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Guzek A, Rybicki Z, Tomaszewski D, Mackiewicz K, Piechota W, Chciałowski A. Outcomes of 23 patients diagnosed with New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae infection treated with ceftazidime/avibactam and aztreonam at a single center in Poland. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04859-y. [PMID: 38811482 DOI: 10.1007/s10096-024-04859-y] [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: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Amongst all etiologic hospital-acquired infection factors, K. pneumoniae strains producing New Delhi metallo-β-lactamase (KP-NDM) belong to pathogens with the most effective antibiotic resistance mechanisms. Clinical guidelines recommend using ceftazidime/avibactam with aztreonam (CZA + AT) as the preferred option for NDM-producing Enterobacterales. However, the number of observations on such treatment regimen is limited. This retrospective study reports the clinical and microbiological outcomes of 23 patients with KP-NDM hospital-acquired infection treated with CZA + AT at a single center in Poland. METHODS The isolates were derived from the urine, lungs, blood, peritoneal cavity, wounds, and peritonsillar abscess. In microbiological analysis, mass spectrometry for pathogen identification, polymerase chain reaction, or an immunochromatographic assay for detection of carbapenemase, as well as VITEK-2 system, broth microdilution, and microdilution in agar method for antimicrobial susceptibility tests were used, depending of the pathogens' nature. CZA was administered intravenously (IV) at 2.5 g every eight hours in patients with normal kidney function, and aztreonam was administered at 2 g every eight hours IV. Such dosage was modified when renal function was reduced. RESULTS KP-NDM was eradicated in all cases. Four patients (17.4%) died: three of them had a neoplastic disease, and one - a COVID-19 infection. CONCLUSION The combination of CZA + AT is a safe and effective therapy for infections caused by KP-NDM, both at the clinical and microbiological levels. The synergistic action of all compounds resulted in a good agreement between the clinical efficacy of CZA + AT and the results of in vitro susceptibility testing.
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Affiliation(s)
- Aneta Guzek
- Section of Microbiology, Department of Laboratory Diagnostics, Military Institute of Medicine-National Research Institute, Warsaw, Poland
| | - Zbigniew Rybicki
- Department of Anesthesiology and Intensive Therapy, Military Institute of Medicine-National Research Institute, Warsaw, Poland
| | - Dariusz Tomaszewski
- Department of Anesthesiology and Intensive Therapy, Military Institute of Aviation Medicine, Warsaw, Poland.
| | - Katarzyna Mackiewicz
- Section of Microbiology, Department of Laboratory Diagnostics, Military Institute of Medicine-National Research Institute, Warsaw, Poland
| | - Wiesław Piechota
- Department of Laboratory Diagnostics, Military Institute of Medicine-National Research Institute, Warsaw, Poland
| | - Andrzej Chciałowski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine-National Research Institute, Warsaw, Poland
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Soman R, Veeraraghavan B, Hegde A, Varma S, Todi S, Singh RK, Nagavekar V, Rodrigues C, Swaminathan S, Ramsubramanian V, Ansari A, Chaudhry D, Pednekar A, Bhagat S, Patil S, Barkate H. Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II). Expert Rev Anti Infect Ther 2024:1-16. [PMID: 38790080 DOI: 10.1080/14787210.2024.2360116] [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: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The rising challenge of carbapenem-resistant Enterobacterales (CRE) infections in Indian healthcare settings calls for clear clinical guidance on the management of these infections. The Indian consensus on the management of CRE infection in critically ill patients (ICONIC-II) is a follow-up of the ICONIC-I study, which was undertaken in 2019. AREAS COVERED A modified Delphi method was used to build expert consensus on CRE management in India, involving online surveys, face-to - face expert meetings, and a literature review. A panel of 12 experts was formed to develop potential clinical consensus statements (CCSs), which were rated through two survey rounds. The CCSs were finalized in a final face-to - face discussion. The finalized CCSs were categorized as consensus, near consensus, and no consensus. EXPERT OPINION The outcomes included 46 CCSs (consensus: 40; near consensus: 3; and no consensus: 3). The expert panel discussed and achieved consensus on various strategies for managing CRE infections, emphasizing the significance of existing and emerging resistance mechanisms, prompt and tailored empiric therapy, and use of combination therapies. The consensus statements based on the collective expertise of the panel can potentially assist clinicians in the management of CRE infections that lack high-level evidence.
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Affiliation(s)
- Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | | | - Ashit Hegde
- Department of Critical care, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Subhash Varma
- Internal Medicine and Hematology Fortis Hospital Mohali, Mohali, India
| | - Subhash Todi
- Department of Critical Care and Emergency Medicine, AMRI Hospital, Kolkata, India
| | - R K Singh
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vasant Nagavekar
- Department of Infectious Disease, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Camilla Rodrigues
- Department of Microbiology and Serology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | | | - V Ramsubramanian
- Department of Infectious Diseases, Apollo Hospital, Chennai, India
| | - Abdul Ansari
- Department of Critical Care Services, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical care medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Amullya Pednekar
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Saiprasad Patil
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd, Mumbai, Maharashtra, India
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Gupta N, Boodman C, Prayag P, Manesh A, Kumar TP. Ceftazidime-avibactam and aztreonam combination for Carbapenem-resistant Enterobacterales bloodstream infections with presumed Metallo-β-lactamase production: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2024; 22:203-209. [PMID: 38258529 DOI: 10.1080/14787210.2024.2307912] [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: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Carbapenem-resistant Enterobacterales (CRE) due to Metallo-β-lactamase (MBL) production are treated with either polymyxins or the novel combination of ceftazidime-avibactam and aztreonam (AA). This study aims to evaluate the 30-day mortality of AA in patients with BSI caused by MBL-CRE infections. METHODOLOGY In this systematic review and meta-analysis, all articles up to June 2023 were screened using search terms like 'CRE', 'MBL', 'AA' and 'polymyxins'. The risk ratio for AA vs polymyxins was pooled using a random-effect model, and the results were represented by a point estimate with a 95% confidence interval. RESULTS After removing the duplicates, the titles and abstracts of 455 articles were screened, followed by a full-text screening of 50 articles. A total of 24 articles were included for systematic review, and four comparative studies were included in the meta-analysis. All four studies had a moderate or serious risk of bias. The pooled risk ratio for 30-day mortality for AA vs. polymyxins was 0.51 (95%CI: 0.34-0.76), p < 0.001. There was no significant heterogeneity. CONCLUSION The meta-analysis from studies with a high risk of bias shows that AA is associated with lesser 30-day mortality when compared to polymyxins in patients with MBL-producing CRE BSI. Registration with PROSPERO- CRD42023433608.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Carl Boodman
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Disease, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Parikshit Prayag
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Tirlangi Praveen Kumar
- Department of Infectious Disease, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Bonomo RA, Perez F, Hujer AM, Hujer KM, Vila AJ. The Real Crisis in Antimicrobial Resistance: Failure to Anticipate and Respond. Clin Infect Dis 2024:ciad758. [PMID: 38289748 DOI: 10.1093/cid/ciad758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Robert A Bonomo
- Clinician Scientist Investigator, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (VAMC), Cleveland, Ohio, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Case Western Reserve University (CWRU)-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
| | - Federico Perez
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Andrea M Hujer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kristine M Hujer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Alejandro J Vila
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario, Argentina
- Área Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
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Zhang L, Ma Y, Zhao C, Zhao S, Zhao L, Yang Y, Wang Y, Meng H, Sun J. Clinical Outcomes and Risk Factors for Death in Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumoniae Treated with Ceftazidime-Avibactam: A Retrospective Study. Infect Drug Resist 2024; 17:239-248. [PMID: 38293316 PMCID: PMC10824611 DOI: 10.2147/idr.s445243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose Carbapenem-Resistant Klebsiella pneumoniae (CRKP) is a significant public health threat, because it is associated with substantial morbidity and mortality. However, the risk factors associated with treatment failure of ceftazidime-avibactam (CAZ-AVI) and the need for CAZ-AVI-based combination remain unclear. Methods We conducted a retrospective study of critically ill patients (age: > 18 years) diagnosed with CRKP infections and treated with CAZ-AVI for at least 24 h between June 2020 and December 2022 at Henan Provincial People's Hospital. Results This study included a total of 103 patients who received CAZ-AVI. Of these, 91 (88.3%) patients received the standard dosage of 2.5 g every q8h, while only 20 (19.4%) received monotherapy. The Kaplan-Meier curves showed that the all-cause 30-day mortality was significantly higher among patients who experienced septic shock than those who did not. There was no significant difference in mortality between monotherapy and combination therapy. Dose reduction of CAZ-AVI was associated with a significantly increased mortality rate. Independent risk factors for the 30-day mortality included higher APACHE II score (HR: 1.084, 95% CI: 1.024-1.147, p = 0.005) and lower lymphocyte count (HR: 0.247, 95% CI: 0.093-0.655, p = 0.005). Conversely, a combination therapy regimen containing carbapenems was associated with lower mortality (HR: 0.273, 95% CI: 0.086-0.869, p = 0.028). Conclusion Our study suggests that CAZ-AVI provides clinical benefits in terms of survival and clinical response in critically ill patients with CRKP infection. A higher APACHE II score and lower lymphocyte count were associated with 30-day mortality, while the combination therapy regimen containing carbapenems was the only protective factor. CAZ-AVI dose reduction was associated with an increased mortality rate. Futher large-scale studies are needed to validate these findings.
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Affiliation(s)
- Lingchun Zhang
- Department of Pharmacy, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, People’s Republic of China
| | - Yani Ma
- Department of Pharmacy, the First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Chenglong Zhao
- Department of Pharmacy, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, People’s Republic of China
| | - Shujuan Zhao
- Department of Pharmacy, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, People’s Republic of China
| | - Lulu Zhao
- Department of Pharmacy, Gongyi People’s Hospital, Zhengzhou, People’s Republic of China
| | - Yuxin Yang
- Department of Pharmacy, Anyang Ophthalmic Hospital, Anyang, People’s Republic of China
| | - Yuhan Wang
- Department of Pharmacy, Henan Integrative Medicine Hospital, Zhengzhou, People’s Republic of China
| | - Haiyang Meng
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Jun Sun
- Department of Pharmacy, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, People’s Republic of China
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