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Oliva A, Volpicelli L, Di Bari S, Curtolo A, Borrazzo C, Cogliati Dezza F, Cona A, Agrenzano S, Mularoni A, Trancassini M, Mengoni F, Stefani S, Raponi G, Venditti M. Effect of ceftazidime/avibactam plus fosfomycin combination on 30 day mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae: results from a multicentre retrospective study. JAC Antimicrob Resist 2022; 4:dlac121. [PMID: 36506890 PMCID: PMC9728520 DOI: 10.1093/jacamr/dlac121] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The primary outcome of the study was to evaluate the effect on 30 day mortality of the combination ceftazidime/avibactam + fosfomycin in the treatment of bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Materials and methods From October 2018 to March 2021, a retrospective, two-centre study was performed on patients with KPC-Kp BSI hospitalized at Sapienza University (Rome) and ISMETT-IRCCS (Palermo) and treated with ceftazidime/avibactam-containing regimens. A matched cohort (1:1) analysis was performed. Cases were patients receiving ceftazidime/avibactam + fosfomycin and controls were patients receiving ceftazidime/avibactam alone or in combination with in vitro non-active drugs different from fosfomycin (ceftazidime/avibactam ± other). Patients were matched for age, Charlson comorbidity index, ward of isolation (ICU or non-ICU), source of infection and severity of BSI, expressed as INCREMENT carbapenemase-producing Enterobacteriaceae (CPE) score. Results Overall, 221 patients were included in the study. Following the 1:1 match, 122 subjects were retrieved: 61 cases (ceftazidime/avibactam + fosfomycin) and 61 controls (ceftazidime/avibactam ± other). No difference in overall mortality emerged between cases and controls, whereas controls had more non-BSI KPC-Kp infections and a higher number of deaths attributable to secondary infections. Almost half of ceftazidime/avibactam + fosfomycin patients were prescribed fosfomycin without MIC fosfomycin availability. No difference in the outcome emerged after stratification for fosfomycin susceptibility availability and dosage. SARS-CoV-2 infection and ICS ≥ 8 independently predicted 30 day mortality, whereas an appropriate definitive therapy was protective. Conclusions Our data show that fosfomycin was used in the treatment of KPC-Kp BSI independently from having its susceptibility testing available. Although no difference was found in 30 day overall mortality, ceftazidime/avibactam + fosfomycin was associated with a lower rate of subsequent KPC-Kp infections and secondary infections than other ceftazidime/avibactam-based regimens.
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Affiliation(s)
- A Oliva
- Corresponding author. E-mail:
| | | | - S Di Bari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - A Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - C Borrazzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - F Cogliati Dezza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - A Cona
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via E. Tricomi, 5, Palermo 90127, Italy
| | - S Agrenzano
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via E. Tricomi, 5, Palermo 90127, Italy
| | - A Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Via E. Tricomi, 5, Palermo 90127, Italy
| | - M Trancassini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - F Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - S Stefani
- Department of Biomedical and Biotechnological Sciences. Policlinico Hospital, University of Catania, Via Androne 81, Catania 95124, Italy
| | - G Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
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Lona-Reyes JC, Gómez-Ruiz LM, Cordero-Zamora A, Cortés-González SI, Quiles-Corona M, Pérez-Ramírez RO, Pinto-Macedo H. Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico. An Pediatr (Barc) 2022; 97:79-86. [PMID: 35850964 DOI: 10.1016/j.anpede.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/04/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
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Affiliation(s)
- Juan C Lona-Reyes
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México.
| | - Larissa M Gómez-Ruiz
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Araceli Cordero-Zamora
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
| | - Sandra I Cortés-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Moisés Quiles-Corona
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Rene O Pérez-Ramírez
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Herlinda Pinto-Macedo
- Laboratorio Clínico y Microbiología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
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Lona-Reyes JC, Gómez-Ruiz LM, Cordero-Zamora A, Cortés-González SI, Quiles-Corona M, Pérez-Ramírez RO, Pinto-Macedo H. [Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico]. An Pediatr (Barc) 2021; 97:S1695-4033(21)00235-6. [PMID: 34334329 DOI: 10.1016/j.anpedi.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/26/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84). CONCLUSIONS Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
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Affiliation(s)
- Juan C Lona-Reyes
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México.
| | - Larissa M Gómez-Ruiz
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Araceli Cordero-Zamora
- División de Pediatría, Servicio de Infectología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá, Jalisco, México
| | - Sandra I Cortés-González
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Moisés Quiles-Corona
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
| | - Rene O Pérez-Ramírez
- División de Pediatría, Servicio de Neonatología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Herlinda Pinto-Macedo
- Laboratorio Clínico y Microbiología, Hospital Civil de Guadalajara «Dr. Juan I. Menchaca», Guadalajara, Jalisco, México
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