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For: Trecarichi EM, Giuliano G, Cattaneo C, Ballanti S, Criscuolo M, Candoni A, Marchesi F, Laurino M, Dargenio M, Fanci R, Cefalo M, Delia M, Spolzino A, Maracci L, Bonuomo V, Busca A, Principe MID, Daffini R, Simonetti E, Dragonetti G, Zannier ME, Pagano L, Tumbarello M. Bloodstream infections due to Gram-negative bacteria in patients with hematologic malignancies: updated epidemiology and risk factors for multidrug-resistant strains in an Italian perspective survey. Int J Antimicrob Agents 2023;61:106806. [PMID: 37030470 DOI: 10.1016/j.ijantimicag.2023.106806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]

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Cited by Other Article(s)

Herrera F, Torres D, Laborde A, Jordán R, Mañez N, Berruezo L, Lambert S, Suchowiercha N, Costantini P, Nenna A, Pereyra ML, Benso J, González Ibañez ML, Eusebio MJ, Barcán L, Baldoni N, Tula L, Roccia Rossi I, Luck M, Soto V, Fernández V, Carena AÁ. Ceftazidime-Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia. Microorganisms 2024;12:195. [PMID: 38258022 PMCID: PMC10819230 DOI: 10.3390/microorganisms12010195] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open

Abstract

Few studies have evaluated the efficacy of ceftazidime-avibactam (CA) for Klebsiella pneumoniae carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients with multi-drug resistant Enterobacterales bacteremia. They were compared according to the resistance mechanism and definitive treatment provided: KPC-CPE treated with CA (G1), KPC-CPE treated with other antibiotics (G2), and patients with ESBL-producing Enterobacterales bacteremia who received appropriate definitive therapy (G3). Thirty-day mortality was evaluated using a logistic regression model, and survival was analyzed with Kaplan-Meier curves. A total of 238 patients were included: 18 (G1), 52 (G2), and 168 (G3). Klebsiella spp. (60.9%) and Escherichia coli (26.4%) were the Enterobacterales most frequently isolated, and 71% of the bacteremias had a clinical source. The resistance profile between G1 and G2 was colistin 35.3% vs. 36.5%, amikacin 16.7% vs. 40.4%, and tigeclycline 11.1% vs. 19.2%. The antibiotics prescribed in combination with G2 were carbapenems, colistin, amikacin, fosfomycin, tigecycline, and fluoroquinolones. Seven-day clinical response in G1 vs. G2 vs. G3 was 94.4% vs. 42.3% vs. 82.7%, respectively (p < 0.001). Thirty-day overall mortality in G1 vs. G2 vs. G3 was 22.2% vs. 53.8% vs. 11.9%, respectively (p < 0.001), and infection-related mortality was 5.5% vs. 51.9% vs. 7.7% (p < 0.001). The independent risk factors for mortality were Pitt score > 4: OR 3.63, 95% CI, 1.18-11.14 (p = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58-30.33 (p = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01-0.08 (p < 0.001). High-risk neutropenic patients with KPC-CPE treated with CA had an outcome similar to those treated for ESBL-producing Enterobacterales, with higher 7-day clinical response and lower overall and infection-related mortality than those treated with other antibiotics. In view of these data, CA may be considered the preferred therapeutic option for KPC-PEB in high-risk neutropenic patients.

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Affiliation(s)

Fabián Herrera Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina; (D.T.); (A.Á.C.)
Diego Torres Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina; (D.T.); (A.Á.C.)
Ana Laborde Fundación para Combatir la Leucemia, Buenos Aires C1114, Argentina; (A.L.); (M.L.G.I.)
Rosana Jordán Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina; (R.J.); (M.J.E.)
Noelia Mañez Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (N.M.); (L.B.)
Lorena Berruezo Infectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina; (L.B.); (N.B.)
Sandra Lambert Infectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, Argentina; (S.L.); (L.T.)
Nadia Suchowiercha Infectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, Argentina; (N.S.); (I.R.R.)
Patricia Costantini Infectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina; (P.C.); (M.L.)
Andrea Nenna Infectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina; (A.N.); (V.S.)
María Laura Pereyra Infectious Diseases Service, Hospital Universitario Austral, Buenos Aires B1629, Argentina;
José Benso Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, Argentina; (J.B.); (V.F.)
María Luz González Ibañez Fundación para Combatir la Leucemia, Buenos Aires C1114, Argentina; (A.L.); (M.L.G.I.)
María José Eusebio Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina; (R.J.); (M.J.E.)
Laura Barcán Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (N.M.); (L.B.)
Nadia Baldoni Infectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina; (L.B.); (N.B.)
Lucas Tula Infectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, Argentina; (S.L.); (L.T.)
Inés Roccia Rossi Infectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, Argentina; (N.S.); (I.R.R.)
Martín Luck Infectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina; (P.C.); (M.L.)
Vanesa Soto Infectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina; (A.N.); (V.S.)
Verónica Fernández Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, Argentina; (J.B.); (V.F.)
Alberto Ángel Carena Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina; (D.T.); (A.Á.C.)

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Castelli V, Sastre-Escolà E, Puerta-Alcalde P, Huete-Álava L, Laporte-Amargós J, Bergas A, Chumbita M, Marín M, Domingo-Domenech E, Badia-Tejero AM, Pons-Oltra P, García-Vidal C, Carratalà J, Gudiol C. The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients. Antibiotics (Basel) 2023;12:1722. [PMID: 38136755 PMCID: PMC10740481 DOI: 10.3390/antibiotics12121722] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open

Affiliation(s)

Valeria Castelli Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.) Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122 Milan, Italy
Enric Sastre-Escolà Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.) Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
Pedro Puerta-Alcalde Infectious Diseases Department, Hospital Clinic of Barcelona—IDIBAPS, 08036 Barcelona, Spain; (P.P.-A.); (M.C.) Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), 08036 Barcelona, Spain
Leyre Huete-Álava Internal Medicine Department, Hospital Reina Sofía de Tudela, 31500 Tudela, Spain;
Júlia Laporte-Amargós Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.)
Alba Bergas Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.)
Mariana Chumbita Infectious Diseases Department, Hospital Clinic of Barcelona—IDIBAPS, 08036 Barcelona, Spain; (P.P.-A.); (M.C.)
Mar Marín Oncology Department, Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
Eva Domingo-Domenech Hematology Department, Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
Ana María Badia-Tejero Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.)
Paula Pons-Oltra Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.)
Carolina García-Vidal Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; Infectious Diseases Department, Hospital Clinic of Barcelona—IDIBAPS, 08036 Barcelona, Spain; (P.P.-A.); (M.C.) Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Campus Clínic, Universitat de Barcelona (UB), 08036 Barcelona, Spain
Jordi Carratalà Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.) Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
Carlota Gudiol Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (V.C.); (J.L.-A.); (A.B.); (A.M.B.-T.); (P.P.-O.); (J.C.); (C.G.) Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain

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