1
|
Wijnant GJ, Ngougni Pokem P, Coessens M, Cottone E, Ermtraud J, Goeman L, Vervaeke S, Wicha SG, Van Bambeke F. Pharmacokinetics and pharmacological target attainment of standard temocillin dosing in non-critically ill patients with complicated urinary tract infections. J Antimicrob Chemother 2024; 79:2204-2212. [PMID: 38985543 DOI: 10.1093/jac/dkae215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES Temocillin, a carbapenem-sparing β-lactam antibiotic, is commonly used at the standard 4 g/day dosage for treating complicated urinary tract infections (cUTIs). However, pharmacokinetic/pharmacodynamic (PK/PD) data supporting this regimen is limited. This study evaluated the plasma pharmacokinetics (PK) and PTA of temocillin in non-critically ill cUTI patients with varying degrees of renal insufficiency (RI). METHODS In this single-centre clinical study, 22 cUTI patients received a fixed 4 g/day (2 g q12h, intravenously) temocillin dose, irrespective of renal function (no RI: n = 5, mild RI: n = 8, moderate RI: n = 9). Plasma samples were collected post-dosing for LC-MS analysis of total and unbound temocillin levels. Monte Carlo simulations were performed based on the established PK/PD target of ≥35% fT > MIC (minimal inhibitory concentration). RESULTS Among patients, the highest plasma drug exposure and PK/PD target attainment were observed in those with moderate RI (median AUC0-12h = 1143 h.mg/L and %fT > MIC = 68%), followed by mild RI patients (median AUC0-12h = 918 h.mg/L and %fT > MIC = 34%), and the lowest in those with healthy kidney function (median AUC0-12h = 692 h.mg/L and %fT > MIC = 26%). Simulations indicated that the 4 g/day temocillin dose achieves 90% PTA only for glomerular filtration rate < 60 mL/min and MIC ≤ 8 mg/L. CONCLUSION The standard temocillin dose may need to be increased from 4 to 6 g/day to treat non-critically ill cUTI patients, in line with recent EUCAST recommendations. For patients with moderate RI, who experience higher exposure due to reduced renal drug clearance, 4 g/day temocillin remains appropriate.
Collapse
Affiliation(s)
- Gert-Jan Wijnant
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Marie Coessens
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Eleonora Cottone
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Julian Ermtraud
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Lieven Goeman
- Department of Urology, AZ Delta Hospital, Roeselare, Belgium
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
2
|
van Os W, Nussbaumer-Pröll A, Pham AD, Wijnant GJ, Ngougni Pokem P, Van Bambeke F, van Hasselt JGC, Zeitlinger M. Pharmacokinetic/pharmacodynamic model-based optimization of temocillin dosing strategies for the treatment of systemic infections. J Antimicrob Chemother 2024:dkae243. [PMID: 39030832 DOI: 10.1093/jac/dkae243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Temocillin is increasingly considered as an alternative to carbapenems. However, there is no consensus on optimal dosing strategies and limited data on temocillin efficacy in systemic infections. OBJECTIVES We compared temocillin dosing strategies using pharmacokinetic/pharmacodynamic (PK/PD) modelling and simulation based on plasma exposure and in vitro time-kill data. METHODS Temocillin effects on four Escherichia coli strains were evaluated using static time-kill experiments and the hollow-fibre infection model, in which unbound plasma concentrations following intermittent and continuous infusion regimens of 4 and 6 g daily were replicated over 72 h. A PK/PD model was developed to describe the time-kill data. The PK/PD model was coupled to a population PK model of temocillin in critically ill patients to predict bacterial killing and resistance development following various dosing regimens. RESULTS Amplification of resistant subpopulations was observed within 24 h for all strains. The PK/PD model described the observed bacterial kill kinetics and resistance development from both experimental systems well. Simulations indicated dose-dependent bacterial killing within and beyond the currently used daily dose range, and a superiority of continuous compared with intermittent infusions. However, regrowth of resistant subpopulations was frequently observed. For two strains, bacteriostasis over 72 h was predicted only with doses that are higher than those currently licensed. CONCLUSIONS Continuous infusions and 6 g daily doses of temocillin kill E. coli more effectively than 4 g daily doses and intermittent infusions, and may increase efficacy in the treatment of systemic infections. However, higher daily doses may be required to suppress resistance development.
Collapse
Affiliation(s)
- Wisse van Os
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Anh Duc Pham
- Division of Systems Pharmacology & Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Gert-Jan Wijnant
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, 1200 Brussels, Belgium
| | - Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, 1200 Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, 1200 Brussels, Belgium
| | - J G Coen van Hasselt
- Division of Systems Pharmacology & Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
3
|
Deckers C, Bélik F, Denis O, Montesinos I, Bogaerts P, Boelens J, Brassinne L, Descy J, Desmet S, Gils S, Lissoir B, Magerman K, Matheeussen V, Meex C, Rodriguez Villalobos H, Van den Abeele AM, Vernelen K, Ceyssens PJ, Huang TD. Multicenter interlaboratory study of routine systems for the susceptibility testing of temocillin using a challenge panel of multidrug-resistant strains. Eur J Clin Microbiol Infect Dis 2023; 42:1477-1483. [PMID: 37870713 DOI: 10.1007/s10096-023-04681-y] [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: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
Accurate susceptibility result of temocillin (TMO) is important for treating infections caused by multidrug-resistant Enterobacterales. This multicenter study aimed to investigate the performance of routine temocillin testing assays against Enterobacterales challenging strains. Forty-seven selected clinical isolates were blindly analyzed by 12 Belgian laboratories using VITEK® 2 (n = 5) and BD Phoenix™ (n = 3) automated systems, ETEST® gradient strip (n = 3), and disk (3 brands) diffusion method (DD; n = 6) for temocillin susceptibility using standardized methodology. Results were interpreted using EUCAST 2023 criteria and compared to the broth microdilution (BMD; Sensititre™ panel) method used as gold standard. Methods' reproducibility was assessed by testing 3 reference strains in triplicate. A total of 702 organism-drug results were obtained against 33 TMO-susceptible and 14 TMO-resistant isolates. Excluding Proteae species (P. mirabilis and M. morganii), the essential agreement rates were excellent (91.5-100%) for all MIC-based methods. The highest category agreement was achieved by ETEST® (97.5%) followed by VITEK® 2 (93.2%), disk diffusion (91.6%), and BD Phoenix™ (88.5%). BD Phoenix™ and paper disk diffusion overcalled resistance (11.5% and 6.8% of major discrepancies, respectively), while ROSCO tablets diffusion and VITEK® 2 generated higher very major discrepancies (7.1% and 4.2% respectively). Inter-assay reproducibility was unsatisfactory using recommended E. coli ATCC 25922 strain but was excellent with E. coli ATCC 35218 and K. pneumoniae ATCC 700603 strains. This interlaboratory study suggests that routine testing methods provide accurate and reproducible TMO categorization results except for Proteae species.
Collapse
Affiliation(s)
- Corentin Deckers
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium.
| | - Florian Bélik
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Olivier Denis
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Isabel Montesinos
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Pierre Bogaerts
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| | - Jerina Boelens
- Laboratory of Clinical Microbiology, UZ Gent, Ghent, Belgium
| | - Laetitia Brassinne
- Laboratory of Clinical Microbiology, Cliniques de L'Europe, Brussels, Belgium
| | - Julie Descy
- Laboratory of Clinical Microbiology, Clinique André Renard, Herstal, Belgium
| | - Stefanie Desmet
- Laboratory of Clinical Microbiology, UZ Leuven, Louvain, Belgium
| | - Sarah Gils
- Laboratory of Clinical Microbiology, Medisch Centrum Huisartsen, Louvain, Belgium
| | - Bénédicte Lissoir
- Laboratory of Clinical Microbiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Koen Magerman
- Laboratory of Clinical Microbiology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Cécile Meex
- Laboratory of Clinical Microbiology, CHU de Liège, Liège, Belgium
| | | | | | - Kris Vernelen
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | | | - Te-Din Huang
- Laboratory of Clinical Microbiology, CHU UCL Namur, UCLouvain, Site Godinne, Avenue Gaston Therasse, 1, 5530, Yvoir, Belgium
| |
Collapse
|
4
|
Oosterbos J, Schalkwijk M, Thiessen S, Oris E, Coppens G, Lagrou K, Steensels D. Clinical and microbiological evaluation of temocillin for bloodstream infections with Enterobacterales: a Belgian single-centre retrospective study. JAC Antimicrob Resist 2022; 4:dlac086. [PMID: 36003075 PMCID: PMC9397121 DOI: 10.1093/jacamr/dlac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Expanding the use of temocillin could be an important weapon in the fight against antimicrobial resistance. However, EUCAST defined clinical breakpoints for a limited number of species and only for urinary tract infections (UTI), including urosepsis but excluding severe sepsis and septic shock. Moreover, a dosage of 2 g q8h is advised in most cases. Objectives Evaluation of temocillin use for the treatment of bacteraemia, correlating clinical and microbiological outcomes with infection site, infection severity, temocillin dosage, Enterobacterales species and MIC. Patients and methods All adult patients with blood cultures positive for temocillin-susceptible Enterobacterales and treated with temocillin for ≥72 h from June 2018 until June 2021 were considered for inclusion. The primary outcome was clinical success, defined as resolution of infection signs, no relapse of the same infection and no antibiotic switch due to insufficient clinical improvement. The secondary outcome was microbiological success. Results In total, 182 episodes were included [140 UTI versus 42 non-UTI, 171 Escherichia coli, Klebsiella species (except Klebsiella aerogenes) and Proteus mirabilis (EKPs) versus 11 non-EKPs]. Clinical and microbiological failure were low (8% and 3%, respectively). No difference in outcome was observed for dosages of 2 g q12h versus 2 g q8h, either for EKP versus non-EKP isolates or MIC values ≤8 versus 16 mg/L. Considering only bacteraemia episodes of UTI origin, using the 16 mg/L breakpoint, there was no difference in success rate between regimens of 2 g q12h and 2 g q8h. Conclusions Temocillin 2 g q12h can be successfully used for the treatment of systemic UTI. Prospective studies are needed to assess outcomes and evaluate non-inferiority compared with other broad-spectrum antibiotics in non-UTI infections, including bacteraemia.
Collapse
Affiliation(s)
| | | | | | - Els Oris
- Ziekenhuis Oost-Limburg hospital , Genk , Belgium
| | - Guy Coppens
- Ziekenhuis Oost-Limburg hospital , Genk , Belgium
| | | | - Deborah Steensels
- Ziekenhuis Oost-Limburg hospital , Genk , Belgium
- Université Libre de Bruxelles , Brussels , Belgium
| |
Collapse
|
5
|
Alexandre K, Caron F. Efficacy of temocillin against MDR Enterobacterales: a retrospective cohort study-authors' response. J Antimicrob Chemother 2021; 76:1950-1951. [PMID: 33893503 DOI: 10.1093/jac/dkab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kévin Alexandre
- Normandie Univ, UNIROUEN, UNICAEN, GRAM 2.0, Rouen University Hospital, Department of Infectious Disease, F 76000 Rouen, France
| | - François Caron
- Normandie Univ, UNIROUEN, UNICAEN, GRAM 2.0, Rouen University Hospital, Department of Infectious Disease, F 76000 Rouen, France
| |
Collapse
|
6
|
Delory T, Gravier S, Le Pluart D, Gaube G, Simeon S, Davido B, Piet E, Lepeule R, Lesprit P, Lafaurie M. Temocillin versus carbapenems for urinary tract infection due to ESBL-producing Enterobacteriaceae: a multicenter matched case-control study. Int J Antimicrob Agents 2021; 58:106361. [PMID: 34000372 DOI: 10.1016/j.ijantimicag.2021.106361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the efficacy of temocillin with carbapenems for extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae urinary tract infections (ESBL-E UTI). METHODS A multicenter retrospective case-control study of adults with ESBL-E UTI was conducted between January 2015 and October 2019. Cases received temocillin ≥ 50% of the effective antibiotic therapy duration and controls exclusively received carbapenem; they were statistically matched (1:1 ratio) on 6-month period, sex and age. The clinical cure at the end of antibiotic therapy was analysed using conditional logistic regression. RESULTS Seventy-two temocillin cases were matched to 72 carbapenem controls. Most (67%) were male, median age was 69.4 years, 81 (56%) were immunocompromised, including 44 (31%) solid organ transplant recipients. There was no difference between cases and controls for baseline characteristics and microorganisms involved: Klebsiella pneumoniae in 59 (41%), Escherichia coli in 57 (40%), and Enterobacter spp. in 24 (17%). The median time from admission to effective antibiotic therapy was 0 days [range, 0-2]. Among cases, first-line antibiotic therapy (≤ 72 hours) was temocillin in six (8%) and carbapenems in 39 (54%). Temocillin was given at the median daily dose of 4 g [range, 2-4] after 3 days [range, 2-5] of carbapenems. Patients received temocillin for 81% [range, 70-93] of the effective antibiotic course duration over 11 days [range, 8-14]. The effective antibiotic duration was similar in cases and controls (P = 0.067). Clinical cure at the end of antibiotic therapy was 94% (68/72) in cases vs. 99% (71/72) in controls (P = 0.206), with no difference among immunocompromised and solid organ transplant patients (P > 0.050). CONCLUSIONS Temocillin effectively relayed β-lactams, including carbapenems, to treat (complicated) ESBL-E UTI. Its efficacy was consistent among kidney transplant recipients.
Collapse
Affiliation(s)
- Tristan Delory
- APHP, Infectious Diseases and Tropical Medicine Department, Saint-Louis Hospital, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
| | - Simon Gravier
- APHP, Infectious Diseases and Tropical Medicine Department, Saint-Louis Hospital, Paris, France; Infectious Diseases Department, Hôpitaux Civils de Colmar, Colmar, France
| | - Diane Le Pluart
- Unité Transversale d'hygiène et d'infectiologie, Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Géraldine Gaube
- APHP, Unité Transversale de Traitement des Infections, Département de Prevention Diagnostic et de Traitement des Infections, Hôpital Henri-Mondor, Créteil, France
| | - Soline Simeon
- APHP, Infectious Diseases and Tropical Medicine Department, Raymond-Poincaré, Hospital, Garches, France
| | - Benjamin Davido
- APHP, Infectious Diseases and Tropical Medicine Department, Raymond-Poincaré, Hospital, Garches, France
| | - Emilie Piet
- Infectious Diseases Department, Annecy-Genevois hospital, Epagny-Metz-Tessy, France
| | - Raphaël Lepeule
- APHP, Unité Transversale de Traitement des Infections, Département de Prevention Diagnostic et de Traitement des Infections, Hôpital Henri-Mondor, Créteil, France
| | - Philippe Lesprit
- Unité Transversale d'hygiène et d'infectiologie, Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Matthieu Lafaurie
- APHP, Infectious Diseases and Tropical Medicine Department, Saint-Louis Hospital, Paris, France.
| |
Collapse
|