumps reduce the ability of beta-lactamase inhibitors to protect the activity of beta-lactams. This multifactorial nature of resistance exhibited by non-fermenting Gram-negative organisms is difficult to overcome and novel agents are needed to combat this growing threat.
Summary
Cefiderocol is a novel siderophore cephalosporin that utilizes the active transport of ferric iron to gain access to the periplasmic space of Gram-negative organisms. Cefiderocol also has additional modifications that confer some stability in the presence of beta-lactamases, which can be particularly beneficial for infections caused by non-fermenters. Herein, we discuss the potential role of cefiderocol therapy in the management of infections caused by non-fermenting Gram-negative bacilli, with an intentional focus on carbapenem-resistant Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa, and Stenotrophomonas spp.
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Hoellinger B, Danion F, Hansmann Y, Schramm F, Ruch Y. 'Real world clinical outcome of cefiderocol for treatment of multidrug resistant non-fermenting gram-negative bacilli infections' - Author's reply. Clin Microbiol Infect 2023:S1198-743X(23)00089-7. [PMID: 36871827 DOI: 10.1016/j.cmi.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Affiliation(s)
- B Hoellinger
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
| | - F Danion
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Y Hansmann
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - F Schramm
- Department of Bacteriology, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Y Ruch
- Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
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Larcher R, Laffont-Lozes P, Loubet P, Laureillard D, Naciri T, Sotto A. Re: 'Real world clinical outcome of cefiderocol for treatment of multidrug-resistant nonfermenting gram-negative bacilli infections' by Hoellinger et al. Clin Microbiol Infect 2023:S1198-743X(23)00047-2. [PMID: 36739087 DOI: 10.1016/j.cmi.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Romaric Larcher
- PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, France and Department of Infectious and Tropical Diseases, Nîmes University Hospital, France.
| | - Paul Laffont-Lozes
- Department of Infectious and Tropical Diseases and Department of Pharmacy, Nîmes University Hospital, France
| | - Paul Loubet
- VBIC (Bacterial Virulence and Chronic Infection), INSERM (French Institute of Health and Medical Research), Montpellier University, Department of Infectious and Tropical Diseases, Nîmes University Hospital, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, Nîmes University Hospital, France
| | - Tayma Naciri
- Department of Infectious and Tropical Diseases, Nîmes University Hospital, France
| | - Albert Sotto
- VBIC (Bacterial Virulence and Chronic Infection), INSERM (French Institute of Health and Medical Research), Montpellier University, Department of Infectious and Tropical Diseases, Nîmes University Hospital, France
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Karruli A, Massa A, Andini R, Marrazzo T, Ruocco G, Zampino R, Durante-Mangoni E. Clinical efficacy and safety of cefiderocol for resistant Gram-negative infections: a real-life, single-centre experience. Int J Antimicrob Agents 2023; 61:106723. [PMID: 36642233 DOI: 10.1016/j.ijantimicag.2023.106723] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Cefiderocol is a 'siderophore' cephalosporin active against Gram-negative bacteria, including carbapenem-resistant strains. Data on the use of cefiderocol in real life are limited. We evaluated the efficacy and safety of cefiderocol in the context of our hospital clinical practice. METHODS This was a single-centre, observational, retrospective clinical study. We collected data for all patients who received cefiderocol therapy in our hospital, with a focus on clinical outcomes and adverse events. RESULTS The study cohort included 28 patients, with a median age of 73 years (25-83 years) and a high burden of co-morbidities. Up to 45 Gram-negative isolates were cultured from the study patients, the most common pathogen being Acinetobacter baumannii (31.1%). Cefiderocol was mostly prescribed for pneumonia (37.8% of cases), bloodstream infection (24.4%), urinary tract infection (22.2%) and intra-abdominal infection (20%), and largely as salvage therapy (92.8%). Of the 18 patients for whom follow-up cultures were available, 14 (77.8%) achieved eradication of the causative micro-organism. Therapeutic success (improvement/resolution of infection) occurred in 64.3% of cases at 7 days and 50% at 14 days from treatment start. Treatment failed in 9 cases (32.1%). No effects on kidney, liver or bone marrow function were observed. CONCLUSIONS Cefiderocol showed fair efficacy and excellent tolerability in highly co-morbid patients with a range of multiresistant infections. It may be an option for infections due to colistin-resistant pathogens, when other regimens fail or in cases at risk of kidney dysfunction.
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Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessia Massa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy
| | - Tommaso Marrazzo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy
| | - Rosa Zampino
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy.
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Kang Y, Cui J. Evaluation of the Efficacy of Optimized Two-Step-Administration Therapy with Ceftazidime/Avibactam for Treating Extensively Drug-Resistant Pseudomonas aeruginosa Pulmonary Infections: a Pharmacokinetic/Pharmacodynamic Analysis. Jpn J Infect Dis 2023; 76:1-6. [PMID: 35908879 DOI: 10.7883/yoken.jjid.2022.289] [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: 01/28/2023]
Abstract
The objective of this pharmacokinetic (PK)/pharmacodynamic (PD) analysis was to evaluate the efficacy of different dosing regimens of ceftazidime/avibactam (CZA) for the treatment of pulmonary infections by extensively drug-resistant (XDR) Pseudomonas aeruginosa using optimized two-step administration therapy (OTAT) and traditional infusion (TI). We used Monte Carlo simulations (MCS) to integrate PK parameters with PD parameters to assess the adequacy of CZA dosing in critically ill patients with XDR P. aeruginosa pulmonary infections. Dosing models were as follows: 2.5 g q8h, 2.5 g q6h, 4 g q8h, 4 g q6h, 1.25 g q8h, 1.25 g q6h, and 0.94 g q12h. MCS showed that the cumulative fraction of response of all dosing regimens of OTAT was higher than 90%. The probability of target attainment of all dosing regimens of OTAT at MICs (minimal inhibitory concentrations) between 16 mg/L and 32 mg/L was higher than that of TI. Based on these models, PK/PD goals were met with OTAT regimens, even with high MICs (>16 mg/L) compared to traditional infusion (TI) intervals. Thus, this study indicates that OTAT with sufficient PK exposure could improve the efficacy of CZA in critically ill patients with XDR P. aeruginosa pulmonary infections.
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Affiliation(s)
- Yixin Kang
- Department of Respiratory Diseases, The first Medical Center, Chinese People's Liberation Army General Hospital, China
| | - Junchang Cui
- Department of Respiratory Diseases, The first Medical Center, Chinese People's Liberation Army General Hospital, China
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Chou A, Ramsey D, Amenta E, Trautner BW. Real-world experience with cefiderocol therapy for Pseudomonas aeruginosa and other multidrug resistant gram-negative infections within the Veterans Health Administration, 2019-2022. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e90. [PMID: 37179761 PMCID: PMC10173288 DOI: 10.1017/ash.2023.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023]
Abstract
Objective Single-center and regional studies have reported outcomes after treatment with cefiderocol, a novel siderophore cephalosporin. We report on real-world use, clinical outcomes, and microbiological outcomes with cefiderocol therapy within the Veterans' Health Administration (VHA). Design Prospective, observational descriptive study. Setting Veterans' Health Administration, 132 sites across the United States, during 2019-2022. Patients This study included patients admitted to any VHA medical center who received cefiderocol for ≥2 days. Methods Data were obtained from the VHA Corporate Data Warehouse and through manual chart review. We extracted clinical and microbiologic characteristics and outcomes. Results In total, 8,763,652 patients received 1,142,940,842 prescriptions during the study period. Of these, 48 unique individuals received cefiderocol. The median age of this cohort was 70.5 years (IQR, 60.5-74), and the median Charlson comorbidity score was 6 (IQR, 3-9). The most common infectious syndromes were lower respiratory tract infection in 23 patients (47.9%) and urinary tract infection in 14 patients (29.2%). The most common pathogen cultured was P. aeruginosa in 30 patients (62.5%). The clinical failure rate was 35.4% (17 of 48), and 15 (88.2%) of these 17 patients died within 3 days of clinical failure. The 30-day and 90-day all-cause mortality rates were 27.1% (13 of 48) and 45.8% (22 of 48), respectively. The 30-day and 90-day microbiologic failure rates were 29.2% (14 of 48) and 41.7% (20 of 48), respectively. Conclusions In this nationwide VHA cohort clinical and microbiologic failure occurred in >30% of patients treated with cefiderocol, and >40% of these died within 90 days. Cefiderocol is not widely used, and many of the patients who received it had substantial comorbidities.
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Affiliation(s)
- Andrew Chou
- Michael E. DeBakey, Veterans’ Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Corresponding author: Andrew Chou, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), 2450 Holcombe Boulevard, Suite 01Y, Houston, TX, 77021. E-mail:
| | - David Ramsey
- Michael E. DeBakey, Veterans’ Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Eva Amenta
- Michael E. DeBakey, Veterans’ Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Barbara W. Trautner
- Michael E. DeBakey, Veterans’ Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
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Marino A, Stracquadanio S, Campanella E, Munafò A, Gussio M, Ceccarelli M, Bernardini R, Nunnari G, Cacopardo B. Intravenous Fosfomycin: A Potential Good Partner for Cefiderocol. Clinical Experience and Considerations. Antibiotics (Basel) 2022; 12:antibiotics12010049. [PMID: 36671250 PMCID: PMC9854867 DOI: 10.3390/antibiotics12010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022] Open
Abstract
Multidrug resistant Gram-negative bacteremia represents a therapeutic challenge clinicians have to deal with. This concern becomes more difficult when causing germs are represented by carbapenem resistant Acinetobacter baumannii or difficult-to-treat Pseudomonas aeruginosa. Few antibiotics are available against these cumbersome bacteria, although literature data are not conclusive, especially for Acinetobacter. Cefiderocol could represent a valid antibiotic choice, being a molecule with an innovative mechanism of action capable of overcoming common resistance pathways, whereas intravenous fosfomycin may be an appropriate partner either enhancing cefiderocol activity or avoiding resistance development. Here we report two patients with MDR Gram negative bacteremia who were successfully treated with a cefiderocol/fosfomycin combination.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Stefano Stracquadanio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Edoardo Campanella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Antonio Munafò
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Renato Bernardini
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
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Mornese Pinna S, Corcione S, De Nicolò A, Montrucchio G, Scabini S, Vita D, De Benedetto I, Lupia T, Mula J, Di Perri G, D’Avolio A, De Rosa FG. Pharmacokinetic of Cefiderocol in Critically Ill Patients Receiving Renal Replacement Therapy: A Case Series. Antibiotics (Basel) 2022; 11:antibiotics11121830. [PMID: 36551485 PMCID: PMC9774561 DOI: 10.3390/antibiotics11121830] [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: 11/06/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Cefiderocol is a novel parenteral siderophore cephalosporin, demonstrating enhanced activity against multidrug-resistant (MDR) Gram-negative bacteria and difficult-to-treat Acinetobacter baumannii (DTR-AB). Plasma-free trough concentration (fCtrough) over the minimum inhibitory concentration (MIC) was reported as the best pharmacokinetic parameter to describe the microbiological efficacy of cefiderocol. Materials and methods: We retrospectively described the pharmacokinetic and pharmacodynamic profile of three critically ill patients admitted to the intensive care unit, receiving cefiderocol under compassionate use to treat severe DTR-AB infections while undergoing continuous venovenous haemofiltration. Cefiderocol was administrated at a dosage of 2 g every 8 h infused over 3 h. Therapeutic drug monitoring (TDM) was assessed at the steady state. Cthrough was evaluated by assuming a plasma protein binding of 58.0%. The fCmin/MIC was calculated assuming a cefiderocol MIC equal to the PK-PD breakpoint of susceptibility ≤ 2. The association between the PK/PD parameters and microbiological outcome was assessed. Results: fCtrough/MIC were >12 in 2 patients and 2.9 in the 1 who rapidly recovered from renal failure. Microbiological cure occurred in 3/3 of patients. None of the 3 patients died within 30 days. Conclusions: A cefiderocol dosage of 2 g q8 h in critically ill patients with AKI undergoing CVVH may bring about a very high plasma concentration, corresponding to essentially 100% free time over the MIC for DTR-AB.
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Affiliation(s)
- Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-011-6334999
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10126 Turin, Italy
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Citta della Salute e della Scienza Hospital, University of Turin, 10124 Turin, Italy
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Davide Vita
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Tommaso Lupia
- ASL Asti, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Jacopo Mula
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10126 Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Antonio D’Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- ASL Asti, Cardinal Massaia Hospital, 14100 Asti, Italy
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Clinical evidence supporting cefiderol for serious Acinetobacter baumannii infections. Curr Opin Infect Dis 2022; 35:545-551. [PMID: 36345852 DOI: 10.1097/qco.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW Nosocomial infections caused by Acinetobacter baumannii currently represent a serious challenge for clinicians because treatment options are limited and frequently associated with significant toxicity. Cefiderocol is a first-in-class siderophore cephalosporin that has a proven efficacy for the treatment of multidrug-resistant Gram-negative infections, including carbapenem-resistant A. baumannii. The aim of this review is to evaluate the current evidence for the role of cefiderocol in the management of A. baumannii infections. RECENT FINDINGS In this review, we briefly summarize the available data on the efficacy (from randomized controlled trials) and on effectiveness and cure rates (from observational studies), pertaining to the use of cefiderocol for treatment of serious A. baumannii infections. SUMMARY Cefiderocol represents a promising and safe antibiotic option for treating patients with carbapenem-resistant A. baumannii infections. Due to conflicting mortality data from available experience, well-designed future randomized controlled trials and real-life studies are needed.
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Cortegiani A, Ingoglia G, Ippolito M, Girardis M, Falcone M, Pea F, Pugliese F, Stefani S, Viale P, Giarratano A. Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022. [PMCID: PMC9361889 DOI: 10.1186/s44158-022-00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (either new or preexisting). Several mechanisms of resistance, especially those mediated by metallo-β-lactamases (MBL), are responsible for the inefficacy of these treatments, leaving an unmet medical need. Intravenous cefiderocol has been recently approved by the American Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of complicated urinary tract infections and nosocomial pneumonia due to Gram-negative, when limited therapeutical options are available. In addition, its ability to hijack bacterial iron uptake mechanisms makes cefiderocol stable against the whole Ambler β-lactamase inhibitors and increases the in vitro efficacy against Gram-negative pathogens (e.g., Enterobacterales spp., Pseudomonas aeruginosa, and Acinetobacter baumannii). Trials have already demonstrated their non-inferiority to comparators. In 2021, ESCMID guidelines released a conditional recommendation supporting the use of cefiderocol against metallo-β-lactamase-producing Enterobacterales and against Acinetobacter baumannii. This review provides the opinion of experts about the general management of empiric treatment of patients with sepsis and septic shock in the intensive care unit and detects the proper place in therapy of cefiderocol considering recent evidence sought through a systematic search.
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Carbapenem-Resistant Gram-Negative Fermenting and Non-Fermenting Rods Isolated from Hospital Patients in Poland-What Are They Susceptible to? Biomedicines 2022; 10:biomedicines10123049. [PMID: 36551805 PMCID: PMC9775024 DOI: 10.3390/biomedicines10123049] [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: 10/17/2022] [Revised: 11/12/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Gram-negative fermenting and non-fermenting bacteria are important etiological factors of nosocomial and community infections, especially those that produce carbapenemases. Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa are the most frequently-detected carbapenemase-producing microorganisms. The predominant type of resistance is metallo-β-lactamase (MBL). These bacteria are predominantly isolated from bronchial alveolar lavage, urine, and blood. Carbapenemase-producing Enterobacterales (CPE) strains are always multi-drug-resistant. This significantly limits the treatment options for this type of infection, extends the time of patient hospitalization, and increases the risk of a more severe and complicated disease course. Preventing the transmission of these microorganisms should be a major public health initiative. New antibiotics and treatment regimens offer hope against these infections.
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Abushanab D, Nasr ZG, Al-Badriyeh D. Efficacy and Safety of Colistin versus Tigecycline for Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens-A Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11111630. [PMID: 36421274 PMCID: PMC9686723 DOI: 10.3390/antibiotics11111630] [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: 08/15/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: We intended to compare the efficacy and safety outcomes of colistin versus tigecycline as monotherapy or combination therapy against multi-drug resistant (MDR) and extensively drug-resistant (XDR) pathogens. Methods: A search was conducted in PubMed, Cochrane CENTRAL, EMBASE, and in the grey literature (i.e., ClinicalTrials.gov and Google Scholar) up to May 2021. Outcomes were clinical response, mortality, infection recurrence, and renal and hepatic toxicity. We pooled odd ratios (OR) using heterogeneity-guided random or fixed models at a statistical significance of p < 0.05. Results: Fourteen observational studies involving 1163 MDR/XDR pathogens, receiving tigecycline versus colistin monotherapy or combination, were included. Base-case analyses revealed insignificant differences in the clinical response, reinfection, and hepatic impairment. The 30-day mortality was significantly relatively reduced with tigecycline monotherapy (OR = 0.35, 95% CI 0.16−0.75, p = 0.007). The colistin monotherapy significantly relatively reduced in-hospital mortality (OR = 2.27, 95%CI 1.24−4.16, p = 0.008). Renal impairment rates were lower with tigecycline monotherapy or in combination, and were lower with monotherapy versus colistin-tigecycline combination. Low-risk of bias and moderate/high evidence quality were associated with all studies. Conclusions: Within the limitations of this study, it can be concluded that there were no statistically significant differences in main efficacy outcomes between colistin and tigecycline monotherapies or combinations against MDR/XDR infections, except for lower rates of 30-day mortality with tigecycline and in-hospital mortality with colistin. Tigecycline was associated with favourable renal toxicity outcomes.
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Affiliation(s)
- Dina Abushanab
- Department of Pharmacy, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ziad G. Nasr
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Daoud Al-Badriyeh
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
- Correspondence: ; Tel.: +974-4403-5591; Fax: +974-4403-5551
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Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series. Antibiotics (Basel) 2022; 11:antibiotics11111519. [DOI: 10.3390/antibiotics11111519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidime/Avibactam (CAZ/AVI) for KPC-K.p., or CAZ/AVI+ Aztreonam (ATM) for NDM-K.p is reported. All patients hospitalized for COVID-19 in two Italian hospitals with a BSI between March and September 2021 were included. The main outcome was 14-day mortality. Overall, 44 patients were included: 23 with KPC-K.p. and 21 with NDM-K.p. BSIs. The median (q1–q3) age was 67 (57–75) years, and 32 (72%) were males. The two groups were similar in terms of baseline comorbidity, or severity of COVID-19. Notably, 14-day mortality of KPC-K.p. BSIs and NDM-K.p. BSIs (26% vs. 38%, p = 0.521) and 28-day mortality (35% vs. 48%, p = 0.541) were similar. A Cox regression model of delayed initiation of an appropriate antibiotic therapy after the onset of symptoms independently predicted mortality: initiation between 24 and 72 h (aHR = 12.03; 95% CI = 1.10–130, p = 0.041); and initiation after 72h (aHR = 36.9, 95% CI = 3.22–424, p = 0.004). Moreover, a trend towards an increased risk of mortality was observed for polymicrobial infections (aHR = 3.73, 95% CI = 0.87–15.8, p = 0.074), while a protective effect was observed for a beta-lactam loading dose at the start of treatment (aHR = 0.16, 95% CI = 0.02–1.10, p = 0.064). The high mortality of KPC and NDM-K.p. BSIs in COVID-19 patients may be reduced by an early and appropriate antibiotic therapy. Further efforts should be made to develop antimicrobial stewardship and infection control programs in COVID-19 wards.
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Singh A, Malhotra D, Singh K, Chadha R, Bedi PMS. Thiazole derivatives in medicinal chemistry: Recent advancements in synthetic strategies, structure activity relationship and pharmacological outcomes. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Oral Fosfomycin Formulation in Bacterial Prostatitis: New Role for an Old Molecule-Brief Literature Review and Clinical Considerations. Infect Dis Rep 2022; 14:621-634. [PMID: 36005269 PMCID: PMC9408554 DOI: 10.3390/idr14040067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Bacterial prostatitis infections are described as infections that are difficult-to-treat, due to prostate anatomic characteristics along with clinical difficulty in terms of diagnosis and management. Furthermore, the emergence of multidrug resistant (MDR) bacteria, such as extended-spectrum beta-lactamase (ESBL) producer Escherichia coli, also representing the main causative pathogen in prostatitis, poses major problems in terms of antibiotic management and favorable clinical outcome. Oral fosfomycin, an antibiotic commonly used for the treatment of uncomplicated urinary tract infections (UTIs), has been recently evaluated for the treatment of bacterial prostatitis due to its favorable pharmacokinetic profile, its activity against MDR gram-positive and gram-negative bacteria, safety profile, and multiple synergic effect with other antibiotics as well as the low resistance rate. This review addresses fosfomycin pharmacokinetics and pharmacodynamics and discusses the latest clinical evidence on its clinical use to treat acute and chronic bacterial prostatitis in hospitalized patients and in outpatients. As described in several reports, oral fosfomycin may represent a valid therapeutic option to treat susceptible germs commonly causing prostatitis, such as E. coli and other Enterobacterales as well as Enterococcus faecium, even as a first-line regimen in particular clinical settings (patients with previous treatment failure, with allergies or outpatients). Stronger data from further studies, including randomized controlled trials, would be helpful to establish the proper dosage and specific indications.
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Babidhan R, Lewis A, Atkins C, Jozefczyk NJ, Nemecek BD, Montepara CA, Gionfriddo MR, Zimmerman DE, Covvey JR, Guarascio AJ. Safety and efficacy of cefiderocol for off-label treatment indications: A systematic review. Pharmacotherapy 2022; 42:549-566. [PMID: 35611627 DOI: 10.1002/phar.2704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off-label indications. METHODS The PRISMA guidelines were utilized for reporting. Databases searched included PubMed, Scopus, and Embase, from inception to September 2021. Manuscripts describing cefiderocol off-label use in clinical settings were included. Exclusion criteria were studies focused on labeled indications, animal studies, pharmacodynamic/pharmacokinetic studies, in vitro or laboratory studies, and manuscripts in languages other than English or Arabic. Each stage of review utilized two independent investigators, with conflicts resolved and critical appraisal performed. Data regarding presentation, clinical course, and infection characteristics were extracted and descriptively analyzed. RESULTS The search identified a total of 985 records, narrowed to a final set of 27 studies. Among studies included were 18 (66.7%) case reports, 8 (29.6%) case series, and 1 (3.7%) phase 3 clinical trial. Cefiderocol was most frequently used off-label for bacteremia/sepsis with or without an identified source in 51 (67.1%) out of a total of 76 included patients. Among case series/reports with available data, 43 of 53 patients (81.1%) received combination antibiotic therapy. The most common pathogens identified included multi/extensively drug-resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii. Various clinical end points were reported, while microbiological end points were reported in 18 (66.7%) studies. Cefiderocol-related side effects were uncommon and rarely use-limiting. CONCLUSIONS This systematic review depicts relative clinical effectiveness of off-label cefiderocol, most commonly for P. aeruginosa and A. baumannii infections as combination antibiotic therapy. Further study is needed to elucidate the safety and efficacy of cefiderocol across an expanded set of patients and indications.
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Affiliation(s)
- Riyan Babidhan
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Abigale Lewis
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Cailin Atkins
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | | | - Branden D Nemecek
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Courtney A Montepara
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - David E Zimmerman
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Anthony J Guarascio
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Pérez-Nadales E, Fernández-Ruiz M, Gutiérrez-Gutiérrez B, Pascual Á, Rodríguez-Baño J, Martínez-Martínez L, Aguado JM, Torre-Cisneros J. Extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacterales bloodstream infection after solid organ transplantation: Recent trends in epidemiology and therapeutic approaches. Transpl Infect Dis 2022; 24:e13881. [PMID: 35691028 PMCID: PMC9540422 DOI: 10.1111/tid.13881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/08/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
Background Infections caused by multidrug‐resistant gram‐negative bacilli (MDR GNB), in particular extended‐spectrum β‐lactamase‐producing (ESBL‐E) and carbapenem‐resistant Enterobacterales (CRE), pose a major threat in solid organ transplantation (SOT). Outcome prediction and therapy are challenging due to the scarcity of randomized clinical trials (RCTs) or well‐designed observational studies focused on this population. Methods Narrative review with a focus on the contributions provided by the ongoing multinational INCREMENT‐SOT consortium (ClinicalTrials identifier NCT02852902) in the fields of epidemiology and clinical management. Results The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA‐SEIMC), and the Spanish Network for Research in Infectious Diseases (REIPI) recently published their recommendations for the management of MDR GNB infections in SOT recipients. We revisit the SET/GESITRA‐SEIMC/REIPI document taking into consideration new evidence that emerged on the molecular epidemiology, prognostic stratification, and treatment of post‐transplant ESBL‐E and CRE infections. Results derived from the INCREMENT‐SOT consortium may support the therapeutic approach to post‐transplant bloodstream infection (BSI). The initiatives devoted to sparing the use of carbapenems in low‐risk ESBL‐E BSI or to repurposing existing non‐β‐lactam antibiotics for CRE in both non‐transplant and transplant patients are reviewed, as well as the eventual positioning in the specific SOT setting of recently approved antibiotics. Conclusion Due to the clinical complexity and relative rarity of ESBL‐E and CRE infections in SOT recipients, multinational cooperative efforts such as the INCREMENT‐SOT Project should be encouraged. In addition, RCTs focused on post‐transplant serious infection remain urgently needed.
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Affiliation(s)
- Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases (GC-03) and Clinical and Molecular Microbiology (GC-24) Groups, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Clinical Units of Infectious Diseases and Microbiology, Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Department of Agricultural Chemistry, Edaphology and Microbiology, and Department of Medicine, University of Cordoba, Cordoba, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Departments of Microbiology and Medicine, Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Departments of Microbiology and Medicine, Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Departments of Microbiology and Medicine, Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain
| | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases (GC-03) and Clinical and Molecular Microbiology (GC-24) Groups, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Clinical Units of Infectious Diseases and Microbiology, Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Department of Agricultural Chemistry, Edaphology and Microbiology, and Department of Medicine, University of Cordoba, Cordoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Julian Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases (GC-03) and Clinical and Molecular Microbiology (GC-24) Groups, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Clinical Units of Infectious Diseases and Microbiology, Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.,Department of Agricultural Chemistry, Edaphology and Microbiology, and Department of Medicine, University of Cordoba, Cordoba, Spain
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Belati A, Novara R, Bavaro DF, Procopio A, Fico C, Diella L, Romanelli F, Stolfa S, Mosca A, Di Gennaro F, Saracino A. Thoracic aorta graft infection by avibactam-resistant KPC-producing K. pneumoniae treated with meropenem/vaborbactam: a case report and literature review. LE INFEZIONI IN MEDICINA 2022; 30:277-284. [PMID: 35693053 PMCID: PMC9177178 DOI: 10.53854/liim-3002-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
Meropenem/vaborbactam (M/V) is a new carbapenem-carbapenemase inhibitor combination drug active against extensively drug resistant Gram-negative pathogens. Studies about its efficacy and place in therapy are limited in "real-life" and no data are available for deep site infections, like vascular graft infections. We present a case of a patient successfully treated with M/V for a thoracic aorta graft infection, placed for a traumatic penetrating aortic ulcer, due to an extensively KPC-producing Klebsiella pneumoniae resistant to ceftazidime/ avibactam. Furthermore, we conducted a systematic literature review concerning vascular graft infections caused by carbapenem-resistant Klebsiella pneumoniae and the papers published until now about the use of M/V for the treatment of ceftazidime/avibactam-resistant K. pneumoniae. Meropenem/vaborbactam is a promising antibiotic for difficult-to-treat Gram-negative bacteria with limited therapeutic options. Only few reports have been published and more studies are needed to assess which is the best place in therapy of M/V.
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Affiliation(s)
- Alessandra Belati
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Andrea Procopio
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Cecilia Fico
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Federica Romanelli
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Stefania Stolfa
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Adriana Mosca
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
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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: 95] [Impact Index Per Article: 47.5] [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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37
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Losito AR, Raffaelli F, Del Giacomo P, Tumbarello M. New Drugs for the Treatment of Pseudomonas aeruginosa Infections with Limited Treatment Options: A Narrative Review. Antibiotics (Basel) 2022; 11:antibiotics11050579. [PMID: 35625223 PMCID: PMC9137685 DOI: 10.3390/antibiotics11050579] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/13/2022] Open
Abstract
P. aeruginosa is still one of the most threatening pathogens responsible for serious hospital-acquired infections. It is intrinsically resistant to many antimicrobial agents and additional acquired resistance further complicates the management of such infections. High rates of combined antimicrobial resistance persist in many countries, especially in the eastern and south-eastern parts of Europe. The aim of this narrative review is to provide a comprehensive assessment of the epidemiology, latest data, and clinical evidence on the current and new available drugs active against P. aeruginosa isolates with limited treatment options. The latest evidence and recommendations supporting the use of ceftolozane-tazobactam and ceftazidime-avibactam, characterized by targeted clinical activity against a significant proportion of P. aeruginosa strains with limited treatment options, are described based on a review of the latest microbiological and clinical studies. Cefiderocol, with excellent in vitro activity against P. aeruginosa isolates, good stability to all β-lactamases and against porin and efflux pumps mutations, is also examined. New carbapenem combinations are explored, reviewing the latest experimental and initial clinical evidence. One section is devoted to a review of new anti-pseudomonal antibiotics in the pipeline, such as cefepime-taniborbactam and cefepime-zidebactam. Finally, other “old” antimicrobials, mainly fosfomycin, that can be used as combination strategies, are described.
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Affiliation(s)
- Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Mario Tumbarello
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
- Correspondence: or ; Tel.: +39-0577-586572
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38
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Wang C, Yang D, Wang Y, Ni W. Cefiderocol for the Treatment of Multidrug-Resistant Gram-Negative Bacteria: A Systematic Review of Currently Available Evidence. Front Pharmacol 2022; 13:896971. [PMID: 35496290 PMCID: PMC9039133 DOI: 10.3389/fphar.2022.896971] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Cefiderocol is a novel synthetic siderophore-conjugated antibiotic that hijacks the bacterial iron transport systems facilitating drug entry into cells, achieving high periplasmic concentrations. This systematic review analyzed the currently available literature on cefiderocol. It summarized in vitro susceptibility data, in vivo antimicrobial activity, pharmacokinetics/pharmacodynamics (PK/PD), clinical efficacy, safety and resistance mechanisms of cefiderocol. Cefiderocol has potent in vitro and in vivo activity against multidrug-resistant (MDR) Gram-negative bacteria, including carbapenem-resistant isolates. But New Delhi Metallo-β-lactamase (NDM)- positive isolates showed significantly higher MICs than other carbapenemase-producing Enterobacterales, with a susceptible rate of 83.4% for cefiderocol. Cefiderocol is well-tolerated, and the PK/PD target values can be achieved using a standard dose regimen or adjusted doses according to renal function. Clinical trials demonstrated that cefiderocol was non-inferiority to the comparator drugs in treating complicated urinary tract infection and nosocomial pneumonia. Case reports and series showed that cefiderocol was a promising therapeutic agent in carbapenem-resistant infections. However, resistant isolates and reduced susceptibility during treatment to cefiderocol have already been reported. In conclusion, cefiderocol is a promising powerful weapon for treating MDR recalcitrant infections.
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Affiliation(s)
- Chuanhai Wang
- Department of Pulmonary and Critical Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Deqing Yang
- Department of Pharmacy, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yifan Wang
- Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
| | - Wentao Ni
- Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
- *Correspondence: Wentao Ni,
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Soriano MC, Montufar J, Blandino-Ortiz A. Cefiderocol. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35 Suppl 1:31-34. [PMID: 35488822 PMCID: PMC9106201 DOI: 10.37201/req/s01.07.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cefiderocol is a new siderophore cephalosporin with potent in vitro activity against gram-negative bacilli including Enterobacterales that produce all kinds of carbapenemases and non-fermenting Gram-negative with difficult-to-treat resistance. As a β-lactam, its efficacy is optimized in extended-perfusion and requires dose adjustment in renal dysfunction and hyperclearance. Its efficacy has been validated in three clinical trials, one of them in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia. The clinical trial aimed at difficult-to-treat gram-negatives achieved the clinical and microbiological target, but the increase in mortality observed in the cefiderocol arm makes it necessary to demonstrate efficacy in real clinical practice. Cefiderocol is a good option among the new β-lactams for the treatment of pneumonia caused by Gram-negative bacilli carbapenem-resistant.
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Affiliation(s)
- M C Soriano
- María Cruz Soriano, Servicio Medicina Intensiva Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Drwiega EN, Griffith NC, Danziger LH. Pharmacokinetic evaluation of cefiderocol for the treatment of multidrug resistant Gram-negative infections. Expert Opin Drug Metab Toxicol 2022; 18:245-259. [PMID: 35594628 DOI: 10.1080/17425255.2022.2081148] [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: 09/21/2021] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cefiderocol is a siderophore cephalosporin antibiotic and first of its kind approved by the Food and Drug Administration for the treatment of complicated urinary tract infections (cUTI) and hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) in patients 18 years or older caused by susceptible organisms. Cefiderocol's unique mechanism of iron chelation improves Gram-negative membrane penetration as the bacteria's iron uptake mechanism recognizes the chelated iron antibiotic and iron for entry. This also allows for the evasion of cefiderocol from cell entry-related resistance mechanisms. AREAS COVERED This review covers the mechanism of action, resistance mechanisms, pharmacokinetics in various patient populations, and pharmacodynamics. Relevant literature evaluating efficacy and safety are discussed. EXPERT OPINION Limited treatment options are available for the treatment of carbapenem-resistantorganisms. Clinical trials have demonstrated that cefiderocol is no worse than alternative treatment options for cUTIs and HABP/VABP, but more data are currently available to support the use of beta-lactam beta-lactamase inhibitor agents, where susceptible. Mortality differences demonstrated in patients with pneumonia and bloodstream infections must further be explored and logistical and practical considerations regarding susceptibility testing and use as monotherapy vs. combination therapy must be considered prior to confidently recommending cefiderocol for regular use in systemic infections.
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Affiliation(s)
- Emily N Drwiega
- College of Pharmacy, University of Illinois at Chicago, Chicaco, IL, USA
| | - Nicole C Griffith
- College of Pharmacy, University of Illinois at Chicago, Chicaco, IL, USA
| | - Larry H Danziger
- College of Pharmacy, University of Illinois at Chicago, Chicaco, IL, USA
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Editorial for the Special Issue: "Current and Novel Antimicrobial Strategies for Bacterial and Fungal Infections by Resistant Organisms". Antibiotics (Basel) 2022; 11:antibiotics11040426. [PMID: 35453178 PMCID: PMC9025739 DOI: 10.3390/antibiotics11040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
The pandemic driven by the SARS-CoV-2 infection has compelled health services globally to direct all available human and economic resources toward fighting the novel coronavirus [...].
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Meropenem/Vaborbactam Plus Aztreonam as a Possible Treatment Strategy for Bloodstream Infections Caused by Ceftazidime/Avibactam-Resistant Klebsiella pneumoniae: A Retrospective Case Series and Literature Review. Antibiotics (Basel) 2022; 11:antibiotics11030373. [PMID: 35326836 PMCID: PMC8944480 DOI: 10.3390/antibiotics11030373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The aim of this study was to describe our experience of a combination treatment including meropenem/vaborbactam (M/V) plus aztreonam (ATM) for bloodstream infections (BSIs) due to ceftazidime/avibactam-resistant Klebsiella pneumoniae (CAZ/AVI-R-Kp), for which gene typing was not available at the time the blood culture (BC) results were obtained. Methods: Between 20 July and 22 August 2021, in our hospital laboratory, the molecular test for carbapenemase gene typing was not available. All Gram-negative bloodstream infections were recorded, and characteristics of patients were analysed. Among them, three patients had positive BCs for CAZ/AVI-R-Kp, and the empirical therapy was switched to M/V plus ATM pending phenotypic testing of sensitivity to M/V. Therapy was subsequently targeted on the basis of the results of this test. Results: KPC and NDM represent the most prevalent carbapenemases in our polyclinic. Three patients with CAZ/AVI-R-Kp sepsis were treated with M/V plus ATM not knowing the carbapenemase gene. Two had an NDM-Kp infection for which, upon obtaining the result of sensitivity to M/V, combination therapy was maintained. The third had KPC-Kp infection for which ATM was discontinued, after the acquisition of an antibiogram reporting full sensitivity to M/V (MIC = 0.25 mg/L). One patient with NDM-Kp infection died due to complications of the underlying disease for which he was hospitalised. Conclusions: Meropenem/vaborbactam plus ATM and subsequent de-escalation could represent a possible therapeutic strategy in severe CAZ/AVI-R-Kp infections when carbapenemase gene typing is not rapidly available.
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Le C, Pimentel C, Pasteran F, Tuttobene MR, Subils T, Escalante J, Nishimura B, Arriaga S, Carranza A, Mezcord V, Vila AJ, Corso A, Actis LA, Tolmasky ME, Bonomo RA, Ramírez MS. Human Serum Proteins and Susceptibility of Acinetobacter baumannii to Cefiderocol: Role of Iron Transport. Biomedicines 2022; 10:biomedicines10030600. [PMID: 35327400 PMCID: PMC8945497 DOI: 10.3390/biomedicines10030600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/10/2023] Open
Abstract
Cefiderocol, a recently introduced antibiotic, has a chemical structure that includes a cephalosporin that targets cell wall synthesis and a chlorocatechol siderophore moiety that facilitates cell penetration by active iron transporters. Analysis of the effect that human serum, human serum albumin, and human pleural fluid had on growing Acinetobacter baumannii showed that genes related to iron uptake were down-regulated. At the same time, β-lactamase genes were expressed at higher levels. The minimum inhibitory concentrations of this antimicrobial in A. baumannii cells growing in the presence of human serum, human serum albumin, or human pleural fluid were higher than those measured when these fluids were absent from the culture medium. These results correlate with increased expression levels of β-lactamase genes and the down-regulation of iron uptake-related genes in cultures containing human serum, human serum albumin, or human pleural fluid. These modifications in gene expression could explain the less-than-ideal clinical response observed in patients with pulmonary or bloodstream A. baumannii infections. The exposure of the infecting cells to the host’s fluids could cause reduced cefiderocol transport capabilities and increased resistance to β-lactams. The regulation of genes that could impact the A. baumannii susceptibility to cefiderocol, or other antibacterials, is an understudied phenomenon that merits further investigation.
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Affiliation(s)
- Casin Le
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Camila Pimentel
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Fernando Pasteran
- National/Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires C1282, Argentina; (F.P.); (A.C.)
| | - Marisel R. Tuttobene
- Área Biología Molecular, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario S2000, Argentina;
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario S2000, Argentina;
| | - Tomás Subils
- Instituto de Procesos Biotecnológicos y Químicos de Rosario (IPROBYQ, CONICET-UNR), Rosario S2002, Argentina;
| | - Jenny Escalante
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Brent Nishimura
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Susana Arriaga
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Aimee Carranza
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Vyanka Mezcord
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Alejandro J. Vila
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario S2000, Argentina;
- Área Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario S2000, Argentina
| | - Alejandra Corso
- National/Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires C1282, Argentina; (F.P.); (A.C.)
| | - Luis A. Actis
- Department of Microbiology, Miami University, Oxford, OH 45056, USA;
| | - Marcelo E. Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
| | - Robert A. Bonomo
- Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Research Service and GRECC, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH 44106, USA
- Correspondence: (R.A.B.); (M.S.R.); Tel.: +1-216-791-3800 (R.A.B.); Tel.: +1-657-278-4562 (M.S.R.)
| | - Maria Soledad Ramírez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (C.L.); (C.P.); (J.E.); (B.N.); (S.A.); (A.C.); (V.M.); (M.E.T.)
- Correspondence: (R.A.B.); (M.S.R.); Tel.: +1-216-791-3800 (R.A.B.); Tel.: +1-657-278-4562 (M.S.R.)
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Bassetti M, Mularoni A, Giacobbe DR, Castaldo N, Vena A. New Antibiotics for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:280-294. [PMID: 35088403 DOI: 10.1055/s-0041-1740605] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) represent one of the most common hospital-acquired infections, carrying a significant morbidity and risk of mortality. Increasing antibiotic resistance among the common bacterial pathogens associated with HAP and VAP, especially Enterobacterales and nonfermenting gram-negative bacteria, has made the choice of empiric treatment of these infections increasingly challenging. Moreover, failure of initial empiric therapy to cover the causative agents associated with HAP and VAP has been associated with worse clinical outcomes. This review provides an overview of antibiotics newly approved or in development for the treatment of HAP and VAP. The approved antibiotics include ceftobiprole, ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol. Their major advantages include their high activity against multidrug-resistant gram-negative pathogens.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS), Palermo, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nadia Castaldo
- Division of Infectious Diseases, Department of Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Fariñas MC. Clinical experience of cefiderocol. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35 Suppl 2:35-38. [PMID: 36193983 PMCID: PMC9632058 DOI: 10.37201/req/s02.05.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Infections by antibiotic-resistant microorganisms could be considered a "stealth pandemic" that we fight daily in most hospitals. Some estimates suggest that today 700,000 deaths per year can be attributed to antimicrobial resistance. By the year 2050, it is estimated that this will increase to ten million deaths per year as a result of infections by multidrug-resistant microorganisms. In this context, the availability of antimicrobial therapy that is effective against these pathogens is essential to be able to "save the lives" of our patients. Cefiderocol, a new cephalosporin with a different mechanism of action, will be an essential treatment in many infections caused by resistant aerobic gram-negative bacteria. Cefiderocol has been used to treat patients with complicated urinary tract infections (cUTI); hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HAP); in patients with sepsis and bacteremia, some without an identified primary focus of infection.
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Affiliation(s)
- María Carmen Fariñas
- Correspondence: María Carmen Fariñas Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria. Santander. Cantabria, Spain. E-mail:
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Gatti M, Viaggi B, Rossolini GM, Pea F, Viale P. An Evidence-Based Multidisciplinary Approach Focused on Creating Algorithms for Targeted Therapy of Infection-Related Ventilator-Associated Complications (IVACs) Caused by Pseudomonas aeruginosa and Acinetobacter baumannii in Critically Ill Adult Patients. Antibiotics (Basel) 2021; 11:antibiotics11010033. [PMID: 35052910 PMCID: PMC8773303 DOI: 10.3390/antibiotics11010033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: To develop evidence-based algorithms for targeted antibiotic therapy of infection-related ventilator-associated complications (IVACs) caused by non-fermenting Gram-negative pathogens. (2) Methods: A multidisciplinary team of four experts had several rounds of assessments for developing algorithms devoted to targeted antimicrobial therapy of IVACs caused by two non-fermenting Gram-negative pathogens. A literature search was performed on PubMed-MEDLINE (until September 2021) to provide evidence for supporting therapeutic choices. Quality and strength of evidence was established according to a hierarchical scale of the study design. Six different algorithms with associated recommendations in terms of therapeutic choice and dosing optimization were suggested according to the susceptibility pattern of two non-fermenting Gram-negative pathogens: multi-susceptible Pseudomonas aeruginosa (PA), multidrug-resistant (MDR) metallo-beta-lactamase (MBL)-negative-PA, MBL-positive-PA, carbapenem-susceptible Acinetobacter baumannii (AB), and carbapenem-resistant AB. (3) Results: Piperacillin–tazobactam or fourth-generation cephalosporins represent the first therapeutic choice in IVACs caused by multi-susceptible PA. A carbapenem-sparing approach favouring the administration of novel beta-lactam/beta-lactamase inhibitors should be pursued in the management of MDR-MBL-negative PA infections. Cefiderocol should be used as first-line therapy for the management of IVACs caused by MBL-producing-PA or carbapenem-resistant AB. Fosfomycin-based combination therapy, as well as inhaled colistin, could be considered as a reasonable alternative for the management of IVACs due to MDR-PA and carbapenem-resistant AB. (4) Conclusions: The implementation of algorithms focused on prompt revision of antibiotic regimens guided by results of conventional and rapid diagnostic methodologies, appropriate place in therapy of novel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and pharmacokinetic/pharmacodynamic optimization of antibiotic dosing regimens is strongly suggested.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
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Meschiari M, Volpi S, Faltoni M, Dolci G, Orlando G, Franceschini E, Menozzi M, Sarti M, Del Fabro G, Fumarola B, Guarneri F, Lanza P, Lorenzotti S, Saccani B, Signorini L, Van Hauwermeiren E, Gatti M, Pea F, Castelli F, Mussini C. Real-life experience with compassionate use of cefiderocol for difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections. JAC Antimicrob Resist 2021; 3:dlab188. [PMID: 34909691 PMCID: PMC8665210 DOI: 10.1093/jacamr/dlab188] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe our real-life experience with cefiderocol in XDR and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections without any other available treatment options. Methods We included patients with a proven infection due to an XDR/DTR-P, who had failed on previous regimens, and were treated with cefiderocol, following them prospectively to day 90 or until hospital discharge or death. Results Seventeen patients treated for >72 h with cefiderocol were included: 14 receiving combination regimens (82.4%) and 3 receiving monotherapy (17.6%). Fourteen patients were males (82%) with a median age of 64 years (IQR 58–73). Fifteen patients (88.2%) were admitted to the ICU and five had septic shock (29%). Seven cases (41.2%) were ventilator-associated pneumonia, of which 71% (5/7) occurred in COVID-19 patients. Four were complicated intrabdominal infections, one ecthyma gangrenosum, one nosocomial pneumonia and one empyema, one osteomyelitis, one primary bacteraemia, and one nosocomial external ventricular drainage meningitis. Clinical cure and microbiological cure rates were 70.6% and 76.5%, respectively. There were six deaths (35.3%) after a median of 8 days (IQR 3–10) from the end of treatment, but only two of them (11.7%) were associated with P. aeruginosa infection progression. Conclusions Our experience collecting this large case series of DTR-P treated with cefiderocol may help clinicians consider this new option in this hard-to-manage setting. Our results are even more relevant in the current scenario of ceftolozane/tazobactam shortage. Importantly, this is the first study providing real-life data indicating adequate cefiderocol concentrations in CSF.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Matteo Faltoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Dolci
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Del Fabro
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Benedetta Fumarola
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.,Department of Infectious Diseases, University of Brescia, Brescia, Italy
| | - Francesco Guarneri
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Paola Lanza
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Silvia Lorenzotti
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Barbara Saccani
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Liana Signorini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Evelyn Van Hauwermeiren
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Milo Gatti
- SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Federico Pea
- SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.,Department of Infectious Diseases, University of Brescia, Brescia, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Abstract
PURPOSE OF REVIEW To discuss the current literature on novel agents for the treatment of carbapenem-resistant nonfermenting Gram-negative bacteria (NF-GNB) infections. RECENT FINDINGS Some novel agents have recently become available that are expected to replace classical polymyxins as the first-line options for the treatment of carbapenem-resistant NF-GNB infections. SUMMARY In this narrative review, we provide a brief overview of the differential activity of various recently approved agents against NF-GNB most encountered in the daily clinical practice, as well as the results from phase-3 randomized clinical trials and large postapproval observational studies, with special focus on NF-GNB. Since resistance to novel agents has already been reported, the use of novel agents needs to be optimized, based on their differential activity (not only in terms of targeted bacteria, but also of resistance determinants), the local microbiological epidemiology, and the most updated pharmacokinetic/pharmacodynamic data. Large real-life experiences remain of crucial importance for further refining the optimal treatment of NF-GNB infections in the daily clinical practice.
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Volpicelli L, Venditti M, Ceccarelli G, Oliva A. Place in Therapy of the Newly Available Armamentarium for Multi-Drug-Resistant Gram-Negative Pathogens: Proposal of a Prescription Algorithm. Antibiotics (Basel) 2021; 10:antibiotics10121475. [PMID: 34943687 PMCID: PMC8698671 DOI: 10.3390/antibiotics10121475] [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: 11/06/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022] Open
Abstract
The worldwide propagation of antimicrobial resistance represents one of the biggest threats to global health and development. Multi-drug-resistant organisms (MDROs), including carbapenem-resistant non-fermenting Gram-negatives and Enterobacterales, present a heterogeneous and mutating spread. Infections by MDRO are often associated with an unfavorable outcome, especially among critically ill populations. The polymyxins represented the backbone of antibiotic regimens for Gram-negative MDROs in recent decades, but their use presents multiple pitfalls. Luckily, new agents with potent activity against MDROs have become available in recent times and more are yet to come. Now, we have the duty to make the best use of these new therapeutic tools in order not to prematurely compromise their effectiveness and at the same time improve patients’ outcomes. We reviewed the current literature on ceftazidime/avibactam, meropenem/vaborbactam and cefiderocol, focusing on antimicrobial spectrum, on the prevalence and mechanisms of resistance development and on the main in vitro and clinical experiences available so far. Subsequently, we performed a step-by-step construction of a speculative algorithm for a reasoned prescription of these new antibiotics, contemplating both empirical and targeted use. Attention was specifically posed on patients with life-risk conditions and in settings with elevated prevalence of MDRO.
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Segala FV, Bavaro DF, Di Gennaro F, Salvati F, Marotta C, Saracino A, Murri R, Fantoni M. Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review. Viruses 2021; 13:2110. [PMID: 34834917 PMCID: PMC8624326 DOI: 10.3390/v13112110] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial resistance is an urgent threat to public health and global development; in this scenario, the SARS-CoV2 pandemic has caused a major disruption of healthcare systems and practices. A narrative review was conducted on articles focusing on the impact of COVID-19 on multidrug-resistant gram-negative, gram-positive bacteria, and fungi. We found that, worldwide, multiple studies reported an unexpected high incidence of infections due to methicillin-resistant S. aureus, carbapenem-resistant A. baumannii, carbapenem-resistant Enterobacteriaceae, and C. auris among COVID-19 patients admitted to the intensive care unit. In this setting, inappropriate antimicrobial exposure, environmental contamination, and discontinuation of infection control measures may have driven selection and diffusion of drug-resistant pathogens.
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Affiliation(s)
- Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Federica Salvati
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
| | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy;
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Rita Murri
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Massimo Fantoni
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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