1
|
Kanık-Yüksek S, Güneş Ö, Gülhan B, Erat T, Konca HK, Özen S, Yahşi A, Bayhan Gİ, Özkaya-Parlakay A. Intravenous fosfomycin indications and treatment outcomes in pediatric usage: analysis from a single center in Turkey. J Trop Pediatr 2024; 70:fmae029. [PMID: 39231448 DOI: 10.1093/tropej/fmae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.
Collapse
Affiliation(s)
- Saliha Kanık-Yüksek
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Ömer Güneş
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Belgin Gülhan
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Hatice Kübra Konca
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Seval Özen
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Aysun Yahşi
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Gülsüm İclal Bayhan
- Department of Pediatric Infectious Disease, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Aslınur Özkaya-Parlakay
- Department of Pediatric Infectious Disease, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| |
Collapse
|
2
|
Medugu N, Tickler IA, Duru C, Egah R, James AO, Odili V, Hanga F, Olateju EK, Jibir B, Ebruke BE, Olanipekun G, Tenover FC, Obaro SK. Phenotypic and molecular characterization of beta-lactam resistant Multidrug-resistant Enterobacterales isolated from patients attending six hospitals in Northern Nigeria. Sci Rep 2023; 13:10306. [PMID: 37365355 DOI: 10.1038/s41598-023-37621-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/24/2023] [Indexed: 06/28/2023] Open
Abstract
Infections caused by multi-drug resistant Enterobacterales (MDR-E) are difficult to treat and cause significant mortality, especially in developing countries. This study characterized the phenotypic and genotypic profiles of 49 randomly selected beta-lactam resistant MDR-E previously isolated from patients being managed in hospitals in Nigeria using whole genome sequencing. The study isolates exhibited 85.5% resistance to 3rd generation cephalosporins and 65.3% resistance to carbapenems. The blaTEM-1B (29, 59.2%), blaCTX-M-15 (38, 77.6%), and blaNDM-1 (17, 51.5%) were the most common penicillinase, ESBL, and carbapenem resistant genes across isolates, respectively. Seventeen (45%) of blaCTX-M-15 was carried on the insertion sequence ISEc9 while blaNDM-1 (11, 64.7%) were associated with ISEc33. None of the 21 plasmids detected were associated with β-lactamase genes. Higher resistance rates were found in E. coli ST-88 (n = 2) and the high-risk ST-692 (n = 2). For Klebsiella species, the high-risk clones ST-476 (n = 8) and ST-147 (n = 3) predominated and had higher phenotypic resistance rates and higher number of AMR genes. The mechanisms and pattern of antibiotic resistance differ from patterns previously described with isolates harbouring a wide range of AMRGs. The detection of several chromosomally mediated carbapenemases in our study also represents a significant finding that warrants further investigation to better understand its' implications for clinical practice and public health. The selected MDR-Es were found to be pan-susceptible to tigecycline and had very low resistance to fosfomycin, suggesting a potential for these as empiric treatments. A surveillance approach incorporating both conventional laboratory techniques and modern molecular techniques is essential for the comprehensive characterization of the emergence and dissemination of antimicrobial resistance in Enterobacterales infections within Nigeria.
Collapse
Affiliation(s)
- Nubwa Medugu
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria.
- International Foundation Against Infectious Disease in Nigeria, Dutse Street, Gwarinpa, Abuja, Nigeria.
| | | | - Carissa Duru
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | - Ruth Egah
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | - Abu Ocheiku James
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | - Vivian Odili
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | | | | | - Binta Jibir
- Hasiya Bayero Children's Hospital, Kano, Nigeria
| | - Bernard E Ebruke
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | - Grace Olanipekun
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
| | - Fred C Tenover
- College of Arts and Sciences, University of Dayton, Dayton, OH, 45469, USA
| | - Stephen K Obaro
- Nile University of Nigeria, Cadastral Zone, Research and Institutions Area, Abuja, Nigeria
- University of Nebraska Medical Center, Omaha, NE, 68198, USA
| |
Collapse
|
3
|
Bondi A, Curtoni A, Peradotto M, Zanotto E, Boattini M, Bianco G, Iannaccone M, Barbui AM, Cavallo R, Costa C. Performance Evaluation of BD Phoenix and MicroScan WalkAway Plus for Determination of Fosfomycin Susceptibility in Enterobacterales. Antibiotics (Basel) 2023; 12:1106. [PMID: 37508202 PMCID: PMC10376256 DOI: 10.3390/antibiotics12071106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Fosfomycin is an old bactericidal drug that has gained increasing interest in the last decade for its potential use in multi-drug resistant gram-negative infections. However, evidence on fosfomycin susceptibility testing reports a poor correlation between commercial methods vs. reference agar dilution (AD) for Enterobacterales (EB). The study aimed at assessing the performance of two automated systems for the determination of fosfomycin susceptibility in EB clinical isolates. METHODS Fosfomycin susceptibility testing results of two collections of 100 non-duplicate clinical EB strains obtained using two different platforms (BD Phoenix and MicroScan WalkAway Plus) were compared with those obtained by AD. Categorical agreement (CA), major error (ME) and very major error (VME) rates were calculated. RESULTS BD Phoenix exhibited a 6.9% rate of false-resistant results and achieved a CA of 69%, whereas MicroScan WalkAway Plus achieved 3.7% of false-resistant results and 72% of CA. Both automated systems showed poor detection of resistant isolates, with 49.1% and 56.2% of false-susceptible results for BD Phoenix and Microscan WalkAway Plus, respectively. CONCLUSIONS Overall, agar dilution remains the most suitable method for routine laboratory antimicrobial susceptibility testing of fosfomycin on Enterobacterales strains, given the poor performance of automated systems. The application of both automated systems, in the clinical laboratories reporting of fosfomycin, should be reviewed in light of the accuracy results falling below the acceptable threshold.
Collapse
Affiliation(s)
- Alessandro Bondi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
- Department of Public Healt and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
- Department of Public Healt and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Marco Peradotto
- Clinical Laboratory, Microbiology Unit, Sant'Andrea Hospital, 13100 Vercelli, Italy
| | - Elisa Zanotto
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Marco Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Anna Maria Barbui
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
- Department of Public Healt and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
- Department of Public Healt and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| |
Collapse
|
4
|
Kontou A, Kourti M, Iosifidis E, Sarafidis K, Roilides E. Use of Newer and Repurposed Antibiotics against Gram-Negative Bacteria in Neonates. Antibiotics (Basel) 2023; 12:1072. [PMID: 37370391 DOI: 10.3390/antibiotics12061072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Antimicrobial resistance has become a significant public health problem globally with multidrug resistant Gram negative (MDR-GN) bacteria being the main representatives. The emergence of these pathogens in neonatal settings threatens the well-being of the vulnerable neonatal population given the dearth of safe and effective therapeutic options. Evidence from studies mainly in adults is now available for several novel antimicrobial compounds, such as new β-lactam/β-lactamase inhibitors (e.g., ceftazidime-avibactam, meropenem-vaborbactam, imipenem/cilastatin-relebactam), although old antibiotics such as colistin, tigecycline, and fosfomycin are also encompassed in the fight against MDR-GN infections that remain challenging. Data in the neonatal population are scarce, with few clinical trials enrolling neonates for the evaluation of the efficacy, safety, and dosing of new antibiotics, while the majority of old antibiotics are used off-label. In this article we review data about some novel and old antibiotics that are active against MDR-GN bacteria causing sepsis and are of interest to be used in the neonatal population.
Collapse
Affiliation(s)
- Angeliki Kontou
- 1st Department of Neonatology and Neonatal Intensive Care Unit, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Maria Kourti
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Kosmas Sarafidis
- 1st Department of Neonatology and Neonatal Intensive Care Unit, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| |
Collapse
|
5
|
Riddell A, Cook A, Khavessian N, Ellis S, Bilardi D, Correia E, Kostyanev T, Nardone A, Russell N, Vilken T, Stohr W, Adhisivam B, de Moraes IRA, Ahmed NU, Bekker A, Berezin EN, Boonkasidecha S, Carvalheiro CG, Chauhan P, Chiurchiù S, Chorafa E, Dramowski A, DS M, Feng J, Jia S, Kong Y, Kyohere M, Kontou A, Lochindarat S, De Luca M, Mphaphuli A, Mussi-Pinhata MM, Murunga S, Nakwa FL, Nangia S, Nassolo E, Hoang NTB, Obiero CW, Olson L, Ping W, Plakkal N, Prasad P, Preedisripipat K, Rahman SW, Seef T, Sukrakanchana PO, Thomas R, Yu Z, Zhang Q, Walker AS, Bielicki J, Heath PT, Sharland M, Munera-Huertas T. Challenges in the Implementation of the NeoOBS Study, a Global Pragmatic Observational Cohort Study, to Investigate the Aetiology and Management of Neonatal Sepsis in the Hospital Setting. Antibiotics (Basel) 2023; 12:923. [PMID: 37237826 PMCID: PMC10215156 DOI: 10.3390/antibiotics12050923] [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: 02/23/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income countries. To deliver high-quality data studies and inform future trials, it is crucial to understand the challenges encountered when managing global multi-centre research studies and to identify solutions that can feasibly be implemented in these settings. This paper provides an overview of the complexities faced by diverse research teams in different countries and regions, together with actions implemented to achieve pragmatic study management of a large multi-centre observational study of neonatal sepsis. We discuss specific considerations for enrolling sites with different approval processes and varied research experience, structures, and training. Implementing a flexible recruitment strategy and providing ongoing training were necessary to overcome these challenges. We emphasize the attention that must be given to designing the database and monitoring plans. Extensive data collection tools, complex databases, tight timelines, and stringent monitoring arrangements can be problematic and might put the study at risk. Finally, we discuss the complexities added when collecting and shipping isolates and the importance of having a robust central management team and interdisciplinary collaborators able to adapt easily and make swift decisions to deliver the study on time and to target. With pragmatic approaches, appropriate training, and good communication, these challenges can be overcome to deliver high-quality data from a complex study in challenging settings through a collaborative research network.
Collapse
Affiliation(s)
- Amy Riddell
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | | | | | | | | | - Tomislav Kostyanev
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Antwerpen, Belgium
| | | | - Neal Russell
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Tuba Vilken
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, 2610 Antwerpen, Belgium
| | - Wolfgang Stohr
- MRC Clinical Trials Unit, University College London, London WC1V 6LJ, UK
| | - Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry 605006, India
| | | | | | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | | | | | - Cristina G. Carvalheiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Prachi Chauhan
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi 110001, India
| | - Sara Chiurchiù
- Academic Department of Pediatrics (DPUO), Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Elisavet Chorafa
- Infectious Diseases Unit, 3rd Dept Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, 546 43 Thessaloniki, Greece
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | - Madhusudhan DS
- Seth G. S. Medical College & KEM Hospital, Mumbai 400012, India
| | - Jinxing Feng
- Department of Neonatology, Shenzhen Children’s Hospital, Shenzhen 518048, China
| | - Shengnan Jia
- Department of Neonatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100051, China
| | - Yuan Kong
- Clinical Laboratory, Shenzhen Children’s Hospital, Shenzhen 518048, China
| | - Mary Kyohere
- MUJHU Research Collaboration, Kampala P.O. Box 23491, Uganda
| | - Angeliki Kontou
- 1st Neonatology Department and Neonatal Intensive Care Unit, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42 Thessaloniki, Greece
| | | | - Maia De Luca
- Academic Department of Pediatrics (DPUO), Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Aripfani Mphaphuli
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa AND Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Sheila Murunga
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230, Kenya
| | - Firdose Lambey Nakwa
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi 110001, India
| | - Erinah Nassolo
- MUJHU Research Collaboration, Kampala P.O. Box 23491, Uganda
| | - Ngoc Thi Bin Hoang
- Department of Microbiology, Vietnam National Children’s Hospital, Hanoi 100000, Vietnam
| | - Christina W. Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230, Kenya
- Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Department of Global Health, 1081 Amsterdam, The Netherlands
| | - Linus Olson
- Department of Women’s and Children’s Health, Karolinska institutet, Stockholm, Sweden and Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Wang Ping
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry 605006, India
| | - Priyanka Prasad
- Seth G. S. Medical College & KEM Hospital, Mumbai 400012, India
| | | | | | - Tiffany Seef
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa AND Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | | | - Reenu Thomas
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Zhang Yu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Qiaoru Zhang
- Department of Neonatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100051, China
| | - A. Sarah Walker
- MRC Clinical Trials Unit, University College London, London WC1V 6LJ, UK
| | - Julia Bielicki
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Paul T. Heath
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Michael Sharland
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Tatiana Munera-Huertas
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| |
Collapse
|
6
|
Purcell R, Yeoh D, Bowen A, Britton PN, Carr JP, Chen M, Cheung K, Clark J, Irwin A, Lai T, Lorenzen U, Steer A, Wen S, Williams P, Yap N, Cooper C, Gwee A. A multicentre, retrospective audit of fosfomycin use for urinary tract infections in Australian children and adolescents. J Antimicrob Chemother 2023:7163425. [PMID: 37190910 DOI: 10.1093/jac/dkad131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) due to MDR organisms are increasingly common. The lack of paediatric data on efficacious antibiotics makes UTI treatment particularly challenging. Data on the efficacy of fosfomycin use for UTI in children are variable. METHODS We conducted a retrospective audit of children aged 0-18 years who were treated with fosfomycin for UTI at seven tertiary paediatric hospitals in Australia over a 7 year period, from 2014 to 2020. RESULTS Ninety-one children with a median age of 5 years (range 2 months to 18 years) received oral fosfomycin for UTI. The majority (57/91, 63%) had one or more comorbidity, with the most common being renal tract anomalies (24/91, 26%). Fifty-nine (65%) had febrile UTI, 14/91 (15%) had pyelonephritis and 1/91 (1%) was bacteraemic. A majority (80/91, 88%) of urinary cultures had an ESBL-producing Gram-negative pathogen isolated. Fosfomycin susceptibility was evident in all 80 isolates tested. For uncomplicated UTI, the most common dose in children aged <1, 1-12 and >12 years was 1, 2 and 3 g, respectively. For complicated UTI, doses of 2 and 3 g were most common. The median duration of fosfomycin administration was 5 days (range 1-82). Clinical cure was achieved in 84/90 (93%); the six with treatment failure had underlying comorbidities. Overall, 2/91 (2%) children experienced drug-related adverse effects comprising gastrointestinal symptoms in both, which resolved after treatment discontinuation. CONCLUSIONS Fosfomycin is well tolerated and associated with favourable treatment outcomes in children with UTI. Further research on the optimal dosing strategy is required.
Collapse
Affiliation(s)
- Rachael Purcell
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Health Informatics Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Bioinformatics Group, Centre for Health Analytics, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Asha Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- Westfarmer Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
| | - Jeremy P Carr
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ming Chen
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
| | - Kaman Cheung
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
| | - Julia Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam Irwin
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tony Lai
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
| | - Ulrik Lorenzen
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
| | - Andrew Steer
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Wen
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Phoebe Williams
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Natalie Yap
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
- National Centre for Antimicrobial Stewardship, Adelaide, Australia
| | - Amanda Gwee
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
7
|
Assessment of the Susceptibility of Clinical Gram-Negative and Gram-Positive Bacterial Strains to Fosfomycin and Significance of This Antibiotic in Infection Treatment. Pathogens 2022; 11:pathogens11121441. [PMID: 36558775 PMCID: PMC9786176 DOI: 10.3390/pathogens11121441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Multidrug resistance of bacteria has prompted intensive development work on new medicines, but also the search for effective options among the oldest antibiotics. Although intravenous fosfomycin (IVFOS) seems to be an interesting proposal, the recommended agar dilution method for susceptibility determination poses a major problem in routine diagnostic testing. As a consequence, there is a lack of comprehensive data on the frequency of isolation of susceptible or resistant strains. This fact triggered the disposition of EUCAST concerning the revision of IVFOS breakpoints (BPs), including withdrawal of BPs for Enterobacterales (excluding E. coli) and coagulase-negative staphylococci. Therefore, the aim of this study was to assess the activity of fosfomycin against numerous clinical strains using recommended methods. Materials and methods: A total of 997 bacterial strains were tested from the following genera: Enterobacterales, Pseudomonas spp., Staphylococcus spp., Acinetobacter spp., and Enterococcus spp., for which there are currently no BPs. The strains were isolated from various clinical materials from patients hospitalized in five hospitals. During the investigation, the recommended agar dilution method was used. Susceptibility to other antibiotics and resistance mechanisms were determined using an automatic method (Phoenix) the disk diffusion method, and E-tests. MIC values of fosfomycin were estimated for all strains and for susceptible and multidrug-resistant (MDR) strains individually. Results: Except for Acinetobacter and Enterococcus, 83% of the strains were susceptible to IVFOS, including the largest percentage of S. aureus and E. coli. Klebsiella spp. turned out to be the least susceptible strains (66%). The highest proportion of susceptibility to fosfomycin was found among strains that were sensitive to other antibiotics (80.9%), and the lowest was found among Gram-negative carbapenemase-producing bacteria (55.6%) and ESBL+ bacteria (61.6%). The MIC evaluation revealed the lowest MIC50 and MIC90 values for S. aureus (0.5 mg/L and 1 mg/L, respectively) and E. coli (4 mg/L and 32 mg/L, respectively). The highest values of MIC50 were found for Acinetobacter spp. (256 mg/L), while the highest values of MIC90 were found for Acinetobacter spp. and Klebsiella spp. (256 mg/L and 512 mg/L, respectively). Conclusions: IVFOS appears to be suitable for the treatment of many infections, including the empirical treatment of polymicrobial infections and those caused by MDR strains, since the sensitivity of the studied strains to this antibiotic in different groups ranged from 66% to as much as 99%. Sensitivity to fosfomycin was also demonstrated by 60% of carbapenem-resistant strains; therefore, IVFOS is one of the few therapeutic options that can be effective against the most resistant Gram-negative rods. In light of the general consultation posted by EUCAST, obtaining data such as IVFOS MIC value distributions may be vital for the decision of implementing fosfomycin into breakpoint tables.
Collapse
|
8
|
Purcell R, Wang N, Gwee A. Can fosfomycin be used for the treatment of Gram-negative urinary tract infections in children? Arch Dis Child 2021; 106:925-928. [PMID: 33461959 DOI: 10.1136/archdischild-2020-320529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Rachael Purcell
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nelson Wang
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Kane Z, Gastine S, Obiero C, Williams P, Murunga S, Thitiri J, Ellis S, Correia E, Nyaoke B, Kipper K, van den Anker J, Sharland M, Berkley JA, Standing JF. IV and oral fosfomycin pharmacokinetics in neonates with suspected clinical sepsis. J Antimicrob Chemother 2021; 76:1855-1864. [PMID: 33855449 PMCID: PMC8212774 DOI: 10.1093/jac/dkab083] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fosfomycin has the potential to be re-purposed as part of a combination therapy to treat neonatal sepsis where resistance to current standard of care (SOC) is common. Limited data exist on neonatal fosfomycin pharmacokinetics and estimates of bioavailability and CSF/plasma ratio in this vulnerable population are lacking. OBJECTIVES To generate data informing the appropriate dosing of IV and oral fosfomycin in neonates using a population pharmacokinetic analysis of plasma and CSF data. METHODS The NeoFosfo study (NCT03453177) was a randomized trial that examined the safety and pharmacokinetics of fosfomycin comparing SOC versus SOC plus fosfomycin. Sixty-one neonates received fosfomycin (100 mg/kg IV q12h for 48 h) and then they converted to oral therapy at the same dose. Two plasma pharmacokinetic samples were taken following the first IV and oral doses, sample times were randomized to cover the whole pharmacokinetic profile and opportunistic CSF pharmacokinetic samples were collected. A population pharmacokinetic model was developed in NONMEM and simulations were performed. RESULTS In total, 238 plasma and 15 CSF concentrations were collected. A two-compartment disposition model, with an additional CSF compartment and first-order absorption, best described the data. Bioavailability was estimated as 0.48 (95% CI = 0.347-0.775) and the CSF/plasma ratio as 0.32 (95% CI = 0.272-0.409). Allometric weight and postmenstrual age (PMA) scaling was applied; additional covariates included postnatal age (PNA) on clearance and CSF protein on CSF/plasma ratio. CONCLUSIONS Through this analysis a population pharmacokinetic model has been developed that can be used alongside currently available pharmacodynamic targets to select a neonatal fosfomycin dose based on an infant's PMA, PNA and weight.
Collapse
Affiliation(s)
- Zoe Kane
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.,Quotient Sciences, Mere Way, Ruddington, Nottingham, UK
| | - Silke Gastine
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Phoebe Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Sally Ellis
- GARDP-Global Antibiotic Research & Development Partnership, Genève, Switzerland
| | - Erika Correia
- GARDP-Global Antibiotic Research & Development Partnership, Genève, Switzerland
| | - Borna Nyaoke
- DNDi-Drugs for Neglected Diseases initiative, Nairobi, Kenya
| | - Karin Kipper
- Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - John van den Anker
- Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Joseph F Standing
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.,Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Xie H, Wu L, Chen X, Gao S, Li H, Yuan Y, Liang J, Wang X, Wang S, Xu C, Chu L, Zhan B, Zhou R, Yang X. Schistosoma japonicum Cystatin Alleviates Sepsis Through Activating Regulatory Macrophages. Front Cell Infect Microbiol 2021; 11:617461. [PMID: 33718268 PMCID: PMC7943722 DOI: 10.3389/fcimb.2021.617461] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/14/2021] [Indexed: 12/13/2022] Open
Abstract
Multi-organ failure caused by the inflammatory cytokine storm induced by severe infection is the major cause of death for sepsis. Sj-Cys is a cysteine protease inhibitor secreted by Schistosoma japonicum with strong immunomodulatory functions on host immune system. Our previous studies have shown that treatment with Sj-Cys recombinant protein (rSj-Cys) attenuated inflammation caused by sepsis. However, the immunological mechanism underlying the immunomodulation of Sj-Cys for regulating inflammatory diseases is not yet known. In this study, we investigated the effect of Sj-Cys on the macrophage M2 polarization and subsequent therapeutic effect on sepsis. The rSj-Cys was expressed in yeast Pichia pastoris. Incubation of mouse bone marrow-derived macrophages (BMDMs) with yeast-expressed rSj-Cys significantly activated the polarization of macrophages to M2 subtype characterized by the expression of F4/80+ CD206+ with the elated secretion of IL-10 and TGF-β. Adoptive transfer of rSj-Cys treated BMDMs to mice with sepsis induced by cecal ligation and puncture (CLP) significantly improved their survival rates and the systemic clinical manifestations of sepsis compared with mice receiving non-treated normal BMDMs. The therapeutic effect of Sj-Cys-induced M2 macrophages on sepsis was also reflected by the reduced pathological damages in organs of heart, lung, liver and kidney and reduced serological levels of tissue damage-related ALT, AST, BUN and Cr, associated with downregulated pro-inflammatory cytokines (IFN-gamma and IL-6) and upregulated regulatory anti-inflammatory cytokines (IL-10 and TGF-β). Our results demonstrated that Sj-Cys is a strong immunomodulatory protein with anti-inflammatory features through activating M2 macrophage polarization. The findings of this study suggested that Sj-Cys itself or Sj-Cys-induced M2 macrophages could be used as therapeutic agents in the treatment of sepsis or other inflammatory diseases.
Collapse
Affiliation(s)
- Hong Xie
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Lingqin Wu
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Pediatric, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xingzhi Chen
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Shifang Gao
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China
| | - Huihui Li
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Yuan Yuan
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Jinbao Liang
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China
| | - Xiaoli Wang
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Shuying Wang
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Pediatric, First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Changyan Xu
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| | - Liang Chu
- Department of General Surgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Bin Zhan
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Rui Zhou
- Department of Pediatric, First Affiliated Hospital of Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Immunology in Chronic Diseases of Bengbu Medical College, Bengbu, China
| | - Xiaodi Yang
- Anhui Key Laboratory of Infection and Immunity of Bengbu Medical College, Bengbu, China.,Department of Basic Medical College, Bengbu Medical College, Bengbu, China
| |
Collapse
|
11
|
Perdigão Neto LV, Oliveira MS, Orsi TD, Prado GVBD, Martins RCR, Leite GC, Marchi AP, Lira ESD, Côrtes MF, Espinoza EPS, Carrilho CMDDM, Boszczowski Í, Guimarães T, Costa SF, Levin AS. Alternative drugs against multiresistant Gram-negative bacteria. J Glob Antimicrob Resist 2020; 23:33-37. [PMID: 32822906 DOI: 10.1016/j.jgar.2020.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Enterobacterales and other non-fermenting Gram-negative bacteria have become a threat worldwide owing to the frequency of multidrug resistance in these pathogens. On the other hand, efficacious therapeutic options are quickly diminishing. The aims of this study were to describe the susceptibility of 50 multiresistant Gram-negative bacteria, mostly pan-resistant, against old and less-used antimicrobial drugs and to investigate the presence of antimicrobial resistance genes. METHODS A total of 50 genetically distinct isolates were included in this study, including 14 Acinetobacter baumannii (belonging to ST79, ST317, ST835 and ST836), 1 Pseudomonas aeruginosa (ST245), 8 Serratia marcescens and 27 Klebsiella pneumoniae (belonging to ST11, ST340, ST258, ST16, ST23, ST25, ST101, ST234, ST437 and ST442). The isolates were submitted to antimicrobial susceptibility testing and whole-genome sequencing to evaluate lineages and resistance genes. RESULTS Our results showed that some strains harboured carbapenemase genes, e.g. blaKPC-2 (28/50; 56%) and blaOXA-23 (11/50; 22%), and other resistance genes encoding aminoglycoside-modifying enzymes (49/50; 98%). Susceptibility rates to tigecycline (96%) in all species (except P. aeruginosa), to minocycline (100%) and doxycycline (93%) in A. baumannii, to ceftazidime/avibactam in S. marcescens (100%) and K. pneumoniae (96%), and to fosfomycin in S. marcescens (88%) were high. Chloramphenicol and quinolones (6% susceptibility each) did not perform well, making their use in an empirical scenario unlikely. CONCLUSIONS This study involving genetically distinct bacteria showed promising results for tigecycline for all Gram-negative bacteria (except P. aeruginosa), and there was good activity of minocycline against A. baumannii, ceftazidime/avibactam against Enterobacterales, and fosfomycin against S. marcescens.
Collapse
Affiliation(s)
- Lauro Vieira Perdigão Neto
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil; Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil.
| | - Maura Salaroli Oliveira
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil
| | - Tatiana D'Annibale Orsi
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Gladys Villas Boas do Prado
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Roberta Cristina Ruedas Martins
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Gleice Cristina Leite
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Ana Paula Marchi
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Esther Sant'Ana de Lira
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Marina Farrel Côrtes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil
| | - Evelyn Patricia Sanchez Espinoza
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil
| | | | - Ícaro Boszczowski
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil
| | - Thais Guimarães
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil
| | - Silvia Figueiredo Costa
- Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| | - Anna S Levin
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr Ovídio Pires de Campos 225, Sala 629, São Paulo, SP 05403-010, Brazil; Department of Infectious Diseases and LIM-49, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar 470, São Paulo, SP 05403-000, Brazil
| |
Collapse
|
12
|
Tajik S, Shokri F, Rostamnezhad M, Khoshnood S, Mortazavi SM, Sholeh M, Kouhsari E. Fosfomycin: A look at its various aspects. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
13
|
Carbapenem-Resistant Enterobacterales: Considerations for Treatment in the Era of New Antimicrobials and Evolving Enzymology. Curr Infect Dis Rep 2020; 22:6. [PMID: 32034524 PMCID: PMC7223591 DOI: 10.1007/s11908-020-0716-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose of Review Gram-negative resistance is a growing concern globally. Enterobacterales, formerly Enterobacteriaceae, have developed resistance mechanisms to carbapenems that leave very few antimicrobial options in the clinician’s armamentarium. Recent Findings New antimicrobials like ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, and plazomicin have the potential to overcome resistance mechanisms in Enterobacterales including different classes of carbapenemases. Summary Novel β-lactam/β-lactamase inhibitors, plazomicin, and cefiderocol give the clinician options that were once not available. Utilizing these options is of the utmost importance when treating carbapenem-resistant Enterobacterales.
Collapse
|