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Mancheño-Losa M, Murillo O, Benavent E, Sorlí L, Riera M, Cobo J, Benito N, Morata L, Ribera A, Sobrino B, Fernández-Sampedro M, Múñez E, Bahamonde A, Barbero JM, Del Toro MD, Villa J, Rigo-Bonnin R, Luque S, García-Luque I, Oliver A, Esteban J, Lora-Tamayo J. Efficacy and safety of colistin plus beta-lactams for bone and joint infection caused by fluoroquinolone-resistant gram-negative bacilli: a prospective multicenter study. Infection 2024:10.1007/s15010-024-02379-7. [PMID: 39249177 DOI: 10.1007/s15010-024-02379-7] [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: 06/29/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES The prognosis of bone and joint infections (BJI) caused by Gram-negative bacilli (GNB) worsens significantly in the face of fluoroquinolone-resistance. In this setting, scarce pre-clinical and clinical reports suggest that intravenous beta-lactams plus colistin may improve outcome. Our aim was to assess the efficacy and safety of this treatment in a well-characterized prospective cohort. METHODS Observational, prospective, non-comparative, multicenter (14 hospitals) study of adults with BJI caused by fluoroquinolone-resistant GNB treated with surgery and intravenous beta-lactams plus colistin for ≥ 21 days. The primary endpoint was the cure rate. RESULTS Of the 44 cases included (median age 72 years [IQR 50-81], 22 [50%] women), 32 (73%) had an orthopedic device-related infection, including 17 (39%) prosthetic joints. Enterobacterales were responsible for 27 (61%) episodes, and Pseudomonas spp for 17 (39%), with an overall rate of MDR/XDR GNB infections of 27/44 (61%). Patients were treated with colistin plus intravenous beta-lactam for 28 days (IQR 22-37), followed by intravenous beta-lactam alone for 19 days (IQR 5-35). The cure rate (intention-to-treat analysis; median follow-up = 24 months, IQR 19-30) was 82% (95% CI 68%-90%) and particularly, 80% (95% CI 55%-93%) among patients managed with implant retention. Adverse events (AEs) leading to antimicrobial withdrawal occurred in 10 (23%) cases, all of which were reversible. Colistin AEs were associated with higher plasma drug concentrations (2.8 mg/L vs. 0.9 mg/L, p = 0.0001). CONCLUSIONS Combination therapy with intravenous beta-lactams plus colistin is an effective regimen for BJI caused by fluoroquinolone-resistant GNB. AEs were reversible and potentially preventable by close therapeutic drug monitoring.
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Affiliation(s)
- Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
| | - Oscar Murillo
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain.
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Avda. Feixa Llarga S/N, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Benavent
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Avda. Feixa Llarga S/N, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Sorlí
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases. Instituto Hospital del Mar de Investigaciones Médicas (IMIM). Hospital del Mar, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Melchor Riera
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Univeristari Son Espases, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Palma, Spain
| | - Javier Cobo
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Natividad Benito
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia
| | - Laura Morata
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques Agust Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Alba Ribera
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital de Barcelona, Barcelona, Spain
| | - Beatriz Sobrino
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Marta Fernández-Sampedro
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Elena Múñez
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Alberto Bahamonde
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital El Bierzo, Ponferrada, Spain
| | - José María Barbero
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Mª Dolores Del Toro
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, University of Sevilla, Seville, Spain
| | - Jenifer Villa
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
| | - Raül Rigo-Bonnin
- Clinical Laboratory, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Luque
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Pharmacy Department, Hospital del Mar. Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Antonio Oliver
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitari Son Espases, IdISBa, Palma, Spain
| | - Jaime Esteban
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, ISS-Hospital Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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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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Bouza E, Muñoz P, Burillo A. How to treat severe Acinetobacter baumannii infections. Curr Opin Infect Dis 2023; 36:596-608. [PMID: 37930071 DOI: 10.1097/qco.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW To update the management of severe Acinetobacter baumannii infections (ABI), particularly those caused by multi-resistant isolates. RECENT FINDINGS The in vitro activity of the various antimicrobial agents potentially helpful in treating ABI is highly variable and has progressively decreased for many of them, limiting current therapeutic options. The combination of more than one drug is still advisable in most circumstances. Ideally, two active first-line drugs should be used. Alternatively, a first-line and a second-line drug and, if this is not possible, two or more second-line drugs in combination. The emergence of new agents such as Cefiderocol, the combination of Sulbactam and Durlobactam, and the new Tetracyclines offer therapeutic options that need to be supported by clinical evidence. SUMMARY The apparent limitations in treating infections caused by this bacterium, the rapid development of resistance, and the serious underlying situation in most cases invite the search for alternatives to antibiotic treatment, the most promising of which seems to be bacteriophage therapy.
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Affiliation(s)
- Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
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Sodeifian F, Zangiabadian M, Arabpour E, Kian N, Yazarlou F, Goudarzi M, Centis R, Seghatoleslami ZS, Kameh MC, Danaei B, Goudarzi H, Nasiri MJ, Sotgiu G, Migliori GB. Tigecycline-Containing Regimens and Multi Drug-Resistant Acinetobacter baumannii: A Systematic Review and Meta-Analysis. Microb Drug Resist 2023. [PMID: 37192494 DOI: 10.1089/mdr.2022.0248] [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: 05/18/2023] Open
Abstract
Introduction: The use of tigecycline (TG) for the treatment of Acinetobacter baumannii is controversial. In this systematic review and meta-analysis, we aimed to better explore the safety and efficacy of TG for the treatment of multi drug-resistant (MDR) Acinetobacter. Methods: We searched PubMed/MEDLINE, Scopus, Cochrane Central, and Web of Science to identify studies reporting the clinical and microbiological efficacy and safety of regimens containing TG in patients with drug susceptibility testing (DST)-confirmed MDR A. baumannii, published until December 30, 2022. Observational studies were included if they reported clinical and microbiological efficacy of TG-based regimens. The Newcastle-Ottawa Scale (NOS) and Joana Briggs Institute (JBI) critical appraisal tool were used to assess the quality of included studies. Results: There were 30 observational studies, of which 19 studies were cohort and 11 studies were single group studies. Pooled clinical response and failure rates in the TG-containing regimens group were 58.1 (95% confidence interval [CI] 49.2-66.6) and 40.2 (95% CI 31.1-50.0), respectively. The pooled microbiological response rate was 32.1 (95% CI 19.8-47.5), and the pooled all-cause mortality rate was 41.1 (95% CI 34.1-48.4). Pooled clinical response and failure rates in the colistin-based regimens group were 52.7 (42.7-62.5) and 43.1 (33.1-53.8), respectively. The pooled microbiological response rate was 42.9 (16.2-74.5), and the pooled all-cause mortality rate was 34.3 (26.1-43.5). Conclusions: According to our results, the efficacy of the TG-based regimen is the same as other antibiotics. However, our study showed a high mortality rate and a lower rate of microbiological eradication for TG compared with colistin-based regimen. Therefore, our study does not recommend it for the treatment of MDR A. baumannii. However, this was a prevalence meta-analysis of observational studies, and for better conclusion experimental studies are required.
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Affiliation(s)
- Fatemeh Sodeifian
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Erfan Arabpour
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghmeh Kian
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fartous Yazarlou
- Department of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rosella Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | | | - Mahdis Chahar Kameh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bardia Danaei
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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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; 11:1630. [PMID: 36421274 PMCID: PMC9686723 DOI: 10.3390/antibiotics11111630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
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Morrisette T, Alosaimy S, Lagnf AM, Frens JJ, Webb AJ, Veve MP, Stevens R, Bouchard J, Gore TW, Ansari I, Rybak MJ. Real-World, Multicenter Case Series of Patients Treated with Oral Omadacycline for Resistant Gram-Negative Pathogens. Infect Dis Ther 2022; 11:1715-1723. [PMID: 35567718 PMCID: PMC9334473 DOI: 10.1007/s40121-022-00645-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Antibiotic-resistant Gram-negative bacteria have been associated with substantial morbidity and mortality and have limited treatment options available. Omadacycline (OMC) is an aminomethylcycline antibiotic that has been shown to exhibit broad in vitro activity against antibiotic-resistant Gram-negative bacteria. Given the lack of real-world data, the primary objective of our report was to describe early experience with OMC for the treatment of resistant Gram-negative infections. METHODS This was a real-world, multicenter, observational cases series/pilot study conducted in the USA. Inclusion criteria included any adult patient aged ≥ 18 years who received OMC for ≥ 72 h either in the inpatient and/or outpatient setting. Clinical success was defined as a composite of 90-day survival from initiation of OMC, lack of alteration in treatment/addition of other antibiotic due to concerns of OMC failure, and lack of microbiologic recurrence within 30 days from the end of therapy. RESULTS Oral OMC was used in nine cases primarily for multidrug-resistant (MDR)/extensively drug-resistant (XDR) Gram-negative bacterial infections (55.6% XDR and/or carbapenem-resistant Acinetobacter baumannii [CRAB]). The majority of infections were of bone/joint (55.6%) origin, followed by intra-abdominal (33.3%) origin. Clinical success occurred in 66.7% of cases, with 80.0% success each in infections of bone/joint origin or those caused by CRAB. One patient experienced an adverse effect that was not treatment limiting while on therapy (gastrointestinal). CONCLUSION The use of oral OMC in MDR/XDR Gram-negative infections exhibited a relatively high success rate with minimal adverse effects. Real-world studies with larger case numbers are needed to confirm our initial findings.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.,Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC, 29425, USA.,Department of Clinical Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC, 29425, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Jeremy J Frens
- Department of Pharmacy, Cone Health, 1121 North Church Street, Greensboro, NC, 27401, USA
| | - Andrew J Webb
- Department of Pharmacy, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Michael P Veve
- University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.,Department of Clinical Pharmacy and Transplational Science, College of Pharmacy, University of Tennessee Health Science Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48206, USA
| | - Ryan Stevens
- Department of Pharmacy, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Tristan W Gore
- College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Iman Ansari
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. .,Division of Infectious Diseases, Department of Medicine, Wayne State University, 540 E Canfield Street, Detroit, MI, 48201, USA. .,Department of Pharmacy, Detroit Receiving Hospital, 4201 St Antoine, Detroit, MI, 48201, USA.
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:2094-2104. [DOI: 10.1093/jac/dkac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/13/2022] [Indexed: 11/14/2022] Open
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