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Win TZ, Han SM, Edwards T, Maung HT, Brett-Major DM, Smith C, Lee N. Antibiotics for treatment of leptospirosis. Cochrane Database Syst Rev 2024; 3:CD014960. [PMID: 38483092 PMCID: PMC10938876 DOI: 10.1002/14651858.cd014960.pub2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Leptospirosis is a disease transmitted from animals to humans through water, soil, or food contaminated with the urine of infected animals, caused by pathogenic Leptospira species. Antibiotics are commonly prescribed for the management of leptospirosis. Despite the widespread use of antibiotic treatment for leptospirosis, there seems to be insufficient evidence to determine its effectiveness or to recommend antibiotic use as a standard practice. This updated systematic review evaluated the available evidence regarding the use of antibiotics in treating leptospirosis, building upon a previously published Cochrane review. OBJECTIVES To evaluate the benefits and harms of antibiotics versus placebo, no intervention, or another antibiotic for the treatment of people with leptospirosis. SEARCH METHODS We identified randomised clinical trials following standard Cochrane procedures. The date of the last search was 27 March 2023. SELECTION CRITERIA We searched for randomised clinical trials of various designs that examined the use of antibiotics for treating leptospirosis. We did not impose any restrictions based on the age, sex, occupation, or comorbidities of the participants involved in the trials. Our search encompassed trials that evaluated antibiotics, regardless of the method of administration, dosage, and schedule, and compared them with placebo or no intervention, or compared different antibiotics. We included trials regardless of the outcomes reported. DATA COLLECTION AND ANALYSIS During the preparation of this review, we adhered to the Cochrane methodology and used Review Manager. The primary outcomes were all-cause mortality and serious adverse events (nosocomial infection). Our secondary outcomes were quality of life, proportion of people with adverse events considered non-serious, and days of hospitalisation. To assess the risk of bias of the included trials, we used the RoB 2 tool, and for evaluating the certainty of evidence we used GRADEpro GDT software. We presented dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), both accompanied by their corresponding 95% confidence intervals (CI). We used the random-effects model for all our main analyses and the fixed-effect model for sensitivity analyses. For our primary outcome analyses, we included trial data from the longest follow-up period. MAIN RESULTS We identified nine randomised clinical trials comprising 1019 participants. Seven trials compared two intervention groups and two trials compared three intervention groups. Amongst the trials comparing antibiotics versus placebos, four trials assessed penicillin and one trial assessed doxycycline. In the trials comparing different antibiotics, one trial evaluated doxycycline versus azithromycin, one trial assessed penicillin versus doxycycline versus cefotaxime, and one trial evaluated ceftriaxone versus penicillin. One trial assessed penicillin with chloramphenicol and no intervention. Apart from two trials that recruited military personnel stationed in endemic areas or military personnel returning from training courses in endemic areas, the remaining trials recruited people from the general population presenting to the hospital with fever in an endemic area. The participants' ages in the included trials was 13 to 92 years. The treatment duration was seven days for penicillin, doxycycline, and cephalosporins; five days for chloramphenicol; and three days for azithromycin. The follow-up durations varied across trials, with three trials not specifying their follow-up periods. Three trials were excluded from quantitative synthesis; one reported zero events for a prespecified outcome, and two did not provide data for any prespecified outcomes. Antibiotics versus placebo or no intervention The evidence is very uncertain about the effect of penicillin versus placebo on all-cause mortality (RR 1.57, 95% CI 0.65 to 3.79; I2 = 8%; 3 trials, 367 participants; very low-certainty evidence). The evidence is very uncertain about the effect of penicillin or chloramphenicol versus placebo on adverse events considered non-serious (RR 1.05, 95% CI 0.35 to 3.17; I2 = 0%; 2 trials, 162 participants; very low-certainty evidence). None of the included trials assessed serious adverse events. Antibiotics versus another antibiotic The evidence is very uncertain about the effect of penicillin versus cephalosporin on all-cause mortality (RR 1.38, 95% CI 0.47 to 4.04; I2 = 0%; 2 trials, 348 participants; very low-certainty evidence), or versus doxycycline (RR 0.93, 95% CI 0.13 to 6.46; 1 trial, 168 participants; very low-certainty evidence). The evidence is very uncertain about the effect of cefotaxime versus doxycycline on all-cause mortality (RR 0.18, 95% CI 0.01 to 3.78; 1 trial, 169 participants; very low-certainty evidence). The evidence is very uncertain about the effect of penicillin versus doxycycline on serious adverse events (nosocomial infection) (RR 0.62, 95% CI 0.11 to 3.62; 1 trial, 168 participants; very low-certainty evidence) or versus cefotaxime (RR 1.01, 95% CI 0.15 to 7.02; 1 trial, 175 participants; very low-certainty evidence). The evidence is very uncertain about the effect of doxycycline versus cefotaxime on serious adverse events (nosocomial infection) (RR 1.01, 95% CI 0.15 to 7.02; 1 trial, 175 participants; very low-certainty evidence). The evidence is very uncertain about the effect of penicillin versus cefotaxime (RR 3.03, 95% CI 0.13 to 73.47; 1 trial, 175 participants; very low-certainty evidence), versus doxycycline (RR 2.80, 95% CI 0.12 to 67.66; 1 trial, 175 participants; very low-certainty evidence), or versus chloramphenicol on adverse events considered non-serious (RR 0.74, 95% CI 0.15 to 3.67; 1 trial, 52 participants; very low-certainty evidence). Funding Six of the nine trials included statements disclosing their funding/supporting sources and three trials did not mention funding source. Four of the six trials mentioning sources received funds from public or governmental sources or from international charitable sources, and the remaining two, in addition to public or governmental sources, received support in the form of trial drug supply directly from pharmaceutical companies. AUTHORS' CONCLUSIONS As the certainty of evidence is very low, we do not know if antibiotics provide little to no effect on all-cause mortality, serious adverse events, or adverse events considered non-serious. There is a lack of definitive rigorous data from randomised trials to support the use of antibiotics for treating leptospirosis infection, and the absence of trials reporting data on clinically relevant outcomes further adds to this limitation.
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Affiliation(s)
- Tin Zar Win
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Su Myat Han
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hsu Thinzar Maung
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - David M Brett-Major
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, Maryland, USA
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Nathaniel Lee
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Tuesuwan B, Buranapraditkun S, Arjharn W, Suthumchai N, Chongpison Y, Klaewsongkram J. Immunogenicity of cephalosporin components in non-IgE-mediated cephalosporin allergy. Clin Exp Allergy 2024; 54:156-158. [PMID: 38010885 DOI: 10.1111/cea.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Bodin Tuesuwan
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Supranee Buranapraditkun
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weena Arjharn
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Nithikan Suthumchai
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yuda Chongpison
- Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Jettanong Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Kipchumba SK, Njuguna FM, Nyandiko WM. Bacterial Isolates and Characteristics of Children With Febrile Neutropenia on Treatment for Cancer at a Tertiary Hospital in Western Kenya. JCO Glob Oncol 2024; 10:e2300313. [PMID: 38301180 PMCID: PMC10846791 DOI: 10.1200/go.23.00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE This study aimed to identify the patient characteristics of children with febrile neutropenia, the associated bacterial organisms, and their sensitivity patterns. MATERIALS AND METHODS A descriptive cross-sectional study was conducted at the Moi Teaching and Referral Hospital (MTRH) pediatric oncology ward, from June 2021 to April 2022. A total of 110 children who developed fever and neutropenia during chemotherapy were enrolled. Blood samples for culture were collected aseptically. Patient characteristics were presented in frequency tables. Antimicrobial sensitivity patterns were plotted in tables against the bacterial isolates cultured. Chi-square/Fisher's exact test was used to determine any association between patient characteristics, bacterial growth, and antimicrobial sensitivity. RESULTS The majority (n = 66; 60%) were males. The median age was 6.3 years (standard deviation, 3.7). The majority of patients 71 (64.5%) had hematologic malignancies, the most common being AML. There was a significant association between severity of neutropenia and hematologic malignancies (P = .028). In total, 31/110 (28.2%) blood cultures were positive for bacterial growth. Gram-positive bacteria were more frequent (n = 20; 58.1%). The most common organism was Escherichia coli (n = 6; 18.2%), followed by Staphylococcus aureus (n = 5; 15.2%). All the isolates were sensitive to linezolid and vancomycin and also showed good sensitivity toward meropenem (n = 10/11; 90.9%). High resistance to cephalosporins was noted with ceftriaxone (n = 5/6; 83.3%), cefepime (n = 4/7; 57.1%), and ceftazidime (n = 3/4; 75%). CONCLUSION The most common malignancy associated with febrile neutropenia was AML. Gram-positive bacteria were the most common isolates. There was high resistance to cephalosporins.
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Affiliation(s)
- Samuel Kipkemoi Kipchumba
- Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - Festus Muigai Njuguna
- Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
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Herrmann J, Burgener-Gasser AV, Goldenberger D, Roth J, Weisser M, Tamma PD, Tschudin-Sutter S. Cefepime versus carbapenems for treatment of AmpC beta-lactamase-producing Enterobacterales bloodstream infections. Eur J Clin Microbiol Infect Dis 2024; 43:213-221. [PMID: 37993680 PMCID: PMC10821988 DOI: 10.1007/s10096-023-04715-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Cefepime is recommended for treating infections caused by AmpC beta-lactamase-producing Enterobacterales (AmpC-PE), though supporting evidence is limited. Therefore, this study compared outcomes associated with cefepime versus carbapenem therapy for bloodstream infections (BSIs) caused by AmpC-PE after phenotypic exclusion of ESBL-co-producing isolates. METHODS This retrospective cohort study compared definite cefepime versus carbapenem treatment for AmpC-PE BSI in hospitalized patients of the University Hospital Basel, Switzerland, between 01/2015 and 07/2020. Primary outcomes included in-hospital death, renal impairment and neurologic adverse events; secondary outcomes included length of hospital stay and recurrent infection. RESULTS Two hundred and seventy episodes of AmpC-PE BSI were included, 162, 77 and 31 were treated with a carbapenem, cefepime and other antibiotics, respectively. Patients treated with carbapenems were more likely to be transferred to the ICU on admission and more frequently had central venous catheter as a source of infection. In uni- and multivariable analyses, primary and secondary outcomes did not differ between the two treatment groups, except for more frequent occurrence of neurological adverse events among patients treated with carbapenems and shorter length of hospital stay among survivors treated with cefepime. CONCLUSION After excluding isolates with phenotypic ESBL-co-production, cefepime was not associated with adverse outcomes compared to carbapenems when used to treat BSIs caused by AmpC-PE. Our study provides evidence to support the use of cefepime as a safe treatment strategy for AmpC-PE BSI, particularly in clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events.
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Affiliation(s)
- Julia Herrmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Anne-Valérie Burgener-Gasser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Daniel Goldenberger
- Division of Clinical Bacteriology and Mycology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jan Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
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Zarauskas A, Rodrigues B, Alvarez V. Ceftriaxone-induced encephalopathy in a patient with a normal renal function. BMJ Case Rep 2024; 17:e256934. [PMID: 38216159 PMCID: PMC10806959 DOI: 10.1136/bcr-2023-256934] [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] [Indexed: 01/14/2024] Open
Abstract
Ceftriaxone-induced encephalopathy is an exceptionally rare adverse effect of this commonly used cephalosporin and is generally observed in patients undergoing haemodialysis or suffering from severe renal failure. We present a case of a fit woman in her mid-80s with a normal renal function who developed severe fluctuating neurological symptoms (aphasia, loss of contact, chorea-like tongue movements) while being treated with ceftriaxone for a urinary tract infection with bacteraemia. The symptoms began on day 4 of treatment and an adverse drug reaction was suspected on day 7, after exhaustive investigations failed to reveal another cause. A complete recovery was observed 3 days after discontinuing ceftriaxone. Our case highlights the need to consider the diagnosis of ceftriaxone encephalopathy, even if the traditional risk factors are lacking. In this article, we also provide a brief overview of the pathophysiology as well as a literature review concerning the subject.
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Affiliation(s)
- Audrius Zarauskas
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Bruno Rodrigues
- Internal Medicine, Hopital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Vincent Alvarez
- Neurology, Hôpital de Sion Centre Hospitalier du Valais Romand, Sion, Switzerland
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Sillcox C, Gabrielli S, O'Keefe A, McCusker C, Abrams EM, Eiwegger T, Atkinson A, Kim V, Copaescu AM, Ben-Shoshan M. Assessing Pediatric Cephalosporin Allergic Reactions Through Direct Graded Oral Challenges. J Allergy Clin Immunol Pract 2024; 12:156-164.e4. [PMID: 37832819 DOI: 10.1016/j.jaip.2023.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Cephalosporins, β-lactam antibiotics, commonly cause allergic reactions. OBJECTIVE To assess the clinical characteristics and management of pediatric patients with suspected cephalosporin allergy using direct graded oral challenges (GOCs). METHODS Children referred for suspected cephalosporin allergy at 4 Canadian clinics were recruited over 10 years. Data on demographics, clinical reaction characteristics, and management were collected through a questionnaire. Patients underwent a direct GOC (initially 10% of the treatment dose, then 90% after 20 min), and reactions were monitored 1 week postchallenge. Families were contacted annually for up to 5 years to detect subsequent antibiotic reactions. Logistic regression analysis identified factors associated with positive GOC reactions. RESULTS Among the 136 patients reporting cephalosporin allergy, 75 (55.1%) were males with a median age of 3.9 years (interquartile range 2.3-8.7). Cefprozil represented the most common cephalosporin linked to the index reaction (67.6% of cases). Of the 136 direct GOCs, 5.1% had an immediate and 4.4% a nonimmediate reaction, respectively. Positive GOCs conducted in children with a history of skin-limited nonsevere rashes were classified as mild, benign skin rashes. Positive GOCs were more likely in children with food allergies (adjusted odds ratio 1.14; 95% confidence interval [95% CI] 1.00-1.29). CONCLUSIONS Direct GOCs are safe and effective for diagnosing pediatric cases that report nonvesicular skin-limited symptoms while being treated with cephalosporins.
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Affiliation(s)
- Carly Sillcox
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada
| | - Thomas Eiwegger
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria; Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria; Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Ont, Canada; Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont, Canada
| | - Adelle Atkinson
- Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada
| | - Vy Kim
- Division of Clinical Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada
| | - Ana-Maria Copaescu
- Division of Allergy and Clinical Immunology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Bavaro DF, Belati A, Bussini L, Cento V, Diella L, Gatti M, Saracino A, Pea F, Viale P, Bartoletti M. Safety and effectiveness of fifth generation cephalosporins for the treatment of methicillin-resistant staphylococcus aureus bloodstream infections: a narrative review exploring past, present, and future. Expert Opin Drug Saf 2024; 23:9-36. [PMID: 38145925 DOI: 10.1080/14740338.2023.2299377] [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: 07/27/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is a major issue in healthcare, since it is often associated with endocarditis or deep site foci. Relevant morbidity and mortality associated with MRSA-BSIs forced the development of new antibiotic strategies; in particular, this review will focus the attention on fifth-generation cephalosporins (ceftaroline/ceftobiprole), that are the only ß-lactams active against MRSA. AREAS COVERED The review discusses the available randomized controlled trials and real-world observational studies conducted on safety and effectiveness of ceftaroline/ceftobiprole for the treatment of MRSA-BSIs. Finally, a proposal of MRSA-BSI treatment flowchart, based on fifth-generation cephalosporins, is described. EXPERT OPINION The use of anti-MRSA cephalosporins is an acceptable choice either in monotherapy or combination therapy for the treatment of MRSA-BSIs due to their relevant effectiveness and safety. Particularly, their use may be advisable in combination therapy in case of severe infections (including endocarditis or persistent bacteriemia) or in monotherapy in subjects at higher risk of drugs-induced toxicity with older regimens. On the contrary, caution should be taken in case of suspected/ascertained central nervous system infections due to inconsistent data regarding penetration of these drugs in cerebrospinal fluid and brain tissues.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Belati
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Linda Bussini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valeria Cento
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Microbiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lucia Diella
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Norton AE, Koo G, Stone CA. Building the Evidence Base for Safe Direct Cephalosporin Challenges. J Allergy Clin Immunol Pract 2024; 12:165-167. [PMID: 38185495 DOI: 10.1016/j.jaip.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Allison E Norton
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn
| | - Grace Koo
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Cosby A Stone
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
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Torres A, Kuraieva A, Stone GG, Cillóniz C. Systematic review of ceftaroline fosamil in the management of patients with methicillin-resistant Staphylococcus aureus pneumonia. Eur Respir Rev 2023; 32:230117. [PMID: 37852658 PMCID: PMC10582922 DOI: 10.1183/16000617.0117-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for an array of problematic community- and healthcare-acquired infections, including pneumonia, and is frequently associated with severe disease and high mortality rates. Standard recommended treatments for empiric and targeted coverage of suspected MRSA in patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), are vancomycin and linezolid. However, adverse events such as acute kidney injury and Clostridium difficile infection have been associated with these antibiotics. Ceftaroline fosamil is a β-lactam/extended-spectrum cephalosporin approved for the treatment of adults and children with CAP and complicated skin and soft tissue infections. Ceftaroline has in vitro activity against a range of common Gram-positive bacteria and is distinct among the β-lactams in retaining activity against MRSA. Due to the design of the pivotal randomised controlled trials of ceftaroline fosamil, outcomes in patients with MRSA CAP were not evaluated. However, various reports of real-world outcomes with ceftaroline fosamil for pneumonia caused by MRSA, including CAP and HAP/VAP, been published since its approval. A systematic literature review and qualitative analysis of relevant publications was undertaken to collate and summarise relevant published data on the efficacy and safety of ceftaroline fosamil in patients with MRSA pneumonia. While relatively few real-world outcomes studies are available, the available data suggest that ceftaroline fosamil is a possible alternative to linezolid and vancomycin for MRSA pneumonia. Specific scenarios in which ceftaroline fosamil might be considered include bacteraemia and complicating factors such as empyema.
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Affiliation(s)
- Antoní Torres
- Dept of Pulmonology, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERES, Barcelona, Spain
| | | | | | - Catia Cillóniz
- Dept of Pulmonology, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERES, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
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Smith M, Foong KS. Cefiderocol-associated brown chromaturia. BMJ Case Rep 2023; 16:e258207. [PMID: 38103906 PMCID: PMC10728909 DOI: 10.1136/bcr-2023-258207] [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] [Indexed: 12/19/2023] Open
Abstract
Cefiderocol is a novel siderophore cephalosporin antibiotic. In the present case report, a woman in her 70s presented with a 1-week history of altered mental status and progressive purulent discharge from a non-healing diabetic foot ulcer on her right heel. MRI of the right foot revealed chronic osteomyelitis of the calcaneum. Surgical debridement was performed, and the tissue cultures grew extensively drug resistant (XDR) Pseudomonas aeruginosa, XDR Acinetobacter baumannii and Enterococcus faecalis The patient received ampicillin-sulbactam and cefiderocol. The antibiotic treatment course was complicated by brown urine discolouration. Investigations were unrevealing for haemoglobinuria, myoglobinuria and bilirubinuria. A side effect from cefiderocol was suspected and subsequently discontinued. Her urine colour returned to its normal colour within 3 days of discontinuation of cefiderocol.
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Fresán D, Luque S, Benítez-Cano A, Sorlí L, Montero MM, De-Antonio M, Vega V, Roberts JA, Horcajada JP, Grau S. Real-world experience of therapeutic drug monitoring and PK/PD achievement of ceftaroline administered by different infusion regimens in patients with confirmed infections caused by Gram-positive bacteria. J Antimicrob Chemother 2023; 78:2810-2815. [PMID: 37823445 DOI: 10.1093/jac/dkad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Ceftaroline is a novel cephalosporin active against MDR Gram-positive (GP) bacteria. For β-lactam antibiotics, such as ceftaroline, prolonged infusions and therapeutic drug monitoring (TDM) are used for dosage optimization based on their pharmacokinetics/pharmacodynamics (PK/PD). OBJECTIVES To describe our experience with TDM and PK/PD target attainment of ceftaroline administered by intermittent and prolonged infusion in a cohort of patients with MDR-GP bacterial infections. METHODS Patients treated with ceftaroline administered by continuous (24 h), extended (3 h/6 h) and intermittent infusion (1 h) and undergoing TDM of plasma concentrations were included. A 100%fT>4×MIC was the pre-specified PK/PD target and 100%fT>10×MIC was considered overexposure. Dose recommendations were made based on TDM results and each patient's clinical condition. RESULTS Twelve patients [83.3% male, median age of 73 (38-83) years] were included. Nine patients (75%) achieved 100%fT>4×MIC, all under prolonged infusions. In one patient, the 100%fT was >10×MIC but no toxicity was observed. Based on TDM results, initial doses were recommended to be maintained in eight patients, decreased in three and increased in one. CONCLUSIONS The administration of ceftaroline by prolonged infusion together with TDM may be a useful strategy for achieving the desired PK/PD target in these patients. However, more studies evaluating the relationship between PK/PD attainment and clinical outcomes are needed.
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Affiliation(s)
- Daniel Fresán
- Pharmacy Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sonia Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
| | - Adela Benítez-Cano
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Luisa Sorlí
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - María Milagro Montero
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta De-Antonio
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Victoria Vega
- Analytical Department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Juan P Horcajada
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
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Qian ET, Wang L, Stollings JL, Casey JD, Rice TW, Semler MW. Piperacillin-Tazobactam Versus Anti-Pseudomonal Cephalosporins and Renal and Neurologic Outcomes in Critically Ill Adults: A Secondary Analysis of the SMART Trial. J Intensive Care Med 2023; 38:1127-1135. [PMID: 37357717 PMCID: PMC10616997 DOI: 10.1177/08850666231184177] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/27/2023]
Abstract
Background: Prior studies suggest associations between receipt of piperacillin-tazobactam and development of acute kidney injury and receipt of anti-pseudomonal cephalosporins and neurotoxicity. We compared clinically-relevant renal and neurologic outcomes in critically ill patients who received piperacillin-tazobactam versus anti-pseudomonal cephalosporins. Methods: We conducted a secondary analysis of data from the Isotonic Solutions and Major Adverse Renal Events Trial examining patients who received piperacillin-tazobactam or an anti-pseudomonal cephalosporin within 24 h of intensive care unit admission. We performed multivariable analysis using a proportional odds model to examine the association between the first antibiotic received and the outcomes of Major Adverse Kidney Events within 30 days (MAKE30) and days alive and free of delirium and coma to day 28. Results: 3199 were included in the study; 2375 (74%) receiving piperacillin-tazobactam and 824 (26%) receiving anti-pseudomonal cephalosporin. After adjustment for prespecified confounders, initial receipt of piperacillin-tazobactam, compared to anti-pseudomonal cephalosporins, was not associated with higher incidence of MAKE30 (adjusted odds ratio, 1.03; 95% CI, 0.83-1.27; P = .80) but was associated with a greater number of days alive and free of delirium and coma (adjusted odds ratio, 1.18; 95% CI, 1.00-1.38; P = .04). In a sensitivity analysis adjusting for baseline receipt of medications which may impact neuro function, this finding was not significant. Conclusion: Among critically ill adults, receipt of piperacillin-tazobactam was not associated with an increased incidence of death, renal replacement therapy, or persistent renal dysfunction or a greater number of days alive and free of delirium and coma. Randomized trials are needed to inform the choice of antibiotics for empiric treatment infection in critically ill adults.
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Affiliation(s)
- Edward T. Qian
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joanna L. Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Medical Center, Critical Illness Brain Dysfunction Survivorship Center, Nashville, TN, USA
| | - Jonathan D. Casey
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W. Rice
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew W. Semler
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
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Hedin K, Thorning S, van Driel ML. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev 2023; 11:CD004406. [PMID: 37965935 PMCID: PMC10646936 DOI: 10.1002/14651858.cd004406.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. This is an update of a review first published in 2010, and updated in 2013, 2016, and 2021. OBJECTIVES To assess the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing clinical relapse (i.e. recurrence of symptoms after initial resolution); and (d) preventing complications (suppurative complications, acute rheumatic fever, post-streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk-benefit of antibiotic treatment for streptococcal pharyngitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2023, Issue 2), MEDLINE Ovid, Embase Elsevier, and Web of Science (Clarivate) up to 19 March 2023. SELECTION CRITERIA Randomised, double-blind trials comparing different antibiotics, and reporting at least one of the following: clinical cure, clinical relapse, or complications and/or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened trials for inclusion and extracted data using standard methodological procedures recommended by Cochrane. We assessed the risk of bias in the included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions, and used the GRADE approach to assess the overall certainty of the evidence for the outcomes. We reported the intention-to-treat analysis, and also performed an analysis of evaluable participants to explore the robustness of the intention-to-treat results. MAIN RESULTS We included 19 trials reported in 18 publications (5839 randomised participants): six trials compared penicillin with cephalosporins; six compared penicillin with macrolides; three compared penicillin with carbacephem; one compared penicillin with sulphonamides; one compared clindamycin with ampicillin; and one compared azithromycin with amoxicillin in children. All participants had confirmed acute GABHS tonsillopharyngitis, and ages ranged from one month to 80 years. Nine trials included only, or predominantly, children. Most trials were conducted in an outpatient setting. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. We downgraded the certainty of the evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both, heterogeneity, and wide confidence intervals. Cephalosporins versus penicillin We are uncertain if there is a difference in symptom resolution (at 2 to 15 days) for cephalosporins versus penicillin (odds ratio (OR) for absence of symptom resolution 0.79, 95% confidence interval (CI) 0.55 to 1.12; 5 trials, 2018 participants; low-certainty evidence). Results of the sensitivity analysis of evaluable participants differed (OR 0.51, 95% CI 0.27 to 0.97; 5 trials, 1660 participants; very low-certainty evidence). Based on an analysis of evaluable participants, we are uncertain if clinical relapse may be lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; number needed to treat for an additional beneficial outcome (NNTB) 50; 4 trials, 1386 participants; low-certainty evidence). Very low-certainty evidence showed no difference in reported adverse events. Macrolides versus penicillin We are uncertain if there is a difference between macrolides and penicillin for resolution of symptoms (OR 1.11, 95% CI 0.92 to 1.35; 6 trials, 1728 participants; low-certainty evidence). Sensitivity analysis of evaluable participants resulted in an OR of 0.79 (95% CI 0.57 to 1.09; 6 trials, 1159 participants). We are uncertain if clinical relapse may be different (OR 1.21, 95% CI 0.48 to 3.03; 6 trials, 802 participants; low-certainty evidence). Children treated with macrolides seemed to experience more adverse events than those treated with penicillin (OR 2.33, 95% CI 1.06 to 5.15; 1 trial, 489 participants; low-certainty evidence). However, the test for subgroup differences between children and adults was not significant. Azithromycin versus amoxicillin Based on one unpublished trial in children, we are uncertain if resolution of symptoms is better with azithromycin in a single dose versus amoxicillin for 10 days (OR 0.76, 95% CI 0.55 to 1.05; 1 trial, 673 participants; very low-certainty evidence). Sensitivity analysis for per-protocol analysis resulted in an OR of 0.29 (95% CI 0.11 to 0.73; 1 trial, 482 participants; very low-certainty evidence). We are also uncertain if there was a difference in relapse between groups (OR 0.88, 95% CI 0.43 to 1.82; 1 trial, 422 participants; very low-certainty evidence). Adverse events were more common with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; 1 trial, 673 participants; very low-certainty evidence). Carbacephem versus penicillin There is low-certainty evidence that compared with penicillin, carbacephem may provide better symptom resolution post-treatment in adults and children (OR 0.70, 95% CI 0.49 to 0.99; NNTB 14.3; 3 trials, 795 participants). Studies did not report on long-term complications, so it was unclear if any class of antibiotics was better at preventing serious but rare complications. AUTHORS' CONCLUSIONS We are uncertain if there are clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Low-certainty evidence in children suggests that carbacephem may be more effective than penicillin for symptom resolution. There is insufficient evidence to draw conclusions regarding the other comparisons in this review. Data on complications were too scarce to draw conclusions. Antibiotics have a limited effect in the treatment of GABHS pharyngitis and the results do not demonstrate that other antibiotics are more effective than penicillin. In the context of antimicrobial stewardship, penicillin can be used if treatment with an antibiotic is indicated. All studies were conducted in high-income countries with a low risk of streptococcal complications, so there is a need for trials in low-income countries and disadvantaged populations, where the risk of complications remains high.
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Affiliation(s)
- Katarina Hedin
- Futurum - the Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Sarah Thorning
- Education and Research Unit, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Mkhoyan A, Hashmi MF, Khan F, Gyulazyan N, Asoyan V, Nersisyan V. Stevens-Johnson syndrome: a case report of possible cephalosporin-induced cutaneous adverse reaction. J Infect Dev Ctries 2023; 17:1493-1496. [PMID: 37956371 DOI: 10.3855/jidc.18301] [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: 04/02/2023] [Accepted: 06/07/2023] [Indexed: 11/15/2023] Open
Abstract
A severe medical condition known as Stevens-Johnson syndrome (SJS) is marked by a cutaneous and mucosal reaction from the use of specific medications. The prodromal illness is followed by severe mucocutaneous symptoms in this immune-mediated disease. We describe the clinical history of a 55-year-old Caucasian woman who was exposed to cephalosporins. In resource-constrained countries and hospitals where cutaneous biopsy is not readily available, it is not easy to diagnose Steven Johnson Syndrome. This is particularly true in countries where the incidence of infectious diseases such as scarlet fever and measles is high and the early symptoms of SJS can be mistaken for these conditions. We used the Naronjo scale to confirm the probable association of the drug with the syndrome. Physicians while writing prescriptions for their patients need to warn them of potential side effects and they should keep in mind conditions like Stevens-Johnson syndrome. This case report highlights the need for improved knowledge and understanding of SJS among healthcare practitioners in resource-limited communities where the prevalence of infectious diseases is high.
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Affiliation(s)
- Anna Mkhoyan
- Department of Infectious Diseases, Yerevan State Medical University, Yerevan, Armenia
| | | | - Fiza Khan
- General Medicine, Yerevan State Medical University, Yerevan, Armenia
| | - Naira Gyulazyan
- Department of Infectious Diseases, Yerevan State Medical University, Yerevan, Armenia
| | - Vigen Asoyan
- Department of Infectious Diseases, Yerevan State Medical University, Yerevan, Armenia
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Holland TL, Cosgrove SE, Doernberg SB, Jenkins TC, Turner NA, Boucher HW, Pavlov O, Titov I, Kosulnykov S, Atanasov B, Poromanski I, Makhviladze M, Anderzhanova A, Stryjewski ME, Assadi Gehr M, Engelhardt M, Hamed K, Ionescu D, Jones M, Saulay M, Smart J, Seifert H, Fowler VG. Ceftobiprole for Treatment of Complicated Staphylococcus aureus Bacteremia. N Engl J Med 2023; 389:1390-1401. [PMID: 37754204 DOI: 10.1056/nejmoa2300220] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Ceftobiprole is a cephalosporin that may be effective for treating complicated Staphylococcus aureus bacteremia, including methicillin-resistant S. aureus. METHODS In this phase 3, double-blind, double-dummy, noninferiority trial, adults with complicated S. aureus bacteremia were randomly assigned in a 1:1 ratio to receive ceftobiprole at a dose of 500 mg intravenously every 6 hours for 8 days and every 8 hours thereafter, or daptomycin at a dose of 6 to 10 mg per kilogram of body weight intravenously every 24 hours plus optional aztreonam (at the discretion of the trial-site investigators). The primary outcome, overall treatment success 70 days after randomization (defined as survival, bacteremia clearance, symptom improvement, no new S. aureus bacteremia-related complications, and no receipt of other potentially effective antibiotics), with a noninferiority margin of 15%, was adjudicated by a data review committee whose members were unaware of the trial-group assignments. Safety was also assessed. RESULTS Of 390 patients who underwent randomization, 387 (189 in the ceftobiprole group and 198 in the daptomycin group) had confirmed S. aureus bacteremia and received ceftobiprole or daptomycin (modified intention-to-treat population). A total of 132 of 189 patients (69.8%) in the ceftobiprole group and 136 of 198 patients (68.7%) in the daptomycin group had overall treatment success (adjusted difference, 2.0 percentage points; 95% confidence interval [CI], -7.1 to 11.1). Findings appeared to be consistent between the ceftobiprole and daptomycin groups in key subgroups and with respect to secondary outcomes, including mortality (9.0% and 9.1%, respectively; 95% CI, -6.2 to 5.2) and the percentage of patients with microbiologic eradication (82.0% and 77.3%; 95% CI, -2.9 to 13.0). Adverse events were reported in 121 of 191 patients (63.4%) who received ceftobiprole and 117 of 198 patients (59.1%) who received daptomycin; serious adverse events were reported in 36 patients (18.8%) and 45 patients (22.7%), respectively. Gastrointestinal adverse events (primarily mild nausea) were more frequent with ceftobiprole. CONCLUSIONS Ceftobiprole was noninferior to daptomycin with respect to overall treatment success in patients with complicated S. aureus bacteremia. (Funded by Basilea Pharmaceutica International and the U.S. Department of Health and Human Services; ERADICATE ClinicalTrials.gov number, NCT03138733.).
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Affiliation(s)
- Thomas L Holland
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sara E Cosgrove
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Sarah B Doernberg
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Timothy C Jenkins
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Nicholas A Turner
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Helen W Boucher
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Oleksander Pavlov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Titov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Serhii Kosulnykov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Boyko Atanasov
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Ivan Poromanski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Manana Makhviladze
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Anastasia Anderzhanova
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Martin E Stryjewski
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Maziar Assadi Gehr
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Marc Engelhardt
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Kamal Hamed
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Daniel Ionescu
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mark Jones
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Mikael Saulay
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Jennifer Smart
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Harald Seifert
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
| | - Vance G Fowler
- From the Division of Infectious Diseases, Duke University (T.L.H., N.A.T., V.G.F.), and Duke Clinical Research Institute (T.L.H., V.G.F.) - both in Durham, NC; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (S.E.C.); the Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco (S.B.D.); the Division of Infectious Diseases, Department of Medicine, Denver Health, Denver (T.C.J.); Tufts Medicine and Tufts University School of Medicine, Boston (H.W.B.); Zaycev V.T. Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine, Kharkiv (O.P.), Regional Clinical Hospital, Ivano-Frankivsk Regional Council, Ivano-Frankivsk (I.T.), and Dnipropetrovsk I.I. Mechnikov Regional Clinical Hospital, Dnipro (S.K.) - all in Ukraine; Eurohospital Plovdiv, Plovdiv (B.A.), and University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov," Clinic of Purulent-Septic Surgery, Sofia (I.P.) - both in Bulgaria; LTD Academician Vakhtang Bochorishvili Clinic, Tbilisi, Georgia (M.M.); N.I. Pirogov City Clinical Hospital No. 1, Moscow (A.A.); the Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires (M.E.S.); Basilea Pharmaceutica International, Allschwil, Switzerland (M.A.G., M.E., K.H., D.I., M.J., M.S., J.S.); and the Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, and the German Center for Infection Research, Partner Site Bonn-Cologne - both in Cologne, Germany (H.S.)
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Belmont AP, Su C, Kwah J. Cephalosporins can be safely administered to patients with verified penicillin allergy. J Allergy Clin Immunol Pract 2023; 11:2933-2935.e2. [PMID: 37245737 DOI: 10.1016/j.jaip.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Ami P Belmont
- Section of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Chang Su
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Jason Kwah
- Section of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
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Brown JP, Wing K, Leyrat C, Evans SJ, Mansfield KE, Wong AYS, Smeeth L, Galwey NW, Douglas IJ. Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection. JAMA Cardiol 2023; 8:865-870. [PMID: 37585175 PMCID: PMC10433140 DOI: 10.1001/jamacardio.2023.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/16/2023] [Indexed: 08/17/2023]
Abstract
Importance Fluoroquinolone use has been associated with increased hospitalization with aortic aneurysm or dissection in noninterventional studies, but the reason for this observed association is unclear. Objective To determine the association between fluoroquinolone use and aortic aneurysm or dissection using multiple study designs and multiple databases to increase the robustness of findings. Design, Setting, and Participants Cohort and case-crossover studies were conducted separately in 2 databases of UK primary care records. Clinical Practice Research Datalink Aurum and GOLD primary care records were linked to hospital admissions data. Adults with a systemic fluoroquinolone or cephalosporin prescription between April 1997 and December 2019 were included in the cohort study. Adults hospitalized with aortic aneurysm or dissection within the eligibility period were included in the case-crossover study. Individuals meeting inclusion criteria in the case-crossover study were matched 1:3 to control individuals on age, sex, index date, and clinical practice to adjust for calendar trends in prescribing. Data were analyzed from January to July 2022. Exposures Systemic fluoroquinolone or comparator antibiotic. Main Outcomes and Measures Hazard ratios (HRs) were estimated in the cohort study for the association between prescription of fluoroquinolones and hospitalization with aortic aneurysm or dissection using stabilized inverse probability of treatment-weighted Cox regression. Odds ratios (OR) were estimated in the case-crossover study for the association between systemic fluoroquinolone use and hospitalization with aortic aneurysm or dissection using a conditional logistic regression model. Estimates were pooled across databases using fixed-effects meta-analysis. Results In the cohort study, we identified 3 134 121 adults in Aurum (mean [SD] age, 52.5 [20.3] years; 1 969 257 [62.8%] female) and 452 086 in GOLD (mean [SD] age, 53.9 [20.2] years; 286 502 [63.4%] female) who were prescribed fluoroquinolones or cephalosporins. In crude analyses, fluoroquinolone relative to cephalosporin use was associated with increased hospitalization with aortic aneurysm or dissection (pooled HR, 1.28; 95% CI, 1.13-1.44; P < .001) but after adjustment for potential confounders, this association disappeared (pooled adjusted HR, 1.03; 95% CI, 0.91-1.17; P = .65). In the case-crossover study, we identified 84 841 individuals hospitalized with aortic aneurysm or dissection in Aurum (mean [SD] age, 75.5 [10.9]; 23 551 [27.8%] female) and 10 357 in GOLD (mean [SD] age, 75.6 [10.5]; 2809 [27.1%] female). Relative to nonuse, fluoroquinolone use was associated with an increase in hospitalization with aortic aneurysm or dissection, but no association was found relative to other antibiotics (vs cephalosporin pooled OR, 1.05; 95% CI, 0.87-1.27; vs trimethoprim, 0.89; 95% CI, 0.75-1.06; vs co-amoxiclav, 0.98; 95% CI, 0.82-1.18). Conclusions and Relevance The results in this study suggest that estimates of association of fluoroquinolones with aortic aneurysm or dissection may be affected by confounding. When such confounding is accounted for, no association was evident, providing reassurance on the safety of fluoroquinolones with respect to aortic aneurysm or dissection.
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Affiliation(s)
- Jeremy P. Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clémence Leyrat
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen J. Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E. Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Y. S. Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas W. Galwey
- Research and Development, GSK Medicines Research Centre, GSK, Stevenage, United Kingdom
| | - Ian J. Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Garnier AS, Drablier G, Briet M, Augusto JF. Nephrotoxicity of Amoxicillin and Third-Generation Cephalosporins: An Updated Review. Drug Saf 2023; 46:715-724. [PMID: 37310614 DOI: 10.1007/s40264-023-01316-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/14/2023]
Abstract
Because of their broad-spectrum bactericidal activity, amoxicillin (AMX) and third-generation cephalosporins (TGC) are widely used for the prophylaxis and treatment of established infections. They are considered relatively safe, but several recent reports have suggested substantial nephrotoxicity, especially with AMX use. Considering the importance of AMX and TGC for clinical practice, we conducted this up-to-date review, using the PubMed database, which focuses specifically on the nephrotoxicity of these molecules. We also briefly review the pharmacology of AMX and TGC. Nephrotoxicity of AMX may be driven by several pathophysiological mechanisms, such as a type IV hypersensitivity reaction, anaphylaxis, or intratubular and/or urinary tract drug precipitation. In this review, we focused on the two main renal adverse effects of AMX, namely acute interstitial nephritis and crystal nephropathy. We summarize the current knowledge in terms of incidence, pathogenesis, factors, clinical features, and diagnosis. The purpose of this review is also to underline the probable underestimation of AMX nephrotoxicity and to educate clinicians about the recent increased incidence and severe renal prognosis associated with crystal nephropathy. We also suggest some key elements on the management of these complications to avoid inappropriate use and to limit the risk of nephrotoxicity. While renal injury appears to be rarer with TGC, several patterns of nephrotoxicity have been reported in the literature, such as nephrolithiasis, immune-mediated hemolytic anemia, or acute interstitial nephropathy, which we detail in the second part of this review.
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Affiliation(s)
- Anne-Sophie Garnier
- Service de Néphrologie-Dialyse-Transplantation, Centre Hospitalo-Universitaire d'Angers, Université Angers, 4 rue Larrey, 49933, Angers, France.
- LUNAM Université, Angers, France.
| | - Guillaume Drablier
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Centre Hospitalo-Universitaire d'Angers, Université Angers, 4 rue Larrey, 49933, Angers, France
- LUNAM Université, Angers, France
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Otani IM, Tang M, Wang L, Anstey KM, Hilts-Horeczko A, Li F, Le VP, Lee M, Bystritsky R, Mulliken JS, Wattier RL, Blumenthal KG, Doernberg SB. Impact of an Inpatient Allergy Guideline on β-Lactam and Alternative Antibiotic Use. J Allergy Clin Immunol Pract 2023; 11:2557-2567.e6. [PMID: 37182569 DOI: 10.1016/j.jaip.2023.04.051] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system. OBJECTIVE To report outcomes of implementing a similar guideline and electronic order set (OS) at an independent academic health care system. METHODS Penicillin/cephalosporin receipt (percentage of inpatients receiving full doses) and alternative antibiotic use (days of therapy per 1000 patient-days [DOT/1000PD]) were compared over 3 periods before (February 1, 2017, to January 31, 2018) and after guideline implementation (February 1, 2018, to January 31, 2019), and after OS implementation (February 1, 2019, to January 31, 2020) among inpatients with PCAAL admitted on medical services with access to guideline/OS and education (Medical-PCAAL, n = 8721), surgical services with access to guideline/OS without education (Surgical-PCAAL, n = 5069), and obstetrics/gynecology services without interventions (Ob/Gyn-PCAAL, n = 798) and inpatients without PCAAL admitted on the same services (Medical-No-PCAAL, n = 50,840; Surgical-No-PCAAL, n = 29,845; Ob/Gyn-No-PCAAL, n = 6109). χ2 tests were used to compare categorical variables, and analysis of variance was used to compare continuous and interrupted time series analyses (ITSA) to investigate the guideline/OS implementation effect on penicillin/cephalosporin receipt. RESULTS In the Medical-PCAAL group, penicillin/cephalosporin receipt increased (58%-68%, P < .001), specifically for cefazolin (8%-11%, P = .02) and third- to fifth-generation cephalosporins (43%-48%, P = .04), and aztreonam use decreased (12 DOT/1000PD, P = .03). In the Medical-No-PCAAL group, penicillin/cephalosporin receipt increased (88%-90%, P = .004), specifically for penicillin (40%-44%, P < .001), without changes in aztreonam use. Significant changes were not observed in these outcomes on surgical or obstetrics/gynecology services. Per ITSA, guideline/OS implementation was associated with increased penicillin/cephalosporin receipt in the Medical-PCAAL group only. CONCLUSION Guideline and OS implementation was associated with improved antibiotic stewardship on inpatient services that also received allergy education.
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Affiliation(s)
- Iris M Otani
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif.
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Lusha Wang
- Department of Quality-Hospital Epidemiology and Infection Prevention, University of California San Francisco, San Francisco, Calif
| | - Karen M Anstey
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Ore
| | - Alexandra Hilts-Horeczko
- Department of Pharmaceutical Services, University of California San Francisco, San Francisco, Calif
| | - Fanny Li
- Department of Pharmaceutical Services, University of California San Francisco, San Francisco, Calif
| | - Vincent P Le
- Health Clinical Systems, University of California San Francisco, San Francisco, Calif
| | - Melissa Lee
- The Center for Nursing Excellence and Innovation, University of California San Francisco, San Francisco, Calif
| | - Rachel Bystritsky
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, Calif
| | - Jennifer S Mulliken
- Infectious Disease Section, Medical Service, San Francisco Veterans' Affairs Medical Center, San Francisco, Calif
| | - Rachel L Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California San Francisco, San Francisco, Calif
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, Calif
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Bassetti M, Vena A, Giacobbe DR. The safety of ceftolozane/tazobactam for the treatment of complicated urinary tract infections. Expert Opin Drug Saf 2023; 22:533-540. [PMID: 37394943 DOI: 10.1080/14740338.2023.2227085] [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: 03/22/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Ceftolozane is a cephalosporin similar to ceftazidime in its structure, which is marketed in combination with tazobactam, a well-known β-lactamase inhibitor. AREAS COVERED After a brief introduction on the drug characteristics and efficacy, we focused on available data from randomized controlled trials and post-marketing observational studies pertaining to the safety of ceftolozane/tazobactam (C/T) for the treatment of complicated urinary tract infections (cUTI). A search was conducted in PubMed from January 2010 to February 2023. EXPERT OPINION The use of C/T for the treatment of cUTI is supported by solid efficacy and safety data, especially for the treatment of those pathogens where it can represent a first-line approach due to some peculiar characteristics: (i) treatment of cUTI caused by multidrug-resistant Pseudomonas aeruginosa, in view of its frequent activity against carbapenem-resistant isolates when resistance mechanisms other than production of carbapenemases are concerned; (ii) treatment of cUTI caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in those settings where the selective pressure for carbapenem resistance needs to be relieved, as a suitable and effective carbapenem-sparing option. Although development of resistance to C/T during or after treatment has been reported, this has been reported very rarely in patients receiving C/T for the treatment of cUTI.
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Affiliation(s)
- Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Jackson CCA, Newland J, Dementieva N, Lonchar J, Su FH, Huntington JA, Bensaci M, Popejoy MW, Johnson MG, De Anda C, Rhee EG, Bruno CJ. Safety and Efficacy of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem From a Phase 2, Randomized Clinical Trial in Pediatric Participants With Complicated Intra-abdominal Infection. Pediatr Infect Dis J 2023; 42:557-563. [PMID: 37000942 PMCID: PMC10259210 DOI: 10.1097/inf.0000000000003911] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ceftolozane/tazobactam, a cephalosporin-β-lactamase inhibitor combination, is approved for the treatment of complicated urinary tract infections and complicated intra-abdominal infections (cIAI). The safety and efficacy of ceftolozane/tazobactam in pediatric participants with cIAI were assessed. METHODS This phase 2 study (NCT03217136) randomized participants to either ceftolozane/tazobactam+metronidazole or meropenem for treatment of cIAI in pediatric participants (<18 years). The primary objective was to assess the safety and tolerability of intravenous ceftolozane/tazobactam+metronidazole. Clinical cure at end of treatment (EOT) and test of cure (TOC) visits were secondary end points. RESULTS The modified intent-to-treat (MITT) population included 91 participants (ceftolozane/tazobactam+metronidazole, n = 70; meropenem, n = 21). Complicated appendicitis was the most common diagnosis (93.4%); Escherichia coli was the most common pathogen (65.9%). Adverse events (AEs) occurred in 80.0% and 61.9% of participants receiving ceftolozane/tazobactam+metronidazole and meropenem, drug-related AEs occurred in 18.6% and 14.3% and serious AEs occurred in 11.4% and 0% of participants receiving ceftolozane/tazobactam+metronidazole and meropenem, respectively. No drug-related serious AEs or discontinuations due to drug-related AEs occurred. Rates of the clinical cure for ceftolozane/tazobactam+metronidazole and meropenem at EOT were 80.0% and 95.2% (difference: -14.3; 95% confidence interval: -26.67 to 4.93) and at TOC were 80.0% and 100.0% (difference: -19.1; 95% confidence interval: -30.18 to -2.89), respectively; 6 of the 14 clinical failures for ceftolozane/tazobactam+metronidazole at TOC were indeterminate responses imputed as failures per protocol. CONCLUSION Ceftolozane/tazobactam+metronidazole was well tolerated in pediatric participants with cIAI and had a safety profile similar to the established safety profile in adults. In this descriptive efficacy analysis, ceftolozane/tazobactam+metronidazole appeared efficacious.
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Affiliation(s)
| | - Jason Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Nataliia Dementieva
- Department of Pediatric Surgery, Dnipropetrovsk Regional Children’s Clinical Hospital, Dnipro, Ukraine
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22
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Roilides E, Ashouri N, Bradley JS, Johnson MG, Lonchar J, Su FH, Huntington JA, Popejoy MW, Bensaci M, De Anda C, Rhee EG, Bruno CJ. Safety and Efficacy of Ceftolozane/Tazobactam Versus Meropenem in Neonates and Children With Complicated Urinary Tract Infection, Including Pyelonephritis: A Phase 2, Randomized Clinical Trial. Pediatr Infect Dis J 2023; 42:292-298. [PMID: 36689671 PMCID: PMC9990597 DOI: 10.1097/inf.0000000000003832] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ceftolozane/tazobactam, a cephalosporin-β-lactamase inhibitor combination, active against multidrug-resistant Gram-negative pathogens, is approved for treatment of adults with complicated urinary tract infections (cUTI). Safety and efficacy of ceftolozane/tazobactam in pediatric participants with cUTI, including pyelonephritis, were assessed. METHODS This phase 2 study (NCT03230838) compared ceftolozane/tazobactam with meropenem for treatment of cUTI in participants from birth to <18 years of age. The primary objective was safety and tolerability. Key secondary end points included clinical cure and per-participant microbiologic response rates at end of treatment (EOT) and test of cure (TOC) visits. RESULTS The microbiologic modified intent-to-treat (mMITT) population included 95 participants (ceftolozane/tazobactam, n = 71; meropenem, n = 24). The most common diagnosis and pathogen were pyelonephritis (ceftolozane/tazobactam, 84.5%; meropenem, 79.2%) and Escherichia coli (ceftolozane/tazobactam, 74.6%; meropenem, 87.5%); 5.7% (ceftolozane/tazobactam) and 4.8% (meropenem) of E. coli isolates were extended-spectrum β-lactamase-producers. Rates of adverse events were similar between treatment groups (any: ceftolozane/tazobactam, 59.0% vs. meropenem, 60.6%; drug-related: ceftolozane/tazobactam, 14.0% vs. meropenem, 15.2%; serious: ceftolozane/tazobactam, 3.0% vs. meropenem, 6.1%). Rates of clinical cure for ceftolozane/tazobactam and meropenem at EOT were 94.4% and 100% and at TOC were 88.7% and 95.8%, respectively. Rates of microbiologic eradication for ceftolozane/tazobactam and meropenem at EOT were 93.0% and 95.8%, and at TOC were 84.5% and 87.5%, respectively. CONCLUSIONS Ceftolozane/tazobactam had a favorable safety profile in pediatric participants with cUTI; rates of clinical cure and microbiologic eradication were high and similar to meropenem. Ceftolozane/tazobactam is a safe and effective new treatment option for children with cUTI, especially due to antibacterial-resistant Gram-negative pathogens.
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Affiliation(s)
- Emmanuel Roilides
- From the Third Department of Pediatrics, Infectious Diseases Unit, School of Medicine, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Negar Ashouri
- Division of Infectious Diseases, CHOC Children’s Hospital, Orange, California
| | - John S. Bradley
- Department of Pediatrics, University of California San Diego School of Medicine and Rady Children’s Hospital of San Diego, San Diego, California
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23
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Tanır Basaranoğlu S, Karaaslan A, Salı E, Çiftçi E, Gayretli Aydın ZG, Aldemir Kocabaş B, Kaya C, Şen Bayturan S, Kara SS, Yılmaz Çiftdoğan D, Çay Ü, Gundogdu Aktürk H, Çelik M, Ozdemir H, Somer A, Diri T, Yazar AS, Sütçü M, Tezer H, Karadag Oncel E, Kara M, Çelebi S, Özkaya Parlakay A, Karakaşlılar S, Arısoy ES, Tanır G, Tural Kara T, Devrim İ, Erat T, Aykaç K, Kaba Ö, Güven Ş, Yeşil E, Tekin Yılmaz A, Yaşar Durmuş S, Çağlar İ, Günay F, Özen M, Dinleyici EÇ, Kara A. Antibiotic associated diarrhea in outpatient pediatric antibiotic therapy. BMC Pediatr 2023; 23:121. [PMID: 36932373 PMCID: PMC10024443 DOI: 10.1186/s12887-023-03939-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/02/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. METHODS The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. RESULTS A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. CONCLUSION This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region.
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Affiliation(s)
- Sevgen Tanır Basaranoğlu
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Ayşe Karaaslan
- Department of Pediatric Infectious Diseases, Istanbul Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Enes Salı
- Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | | | - Bilge Aldemir Kocabaş
- Department of Pediatric Infectious Diseases, Antalya Akdeniz University, Antalya, Turkey
| | - Cemil Kaya
- Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Semra Şen Bayturan
- Department of Pediatric Infectious Diseases, Manisa Celal Bayar University, Manisa, Turkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Department of Pediatric Infectious Diseases, Saglik Bilimleri University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ümmühan Çay
- Department of Pediatric Infectious Diseases, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Hacer Gundogdu Aktürk
- Department of Pediatric Infectious Diseases, Istanbul Zeynep Kamil Women and Children Training and Research Hospital, Istanbul, Turkey
| | - Melda Çelik
- Department of Pediatric Infectious Diseases, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Tijen Diri
- Department of Pediatrics, Istanbul Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Sütçü
- Department of Pediatric Infectious Diseases, Konya Training and Research Hospital, Konya, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Ankara Gazi University, Ankara, Turkey
| | - Eda Karadag Oncel
- Department of Pediatric Infectious Diseases, Saglik Bilimleri University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Manolya Kara
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Solmaz Çelebi
- Department of Pediatric Infectious Diseases, Bursa Uludag University, Bursa, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Emin Sami Arısoy
- Department of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
| | - Gönül Tanır
- Department of Pediatric Infectious Diseases, Ankara Doktor Sami Ulus Women and Children Training and Research Hospital, Ankara, Turkey
| | - Tuğçe Tural Kara
- Department of Pediatric Infectious Diseases, Hatay State Hospital, Hatay, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, Izmir Doktor Behcet Uz Children's Hospital, İzmir, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Kübra Aykaç
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Özge Kaba
- Department of Pediatric Infectious Diseases, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Şirin Güven
- Department of Pediatrics, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Edanur Yeşil
- Department of Pediatric Infectious Diseases, Bursa Uludag University, Bursa, Turkey
| | - Ayşe Tekin Yılmaz
- Department of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
| | - Sevgi Yaşar Durmuş
- Department of Pediatric Infectious Diseases, Ankara Doktor Sami Ulus Women and Children Training and Research Hospital, Ankara, Turkey
| | - İlknur Çağlar
- Department of Pediatric Infectious Diseases, Izmir Doktor Behcet Uz Children's Hospital, İzmir, Turkey
| | - Fatih Günay
- Department of Pediatrics, Ankara University, Ankara, Turkey
| | - Metehan Özen
- Department of Pediatric Infectious Diseases, Istanbul Acıbadem Atakent Hospital, Istanbul, Turkey
| | | | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey.
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Mehringer L, Seybold U, Zoller M. [What is new … cefiderocol]. Anaesthesiologie 2023; 72:189-190. [PMID: 36820866 DOI: 10.1007/s00101-023-01252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Laurenz Mehringer
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Ulrich Seybold
- Medizinische Klinik und Poliklinik IV, Sektion Klinische Infektiologie, LMU Klinikum Innenstadt, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - Michael Zoller
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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25
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Witzke O, Brenner T. [Clinical experience using cefiderocol]. Med Klin Intensivmed Notfmed 2023; 118:149-155. [PMID: 35913604 PMCID: PMC9341408 DOI: 10.1007/s00063-022-00925-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infections due to antibiotic-resistant bacteria are threatening modern healthcare, and antibacterial resistance has become one of the greatest threats to public health. In Germany 54,500 patients become infected with antibiotic-resistant bacteria per year, causing about 2400 attributable deaths. Rising resistance in Gram-negative bacteria especially carbapenem-resistant pathogens is of particular concern due to the lack of effective and safe alternative treatment options. OBJECTIVE The results from trials and compassionate-use programs with the new antibiotic cefiderocol, which was approved by the European Medicines Agency (EMA) in April 2020 for the treatment of adults with infections caused by aerobic Gram-negative bacteria, are summarized. RESULTS The new β‑lactam antibiotic cefiderocol is the first siderophore cephalosporin indicated for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. Its chemical structure and its unique mechanism of action confer enhanced stability against β‑lactamases including all classes of clinically relevant carbapenemases. In vitro data show high antibacterial activity against multidrug resistant Gram-negative bacteria, Enterobacterales and nonfermenters, including carbapenem-resistant strains. In clinical trials, cefiderocol showed superiority in complicated urinary tract infection in comparison to imipenem and non-inferiority versus meropenem in hospital-acquired/ventilator-associated pneumonia patients and severe infections caused by carbapenem-resistant pathogens. CONCLUSION Clinical trial data and case reports identified in the literature search show that cefiderocol is a promising treatment option for severe infections caused by drug-resistant Gram-negative bacteria, particularly carbapenem-resistant bacteria.
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Affiliation(s)
- Oliver Witzke
- Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
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26
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Kufel WD, Parsels KA, Blaine BE, Steele JM, Mahapatra R, Paolino KM, Thomas SJ. Vancomycin plus ceftaroline for persistent methicillin-resistant Staphylococcus aureus bacteremia. Pharmacotherapy 2023; 43:15-23. [PMID: 36371648 DOI: 10.1002/phar.2741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/17/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE The preferred antibiotic salvage regimen for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is unclear. We sought to evaluate the effectiveness and safety of vancomycin plus ceftaroline for persistent MRSAB. The primary outcome was time to MRSAB clearance post-ceftaroline initiation. Secondary outcomes included microbiological cure, hospital length of stay, 90-day readmission for MRSAB, 90-day all-cause mortality, MRSAB-related mortality, and incidence of antibiotic-associated adverse effects. DESIGN Single-center, retrospective cohort study between January 1, 2016, and December 31, 2021. SETTING State University of New York Upstate University Hospital, a 748-bed tertiary care, academic medical center in Syracuse, NY. PATIENTS Adult patients were included if they had blood cultures positive for MRSA ≥72 h, received vancomycin monotherapy initially, and received vancomycin plus ceftaroline for ≥24 h. Patients were excluded if they received other anti-MRSA antibiotics, were pregnant, or were incarcerated. Of the 178 patients identified, 30 unique patients were evaluated. MEASUREMENTS AND MAIN RESULTS Patients were medically complex with a median Pitt bacteremia score of 3, 63.3% (19/30) were admitted to the intensive care unit, and 66.7% (20/30) had infective endocarditis. Vancomycin-associated acute kidney injury was observed in 10% (3/30) of patients, which resulted in dose adjustments. No patients experienced ceftaroline-associated neutropenia or Clostridioides difficile infection, but 6.7% (2/30) developed a rash attributed to ceftaroline. Median time to MRSAB clearance post-ceftaroline initiation was 2.6 days. Microbiologic cure occurred in nearly all patients 96.7% (29/30). Median hospital length of stay was 19.5 days, and 6.7% (2/30) of patients had 90-day readmission for MRSAB. 90-day all-cause mortality and MRSAB-related mortality occurred in 26.7% (8/30) and 13.3% (4/30) of patients, respectively. CONCLUSIONS Vancomycin plus ceftaroline may represent an effective and well-tolerated salvage regimen option for persistent MRSAB.
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Affiliation(s)
- Wesley D Kufel
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Katie A Parsels
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | | | - Jeffrey M Steele
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Rahul Mahapatra
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Kristopher M Paolino
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Stephen J Thomas
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
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27
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Öztürk B, Göktuğ A, Bodur İ, Tekeli A, Tuygun N, Karacan CD. Bloody Stool: Is It Really Scary in Kids? Four Benign Cases. Arch Iran Med 2022; 25:841-843. [PMID: 37543912 PMCID: PMC10685848 DOI: 10.34172/aim.2022.130] [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] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 08/08/2023]
Abstract
Cefdinir is a third-generation oral cephalosporin used frequently in the pediatric population. The most common side effects of cefdinir are diarrhea, nausea and dyspepsia. The side effect of turning the stool color to red and giving a bloody appearance, which is alarming for both families and physicians, is very rare. In this case report, we discussed 4 cases who referred to the emergency department with bloody stool due to the use of cefdinir. The important conclusion to be drawn from this case report is to know the rare side effects of commonly used drugs such as cefdinir. This will save time and resources and prevent unnecessary interventions on the patient.
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Affiliation(s)
- Betül Öztürk
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İlknur Bodur
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aysun Tekeli
- Department of Pediatric Emergency Care, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Care, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Care, Ankara City Hospital, Ankara, Turkey
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28
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Sun Y, Fan J, Chen G, Chen X, Du X, Wang Y, Wang H, Sun F, Johnson MG, Bensaci M, Huntington JA, Bruno CJ. A Phase 3, Multicenter, Double-blind, Randomized Clinical Trial to Evaluate the Efficacy and Safety of Ceftolozane/Tazobactam Plus Metronidazole Versus Meropenem in Chinese Participants With Complicated Intra-abdominal Infections. Int J Infect Dis 2022; 123:157-165. [PMID: 35987467 DOI: 10.1016/j.ijid.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/03/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of ceftolozane/tazobactam plus metronidazole vs meropenem plus placebo for the treatment of complicated intra-abdominal infection (cIAI) in Chinese adult participants. METHODS In this phase 3 clinical trial (NCT03830333), Chinese adult participants with cIAI were randomized 1:1 to receive ceftolozane/tazobactam plus metronidazole or meropenem plus placebo. The primary objective was to assess ceftolozane/tazobactam plus metronidazole for noninferiority vs meropenem for clinical response rate at the test of cure (TOC; 28 ± 2 days after study start) visit in the clinically evaluable (CE) population. Secondary end points included clinical and microbiologic responses at the TOC and end of treatment (EOT; ≤24 hours after last dose) visits and adverse event rates. RESULTS Clinical cure at the TOC visit in the CE population was 95.2% and 93.1% for ceftolozane/tazobactam plus metronidazole and meropenem, respectively (between-treatment difference: 2.1% [95% CI: -4.7%, 8.8%); thus, noninferiority was met. Clinical responses at the TOC and EOT visits and microbiologic responses at the TOC visit were consistent with the primary efficacy end point. Safety was comparable between study treatment groups. CONCLUSION In Chinese adult participants with cIAI, ceftolozane/tazobactam plus metronidazole was noninferior to meropenem, with comparable safety.
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Affiliation(s)
- Yihong Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Gang Chen
- Department of Hepatobiliary Surgery, The First Hospital of Kunming, Kunming, China
| | - Xiaofei Chen
- MSD China, Building A, Headquarters Park Phase II, No. 1582 Gumei Rd, Xuhui District, Shanghai 200233 China
| | - Xiaoling Du
- MSD China, Building A, Headquarters Park Phase II, No. 1582 Gumei Rd, Xuhui District, Shanghai 200233 China
| | - Ye Wang
- MSD China, Building A, Headquarters Park Phase II, No. 1582 Gumei Rd, Xuhui District, Shanghai 200233 China
| | - Hui Wang
- MSD China, Building A, Headquarters Park Phase II, No. 1582 Gumei Rd, Xuhui District, Shanghai 200233 China
| | - Fang Sun
- MSD China, Building A, Headquarters Park Phase II, No. 1582 Gumei Rd, Xuhui District, Shanghai 200233 China
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Maan G, Keitoku K, Kimura N, Sawada H, Pham A, Yeo J, Hagiya H, Nishimura Y. Cefepime-induced neurotoxicity: systematic review. J Antimicrob Chemother 2022; 77:2908-2921. [PMID: 35971666 DOI: 10.1093/jac/dkac271] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cefepime-induced neurotoxicity (CIN) has been well acknowledged among clinicians, although there are no clear diagnostic criteria or specific laboratory testing to help with its diagnosis. We aimed to summarize the existing evidence regarding CIN and provide future agendas for research. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and Embase for all peer-reviewed articles using keywords including 'cefepime', 'neurotoxicity', 'encephalopathy' and 'seizure', from their inception to 20 January 2022. RESULTS We included 92 articles, including 23 observational studies and 69 cases from case reports and case series, in the systematic review. Among 119 patients with CIN, 23.5% were in the ICU at the time of diagnosis and nearly 90% of the cases showed renal dysfunction.Cefepime overdoses were described in 41%. The median latency period of developing CIN from cefepime initiation was 4 days, and about 12% developed CIN during empirical treatment. CIN patients commonly manifested altered mental status (93%), myoclonus (37%) and non-convulsive seizure epilepticus (28%). A serum cefepime trough level of >20 mg/L would put patients at risk for CIN. CIN-related symptoms were ameliorated in 97.5% by dose reduction or discontinuation of cefepime, with median time to improvement of 3 days. No CIN-associated deaths were reported. CONCLUSIONS This systematic review summarizes the current evidence and characteristics of CIN. In the current situation where there are no CIN diagnostic criteria and the drug monitoring platform is not routinely available, candidates for cefepime should be carefully selected. Also, based on these findings, it needs to be appropriately dosed to avoid the development of CIN.
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Affiliation(s)
- Gozun Maan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Koichi Keitoku
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Nobuhiko Kimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Haruki Sawada
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Andrew Pham
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Jihun Yeo
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Babidhan R, Lewis A, Atkins C, Jozefczyk NJ, Nemecek BD, Montepara CA, Gionfriddo MR, Zimmerman DE, Covvey JR, Guarascio AJ. Safety and efficacy of cefiderocol for off-label treatment indications: A systematic review. Pharmacotherapy 2022; 42:549-566. [PMID: 35611627 DOI: 10.1002/phar.2704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/17/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off-label indications. METHODS The PRISMA guidelines were utilized for reporting. Databases searched included PubMed, Scopus, and Embase, from inception to September 2021. Manuscripts describing cefiderocol off-label use in clinical settings were included. Exclusion criteria were studies focused on labeled indications, animal studies, pharmacodynamic/pharmacokinetic studies, in vitro or laboratory studies, and manuscripts in languages other than English or Arabic. Each stage of review utilized two independent investigators, with conflicts resolved and critical appraisal performed. Data regarding presentation, clinical course, and infection characteristics were extracted and descriptively analyzed. RESULTS The search identified a total of 985 records, narrowed to a final set of 27 studies. Among studies included were 18 (66.7%) case reports, 8 (29.6%) case series, and 1 (3.7%) phase 3 clinical trial. Cefiderocol was most frequently used off-label for bacteremia/sepsis with or without an identified source in 51 (67.1%) out of a total of 76 included patients. Among case series/reports with available data, 43 of 53 patients (81.1%) received combination antibiotic therapy. The most common pathogens identified included multi/extensively drug-resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii. Various clinical end points were reported, while microbiological end points were reported in 18 (66.7%) studies. Cefiderocol-related side effects were uncommon and rarely use-limiting. CONCLUSIONS This systematic review depicts relative clinical effectiveness of off-label cefiderocol, most commonly for P. aeruginosa and A. baumannii infections as combination antibiotic therapy. Further study is needed to elucidate the safety and efficacy of cefiderocol across an expanded set of patients and indications.
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Affiliation(s)
- Riyan Babidhan
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Abigale Lewis
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Cailin Atkins
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | | | - Branden D Nemecek
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Courtney A Montepara
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - David E Zimmerman
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Anthony J Guarascio
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Brandariz-Núñez D, Suanzes J, Gutiérrez-Urbón JM, Fernández-Oliveira C, Margusino L, Martín-Herranz I. Incidence and risk factors for mortality in patients treated with combined ceftaroline for Gram-positive infective endocarditis. Eur J Clin Microbiol Infect Dis 2022; 41:827-834. [PMID: 35435629 DOI: 10.1007/s10096-022-04443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ceftaroline is a fifth-generation cephalosporin and represents an alternative in the treatment of infective endocarditis (IE). The main objective of this study was to describe the incidence of in-hospital and 42-day mortality in patients with IE treated with ceftaroline. METHODS An observational retrospective study included adult patients with IE admitted during a 3.5-year period (January 2018-June 2021) and treated with ceftaroline in a single center. All cases were definite or possible IE according to the modified Duke criteria. RESULTS Seventy cases were analyzed. The mean age was 67.35 ± 16.62 (16-89) and 39 (55.7%) were males. The mean number of days of treatment with ceftaroline was 21.26 ± 16.17 (1-75). Overall mortality at 42 days was 30%, 20.7% in the first line, and 36.6% in rescue therapy. Predictors of 42 days-mortality were increased Charlson comorbidity index (CCI) (OR of 1.7 per 1 point increment, 95% CI 1.2-2.4, P 0.001), presence of methicillin-resistance (OR 6.8, 95% CI 1.3-36.8, P 0.026) and evidence of septic shock (OR 8.6 95% CI 1.7-44.2, P 0.01). Predictors of 42 days of therapeutic failure were the increase in the CCI (OR of 1.6 per 1 point increment, 95% CI 1.3-2.1, P 0.000) and septic shock (OR 4.5 95% CI 1.1-18 P 0.036). Adverse effects were described in 6/70 (8.6%) of the patients, precipitating in 4/70 (5.7%) the definitive withdrawal of the antibiotic. CONCLUSIONS The incidence of in-hospital and 42 day-mortality of IE patients treated with ceftaroline remains similar to literature data. Increased CCI, septic shock, and methicillin resistance are associated with poor prognosis.
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Affiliation(s)
- D Brandariz-Núñez
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain.
| | - J Suanzes
- Research Support Unit, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
- Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - J M Gutiérrez-Urbón
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - C Fernández-Oliveira
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - L Margusino
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
| | - I Martín-Herranz
- Pharmacy Deparment, Universitary Complex Hospital A Coruña (CHUAC), A Coruña, Spain
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Higashionna T, Ushio S, Esumi S, Murakawa K, Kitamura Y, Sendo T. Retrospective Cohort Study of Clinical Efficacy and Safety of Cefozopran for Treating Febrile Neutropenia during Chemotherapy in Patients with Lung Cancer. Acta Med Okayama 2022; 76:167-172. [PMID: 35503444 DOI: 10.18926/amo/63410] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Febrile neutropenia (FN) is a serious side effect in patients undergoing cancer chemotherapy and frequently proves fatal. Since infection control is crucial in the management of FN, the antimicrobial agent cefozopran (CZOP) has been recommended but not approved for routine use in clinical care of FN in Japan. However, few studies of CZOP in the management of FN have used a thrice daily dose schedule. The aim of this study was to retrospectively compare the efficacy and safety of CZOP at a dose of 1 g three times daily to those of cefepime (CFPM) in the treatment of FN in our lung cancer patients. The response rates of the CZOP and CFPM groups were 89.5% (17/19 cases) and 83.0% (39/47 cases), respectively, with no significant difference between the two groups. The median duration of antimicrobial treatment was 6 days (4-10 days) in the CZOP group and 7 days (3-13 days) in the CFPM group, with no significant difference between groups. The incidence rates of adverse events were 21.1% (4/19 cases) in the CZOP group and 19.1% (9/47 cases) in the CFPM group. No adverse events of Grade 3 or higher were observed in either group. The findings of the present study suggest that CZOP administration at a dose of 1 g three times per day as an antimicrobial treatment alternative against FN.
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Affiliation(s)
| | | | - Satoru Esumi
- Department of Pharmacy, Okayama University Hospital
| | | | - Yoshihisa Kitamura
- Department of Pharmacy, Okayama University Hospital
- Department of Pharmacotherapy, School of Pharmacy, Shujitsu University
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Dryden M, Kantecki M, Yan JL, Stone GG, Leister-Tebbe H, Wilcox M. Treatment outcomes of secondary bacteraemia in patients treated with ceftaroline fosamil: pooled results from six phase III clinical trials. J Glob Antimicrob Resist 2022; 28:108-114. [PMID: 34922058 DOI: 10.1016/j.jgar.2021.10.027] [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: 04/13/2021] [Revised: 10/06/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This exploratory pooled analysis assessed the efficacy and safety of ceftaroline fosamil and comparators across six phase III clinical trials in adults with community-acquired pneumonia (CAP) or complicated skin and soft-tissue infection (cSSTI) and secondary bacteraemia. METHODS In each trial, FOCUS 1 and 2 (CAP), Asia CAP trial, CANVAS 1 and 2 (cSSTI) and COVERS (cSSTI), patients were randomised to ceftaroline fosamil [600 mg q12h by 1-h i.v. infusion, except in COVERS (600 mg q8h by 2-h i.v. infusion), adjusted for renal function] or comparator. Efficacy assessments included clinical and microbiological responses at test-of-cure visit [microbiological modified intent-to-treat (mMITT) population]. Safety outcomes were assessed. RESULTS The pooled mMITT population comprised 1976 patients, of whom 138 had baseline bacteraemia (ceftaroline fosamil, n = 72; comparator, n = 66). Predominant baseline blood pathogens were Staphylococcus aureus (n = 29), Streptococcus pneumoniae (n = 19) and other streptococci (n = 12). Clinical cure rates in bacteraemic patients were 55/72 (76.4%) and 51/66 (77.3%) for ceftaroline fosamil and comparators, respectively, and in non-bacteraemic patients were 822/966 (85.1%) and 717/872 (82.2%). Favourable microbiological response rates in bacteraemic patients were 56/72 (77.8%) for ceftaroline fosamil and 54/66 (81.8%) for comparators, and in non-bacteraemic patients were 825/966 (85.4%) and 719/872 (82.5%). Adverse events in bacteraemic patients were consistent with the known ceftaroline fosamil safety profile or the underlying indications. CONCLUSION These pooled clinical and microbiological efficacy data demonstrate generally favourable outcomes for ceftaroline fosamil in patients with CAP or cSSTI and secondary bacteraemia. [Trial Registration: NCT00621504, NCT00509106; NCT01371838; NCT00424190, NCT00423657; NCT01499277].
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Affiliation(s)
- Matthew Dryden
- Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK.
| | | | | | | | | | - Mark Wilcox
- Leeds Teaching Hospitals and University of Leeds, Leeds, UK
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Ortega-Cisneros M, Moras-Villela VL, Delgado-Bañuelos A, Madrigal-Beas IM, Aguilar-Chávez Y, Ochoa-García IV, Chávez-Meléndez MÁ, Gómez-Hernández N. [Penicillin allergy]. Rev Alerg Mex 2022; 69 Suppl 1:s81-s93. [PMID: 34998313 DOI: 10.29262/ram.v69isup1.1038] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.
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Affiliation(s)
- Margarita Ortega-Cisneros
- Instituto Mexicano del Seguro Social, Centro Médico Nacional de Occidente, Hospital de Especialidades, Jalisco, México.
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van der Poorten MLM, Hagendorens MM, Faber MA, De Puysseleyr L, Elst J, Mertens CM, Romano A, Ebo DG, Sabato V. Nonirritant concentrations and performance of ceftaroline skin tests in patients with an immediate β-lactam hypersensitivity. J Allergy Clin Immunol Pract 2021; 9:4486-4488.e2. [PMID: 34454097 DOI: 10.1016/j.jaip.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marie-Line M van der Poorten
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics, University of Antwerp, and Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Department of Paediatrics, University of Antwerp, and Antwerp University Hospital, Antwerp, Belgium
| | - Margaretha A Faber
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Leander De Puysseleyr
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Jessy Elst
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Christel M Mertens
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | | | - Didier G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and Infla-Med Centre of Excellence, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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36
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Rubino CM, Polak M, Schröpf S, Münch HG, Smits A, Cossey V, Tomasik T, Kwinta P, Snariene R, Liubsys A, Gardovska D, Hornik CD, Bosheva M, Ruehle C, Litherland K, Hamed K. Pharmacokinetics and Safety of Ceftobiprole in Pediatric Patients. Pediatr Infect Dis J 2021; 40:997-1003. [PMID: 34533489 PMCID: PMC8505155 DOI: 10.1097/inf.0000000000003296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is an advanced-generation, broad-spectrum, intravenous cephalosporin, which is currently approved for the treatment of adults with hospital-acquired or community-acquired pneumonia. METHODS Noncompartmental pharmacokinetics and safety were analyzed from 2 recently completed pediatric studies, a single-dose, phase 1 study in neonates and infants up to 3 months of age (7.5 mg/kg) and a phase 3 study in patients 3 months to 17 years of age with pneumonia (10-20 mg/kg with a maximum of 500 mg per dose every 8 hours for up to 14 days). RESULTS Total ceftobiprole plasma concentrations peaked at the end of infusion. Half life (median ranging from 1.9 to 2.9 hours) and overall exposure (median AUC ranging from 66.6 to 173 μg•h/mL) were similar to those in adults (mean ± SD, 3.3 ± 0.3 hours and 102 ± 11.9 μg•h/mL, respectively). Calculated free-ceftobiprole concentrations in the single-dose study remained above a minimum inhibitory concentration (MIC) of 4 mg/L (fT > MIC of 4 mg/L) for a mean of 5.29 hours after dosing. In the pneumonia study, mean fT > MIC of 4 mg/L was ≥5.28 hours in all dose groups. Ceftobiprole was well tolerated in both studies. CONCLUSIONS Pharmacokinetic parameters of ceftobiprole characterized in the pediatric population were within the range of those observed in adults. In the pneumonia study, the lowest percentage of the dosing interval with fT > MIC of 4 mg/L was 50.8%, which suggests that pharmacokinetic-pharmacodynamic target attainment can be sufficient in pediatric patients. Ceftobiprole was well tolerated.
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Affiliation(s)
| | - Mark Polak
- West Virginia University School of Medicine, Department of Pediatrics, Morgantown, WV
| | - Sebastian Schröpf
- Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hans Georg Münch
- Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anne Smits
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Veerle Cossey
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tomasz Tomasik
- Jagiellonian University Medical College, Department of Pediatrics, Cracow, Poland
| | - Przemko Kwinta
- Jagiellonian University Medical College, Department of Pediatrics, Cracow, Poland
| | - Rima Snariene
- Medical Faculty of Vilnius University, Neonatal Center of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arunas Liubsys
- Medical Faculty of Vilnius University, Neonatal Center of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dace Gardovska
- Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Chi Dang Hornik
- Duke University Hospital, Department of Pediatrics, Durham, NC
| | - Miroslava Bosheva
- Medical University, University Multiprofile Hospital for Active Treatment “Sveti Georgi,” Plovdiv, Clinic of Pediatric and Genetic Diseases, Plovdiv, Bulgaria
| | | | | | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
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Abstract
PURPOSE OF REVIEW To review the most recent literature studying the classifications, immunochemistry, and crossreactivity of allergy reactions to cephalosporins. RECENT FINDINGS Over the last five years, research interest has focused on three areas related to cephalosporin allergy: cross-reactivity among cephalosporins and with other beta-lactams; the incidence of adverse reactions in penicillin allergy patients or in reported penicillin allergy labels; and new cephalosporins structures involved in the immunological recognition. SUMMARY Meta-analysis of a substantial number of studies shows that cephalosporins are safer than previously thought. Evidence supports two main conclusions in that regard. First, there is a relatively low percentage of cross-reactivity between cephalosporins and other beta-lactams with penicillins in penicillin allergy patients. Second, there is a very low incidence of allergy reactions in nonselected as well as in selected penicillin allergy patients when cephalosporins are used prior to surgical intervention.On the other hand, few structures have been discovered related to the immune mechanism of cephalosporin allergy reactions, and these are far from being ready to use in clinical practice.
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Affiliation(s)
- Javier Fernandez
- Allergy Section, Alicante General University Hospital, ISABIAL-UMH, Alicante
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Rhyou HI, Nam YH, Kim SC, Doo GE, Ha CY, Nam HJ, Woo SD, Lee Y, Jang JH, Lee HY, Ye YM. Cefaclor-induced hypersensitivity: Differences in the incidence of anaphylaxis relative to other 2nd and 3rd generation cephalosporins. PLoS One 2021; 16:e0254898. [PMID: 34293048 PMCID: PMC8297852 DOI: 10.1371/journal.pone.0254898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Cefaclor, a second-generation oral cephalosporin, is the most frequently prescribed cephalosporin in Korea. Studies, however, have yet to analyze the incidence of cefaclor-associated adverse drug reactions (ADRs), including hypersensitivity (HS), according to total national usage rates. This study aimed to investigate the incidence rates and clinical features of cefaclor ADRs reported to the Korean Adverse Event Reporting System (KAERS) and Health Insurance Review and Assessment Service (HIRA) database for the most recent 5 years. Reviewing the HIRA database, which contains information on all insurance claims, including prescribed medications and patient demographics, we identified the total number of individuals who had been prescribed cefaclor and other cephalosporins including 2nd generation without cefaclor and 3rd generation antibiotics from January 2014 to December 2018. Additionally, we retrospectively analyzed all ADRs reported to the KAERS for these drugs over the same study period. Incidence rates for ADRs, HS, and anaphylaxis to cefaclor were 1.92/10,000 persons, 1.17/10,000 persons, and 0.38/10,000 persons, respectively, lower than those to other 2nd and 3rd cephalosporins. Among all ADRs, HS (60.9% vs. 43.6% vs. 44.8%, P <0.001) and anaphylaxis (19.8% vs. 4.6% vs. 4.7%, P <0.001) were more common for cefaclor than for other 2nd and 3rd cephalosporins. Females, individuals under 65 years of age, concomitant use of drugs, and serious ADRs were more strongly associated with HS to cefaclor than with HS to other 2nd and 3rd cephalosporins. In a nationwide database for the Korean population, the incidence of cefaclor-induced ADRs, particularly HS and anaphylaxis, was high. Female sex, age younger than 65 years, and concomitant use of drugs may be associated with HS to cefaclor.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Su-Chin Kim
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Go-Eun Doo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Chae-Yeon Ha
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Hee-Joo Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Sung-Dae Woo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Youngsoo Lee
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun-Young Lee
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Young-Min Ye
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- * E-mail:
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Jorda A, Zeitlinger M. Pharmacological and clinical profile of cefiderocol, a siderophore cephalosporin against gram-negative pathogens. Expert Rev Clin Pharmacol 2021; 14:777-791. [PMID: 33849355 DOI: 10.1080/17512433.2021.1917375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Increasing resistance of gram-negative bacteria poses a serious threat to global health. Thus, efficacious and safe antibiotics against resistant pathogens are urgently needed. Cefiderocol, a siderophore cephalosporin, addresses this unmet need.Areas covered: For this article, we screened all preclinical and clinical studies on cefiderocol published by January 2021 on PubMed. Also, regulatory documents, recent conference contributions, and selected data of antibiotic competitors are reviewed. We provide a comprehensive overview of the mode of action, in vitro and in vivo activity, pharmacokinetics/pharmacodynamics, and human pharmacokinetics. Last, we discuss the efficacy and safety data from the pivotal trials.Expert opinion: Cefiderocol was in vitro potent against virtually all gram-negative pathogens and resistance was rare. The target site pharmacokinetics (i.e. urinary and lung penetration) have been well described in humans and important PK/PD targets were reached. In the clinical trials, cefiderocol was non-inferior to carbapenems in the treatment of complicated urinary tract infections and nosocomial pneumonia. Against carbapenem-resistant gram-negative pathogens, cefiderocol was similar to the best available therapy, which was mainly based on the backbone agent colistin. Overall, a substantial body of evidence supports the clinical use of cefiderocol in patients with gram-negative infections and limited treatment options.
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Affiliation(s)
- Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Affiliation(s)
- Arvind V Panchoo
- Department of Pediatrics, Baylor, College of Medicine, Houston, TX; Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of San Antonio, San Antonio, TX
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Stewart AG, Harris PNA, Chatfield MD, Littleford R, Paterson DL. Ceftolozane-tazobactam versus meropenem for definitive treatment of bloodstream infection due to extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales ("MERINO-3"): study protocol for a multicentre, open-label randomised non-inferiority trial. Trials 2021; 22:301. [PMID: 33888139 PMCID: PMC8060904 DOI: 10.1186/s13063-021-05206-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/18/2021] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales are common causes of bloodstream infection. ESBL-producing bacteria are typically resistant to third-generation cephalosporins and result in a sizeable economic and public health burden. AmpC-producing Enterobacterales may develop third-generation cephalosporin resistance through enzyme hyper-expression. In no observational study has the outcome of treatment of these infections been surpassed by carbapenems. Widespread use of carbapenems may drive the development of carbapenem-resistant Gram-negative bacilli. METHODS This study will use a multicentre, parallel group open-label non-inferiority trial design comparing ceftolozane-tazobactam and meropenem in adult patients with bloodstream infection caused by ESBL or AmpC-producing Enterobacterales. Trial recruitment will occur in up to 40 sites in six countries (Australia, Singapore, Italy, Spain, Saudi Arabia and Lebanon). The sample size is determined by a predefined quantity of ceftolozane-tazobactam to be supplied by Merck, Sharpe and Dohme (MSD). We anticipate that a trial with 600 patients contributing to the primary outcome analysis would have 80% power to declare non-inferiority with a 5% non-inferiority margin, assuming a 30-day mortality of 5% in both randomised groups. Once randomised, definitive treatment will be for a minimum of 5 days and a maximum of 14 days with the total duration determined by treating clinicians. Data describing demographic information, risk factors, concomitant antibiotics, illness scores, microbiology, multidrug-resistant organism screening, discharge and mortality will be collected. DISCUSSION Participants will have bloodstream infection due to third-generation cephalosporin non-susceptible E. coli and Klebsiella spp. or Enterobacter spp., Citrobacter freundii, Morganella morganii, Providencia spp. or Serratia marcescens. They will be randomised 1:1 to ceftolozane-tazobactam 3 g versus meropenem 1 g, both every 8 h. Secondary outcomes will be a comparison of 14-day all-cause mortality, clinical and microbiological success at day 5, functional bacteraemia score, microbiological relapse, new bloodstream infection, length of hospital stay, serious adverse events, C. difficile infection, multidrug-resistant organism colonisation. The estimated trial completion date is December 2024. TRIAL REGISTRATION The MERINO-3 trial is registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT04238390 . Registered on 23 January 2020.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia.
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
| | - Roberta Littleford
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. This is an update of a review first published in 2010, and updated in 2013, 2016, and 2020. OBJECTIVES To assess the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing clinical relapse (i.e. recurrence of symptoms after initial resolution); and (d) preventing complications (suppurative complications, acute rheumatic fever, post-streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk-benefit of antibiotic treatment for streptococcal pharyngitis. SEARCH METHODS We searched the following databases up to 3 September 2020: CENTRAL (2020, Issue 8), MEDLINE Ovid (from 1946), Embase Elsevier (from 1974), and Web of Science Thomson Reuters (from 2010). We also searched clinical trial registers on 3 September 2020. SELECTION CRITERIA Randomised, double-blind trials comparing different antibiotics, and reporting at least one of the following: clinical cure, clinical relapse, or complications and/or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened trials for inclusion and extracted data using standard methodological procedures as recommended by Cochrane. We assessed the risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions, and used the GRADE approach to assess the overall certainty of the evidence for the outcomes. We have reported the intention-to-treat analysis, and also performed an analysis of evaluable participants to explore the robustness of the intention-to-treat results. MAIN RESULTS We included 19 trials reported in 18 publications (5839 randomised participants): six trials compared penicillin with cephalosporins; six compared penicillin with macrolides; three compared penicillin with carbacephem; one compared penicillin with sulphonamides; one compared clindamycin with ampicillin; and one compared azithromycin with amoxicillin in children. All participants had confirmed acute GABHS tonsillopharyngitis, and ages ranged from one month to 80 years. Nine trials included only, or predominantly, children. Most trials were conducted in an outpatient setting. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. We downgraded the certainty of the evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both; heterogeneity; and wide confidence intervals. Cephalosporins versus penicillin We are uncertain if there is a difference in symptom resolution (at 2 to 15 days) for cephalosporins versus penicillin (odds ratio (OR) for absence of symptom resolution 0.79, 95% confidence interval (CI) 0.55 to 1.12; 5 trials; 2018 participants; low-certainty evidence). Results of the sensitivity analysis of evaluable participants differed (OR 0.51, 95% CI 0.27 to 0.97; 5 trials; 1660 participants; very low-certainty evidence). We are uncertain if clinical relapse may be lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; number needed to treat for an additional beneficial outcome (NNTB) 50; 4 trials; 1386 participants; low-certainty evidence). Very low-certainty evidence showed no difference in reported adverse events. Macrolides versus penicillin We are uncertain if there is a difference between macrolides and penicillin for resolution of symptoms (OR 1.11, 95% CI 0.92 to 1.35; 6 trials; 1728 participants; low-certainty evidence). Sensitivity analysis of evaluable participants resulted in an OR of 0.79, 95% CI 0.57 to 1.09; 6 trials; 1159 participants). We are uncertain if clinical relapse may be different (OR 1.21, 95% CI 0.48 to 3.03; 6 trials; 802 participants; low-certainty evidence). Azithromycin versus amoxicillin Based on one unpublished trial in children, we are uncertain if resolution of symptoms is better with azithromycin in a single dose versus amoxicillin for 10 days (OR 0.76, 95% CI 0.55 to 1.05; 1 trial; 673 participants; very low-certainty evidence). Sensitivity analysis for per-protocol analysis resulted in an OR of 0.29, 95% CI 0.11 to 0.73; 1 trial; 482 participants; very low-certainty evidence). We are also uncertain if there was a difference in relapse between groups (OR 0.88, 95% CI 0.43 to 1.82; 1 trial; 422 participants; very low-certainty evidence). Adverse events were more common with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; 1 trial; 673 participants; very low-certainty evidence). Carbacephem versus penicillin There is low-certainty evidence that compared with penicillin, carbacephem may provide better symptom resolution post-treatment in adults and children (OR 0.70, 95% CI 0.49 to 0.99; NNTB 14.3; 3 trials; 795 participants). Studies did not report on long-term complications, so it was unclear if any class of antibiotics was better in preventing serious but rare complications. AUTHORS' CONCLUSIONS: We are uncertain if there are clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Low-certainty evidence in children suggests that carbacephem may be more effective than penicillin for symptom resolution. There is insufficient evidence to draw conclusions regarding the other comparisons in this review. Data on complications were too scarce to draw conclusions. These results do not demonstrate that other antibiotics are more effective than penicillin in the treatment of GABHS pharyngitis. All studies were conducted in high-income countries with a low risk of streptococcal complications, so there is a need for trials in low-income countries and Aboriginal communities, where the risk of complications remains high.
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Affiliation(s)
- Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- General Practice Centre for Research in Evidence-Based Practice (CREBP), Bond University, Gold Coast, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - An Im De Sutter
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
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Abstract
BACKGROUND Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects. OBJECTIVES: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant. SEARCH METHODS For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes. AUTHORS' CONCLUSIONS Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.
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Affiliation(s)
- Myfanwy J Williams
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Carolina Carvalho Ribeiro do Valle
- Infection Prevention and Control, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti - CAISM, Department of Obstetrics and Gynaecology, University of Campinas, Campinas, Brazil
| | - Gillian Ml Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Nicolau DP, De Waele J, Kuti JL, Caro L, Larson KB, Yu B, Gadzicki E, Zeng Z, Rhee EG, Rizk ML. Pharmacokinetics and Pharmacodynamics of Ceftolozane/Tazobactam in Critically Ill Patients With Augmented Renal Clearance. Int J Antimicrob Agents 2021; 57:106299. [PMID: 33567333 DOI: 10.1016/j.ijantimicag.2021.106299] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether established ceftolozane/tazobactam (C/T) dosing is adequate for patients with augmented renal clearance (ARC) and bacterial infection. METHODS ARC (creatinine clearance [CrCl] ≥ 130 mL/min) was confirmed by directly measured CrCl in 11 critically ill patients in a phase 1 pharmacokinetics study. Patients received 3 g C/T (ceftolozane 2 g/tazobactam 1 g) as a 60-minute intravenous infusion. Pharmacokinetic sampling occurred at 0 (predose), 1, 2, 4, 6, and 8 hours after the start of the infusion. Noncompartmental analyses were conducted on concentration data. The following pharmacodynamic targets were evaluated: time that free (unbound) drug concentrations exceeded the minimum inhibitory concentration (fT>MIC) of 4 μg/mL for ceftolozane and time that the unbound concentration exceeded the 1 μg/mL target threshold (fT>threshold = 1 µg/mL) for > 20% of the dosing interval for tazobactam. Safety was evaluated. RESULTS Mean (SD) area under the plasma concentration-time curve from 0 to infinity, clearance and volume of distribution at steady state (Vss) were 236 (118) h*µg/mL, 10.4 (4.5) L/h and 30.8 (10.8) L, respectively, for ceftolozane; and 35.5 (18.5) h*µg/mL, 35.3 (16.5) L/h and 54.8 (20.1) L, respectively, for tazobactam. Clearance and Vss were higher for both ceftolozane and tazobactam in patients with ARC compared with healthy individuals. The mean estimated ceftolozane fT>MIC at 4 µg/mL was 86.4%; the mean estimated tazobactam fT>threshold = 1 µg/mL was 54.9%. Treatment-emergent adverse events were mild to moderate. CONCLUSIONS In patients with ARC, a 3 g C/T dose met respective pharmacodynamic targets for ceftolozane and tazobactam. CLINICALTRIALS. GOV IDENTIFIER NCT02387372.
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Affiliation(s)
- David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | | | - Brian Yu
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Zhen Zeng
- Merck & Co., Inc., Kenilworth, New Jersey, USA
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Çağlar Ö, Kaymakoğlu M, Çil A, Atilla B, Sarıcaoğlu F, Tokgözoğlu M. Vancomycin prophylaxis for revision hip arthroplasty in penicillin and cephalosporin sensitive patients: Is dose adjustment necessary in accordance with blood loss and fluid replacement? Acta Orthop Traumatol Turc 2021; 55:53-56. [PMID: 33650512 DOI: 10.5152/j.aott.2021.20019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aims of this study were (1) to investigate the changes in the serum concentration of prophylactically administrated vancomycin in the perioperative period of revision hip arthroplasty in penicillin/cephalosporin-allergic patients, (2) to assess whether the postoperative re-administration of vancomycin is needed, and (3) to determine the relationships of vancomycin serum concentration with blood loss, body weight, and fluid replacement in such patients. METHODS This study consisted of 29 patients (20 females, 9 males; mean age=63.3 years; age range=45-79 years) with a history of penicillin/cephalosporin allergy undergoing revision hip arthroplasty secondary to aseptic loosening or periprosthetic fractures. Serum vancomycin levels were measured (1) before administration of vancomycin, (2) at the time of skin incision, (3) every 1,5 hours thereafter until the end of the operation, (4) during the skin closure, and (5) after three and 12 hours from the initial dosage. Data regarding body weight, amounts of intraoperative blood loss, fluid and blood replacements and postoperative wound drainage were recorded. RESULTS The average blood loss, fluid replacement, and drain volume were 1280.3±575.8 (500-2700) mL, 2922.6±768.8 (1700-4600) mL, and 480.2±163.7 (200-850) mL, respectively. The mean levels of serum vancomycin were 46.3±21.8 (14.1-80.7) mg/L at the time of skin incision, 17.9±4.7 (9.4-30.9) and 9.8±2.2 (4.3-13.8) mg/L after 1.5 and 3 hours from the beginning of the surgery and 5.1±1.1 (2.9-6.8)mg/L after 12th hour postoperatively. The measured vancomycin levels were below the effective serum concentrations (< 5 mg/L) for 18 patients at 12 hours the administration of the first dose. A moderate level negative correlation between the blood loss/body weight ratio and vancomycin levels was found (p=0.004, r=-0.493). Predictive ROC curve analysis resulted in determining a blood loss volume higher than 1150 ml and a blood loss/body weight ratio higher than 18,5 is significant to estimate the vancomycin level below the minimum effective serum level at 12th hour postoperatively (AUC=0.793±0.16, p=0.009, AUC=0.753) 26±0.12, p=0.025, respectively). CONCLUSION Evidence from this study has indicated vancomycin concentration at 12th hour is below the effective level in most patients. Thus, earlier repetitive infusion of vancomycin seems to be necessary in penicillin/cephalosporin-allergic patients undergoing revision hip arthroplasty, especially in those with high blood loss. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Ömür Çağlar
- Department of Orthopaedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mehmet Kaymakoğlu
- Department of Orthopaedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Akın Çil
- Department of Orthopaedics, University of Missouri-Kansas City, Missouri, USA
| | - Bülent Atilla
- Department of Orthopaedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Fatma Sarıcaoğlu
- Department of Anesthesiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mazhar Tokgözoğlu
- Department of Orthopaedics and Traumatology, Hacettepe University, School of Medicine, Ankara, Turkey
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Abstract
BACKGROUND Pelvic inflammatory disease (PID) affects 4% to 12% of women of reproductive age. The main intervention for acute PID is broad-spectrum antibiotics administered intravenously, intramuscularly or orally. We assessed the optimal treatment regimen for PID. OBJECTIVES: To assess the effectiveness and safety of antibiotic regimens to treat PID. SEARCH METHODS In January 2020, we searched the Cochrane Sexually Transmitted Infections Review Group's Specialized Register, which included randomized controlled trials (RCTs) from 1944 to 2020, located through hand and electronic searching; CENTRAL; MEDLINE; Embase; four other databases; and abstracts in selected publications. SELECTION CRITERIA We included RCTs comparing antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment. We limited our review to a comparison of drugs in current use that are recommended by the 2015 US Centers for Disease Control and Prevention guidelines for treatment of PID. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently extracted data, assessed risk of bias and conducted GRADE assessments of the quality of evidence. MAIN RESULTS We included 39 RCTs (6894 women) in this review, adding two new RCTs at this update. The quality of the evidence ranged from very low to high, the main limitations being serious risk of bias (due to poor reporting of study methods and lack of blinding), serious inconsistency, and serious imprecision. None of the studies reported quinolones and cephalosporins, or the outcomes laparoscopic evidence of resolution of PID based on physician opinion or fertility outcomes. Length of stay results were insufficiently reported for analysis. Regimens containing azithromycin versus regimens containing doxycycline We are uncertain whether there was a clinically relevant difference between azithromycin and doxycycline in rates of cure for mild-moderate PID (RR 1.18, 95% CI 0.89 to 1.55; 2 RCTs, 243 women; I2 = 72%; very low-quality evidence). The analyses may result in little or no difference between azithromycin and doxycycline in rates of severe PID (RR 1.00, 95% CI 0.96 to 1.05; 1 RCT, 309 women; low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.71, 95% CI 0.38 to 1.34; 3 RCTs, 552 women; I2 = 0%; low-quality evidence). In a sensitivity analysis limited to a single study at low risk of bias, azithromycin probably improves the rates of cure in mild-moderate PID (RR 1.35, 95% CI 1.10 to 1.67; 133 women; moderate-quality evidence), compared to doxycycline. Regimens containing quinolone versus regimens containing cephalosporin The analysis shows there may be little or no clinically relevant difference between quinolones and cephalosporins in rates of cure for mild-moderate PID (RR 1.05, 95% CI 0.98 to 1.14; 4 RCTs, 772 women; I2 = 15%; low-quality evidence), or severe PID (RR 1.06, 95% CI 0.91 to 1.23; 2 RCTs, 313 women; I2 = 7%; low-quality evidence). We are uncertain whether there was a difference between quinolones and cephalosporins in adverse effects leading to discontinuation of treatment (RR 2.24, 95% CI 0.52 to 9.72; 6 RCTs, 1085 women; I2 = 0%; very low-quality evidence). Regimens with nitroimidazole versus regimens without nitroimidazole There was probably little or no difference between regimens with or without nitroimidazoles (metronidazole) in rates of cure for mild-moderate PID (RR 1.02, 95% CI 0.95 to 1.09; 6 RCTs, 2660 women; I2 = 50%; moderate-quality evidence), or severe PID (RR 0.96, 95% CI 0.92 to 1.01; 11 RCTs, 1383 women; I2 = 0%; moderate-quality evidence). The evidence suggests that there was little to no difference in in adverse effects leading to discontinuation of treatment (RR 1.05, 95% CI 0.69 to 1.61; 17 studies, 4021 women; I2 = 0%; low-quality evidence). . In a sensitivity analysis limited to studies at low risk of bias, there was little or no difference for rates of cure in mild-moderate PID (RR 1.05, 95% CI 1.00 to 1.12; 3 RCTs, 1434 women; I2 = 0%; high-quality evidence). Regimens containing clindamycin plus aminoglycoside versus quinolone We are uncertain whether quinolone have little to no effect in rates of cure for mild-moderate PID compared to clindamycin plus aminoglycoside (RR 0.88, 95% CI 0.69 to 1.13; 1 RCT, 25 women; very low-quality evidence). The analysis may result in little or no difference between quinolone vs. clindamycin plus aminoglycoside in severe PID (RR 1.02, 95% CI 0.87 to 1.19; 2 studies, 151 women; I2 = 0%; low-quality evidence). We are uncertain whether quinolone reduces adverse effects leading to discontinuation of treatment (RR 0.21, 95% CI 0.02 to 1.72; 3 RCTs, 163 women; I2 = 0%; very low-quality evidence). Regimens containing clindamycin plus aminoglycoside versus regimens containing cephalosporin We are uncertain whether clindamycin plus aminoglycoside improves the rates of cure for mild-moderate PID compared to cephalosporin (RR 1.02, 95% CI 0.95 to 1.09; 2 RCTs, 150 women; I2 = 0%; low-quality evidence). There was probably little or no difference in rates of cure in severe PID with clindamycin plus aminoglycoside compared to cephalosporin (RR 1.00, 95% CI 0.95 to 1.06; 10 RCTs, 959 women; I2= 21%; moderate-quality evidence). We are uncertain whether clindamycin plus aminoglycoside reduces adverse effects leading to discontinuation of treatment compared to cephalosporin (RR 0.78, 95% CI 0.18 to 3.42; 10 RCTs, 1172 women; I2 = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS We are uncertain whether one treatment was safer or more effective than any other for the cure of mild-moderate or severe PID Based on a single study at a low risk of bias, a macrolide (azithromycin) probably improves the rates of cure of mild-moderate PID, compared to tetracycline (doxycycline).
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Affiliation(s)
| | | | - Jackson Maissiat
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Jonathan Ross
- Department of G U Medicine, The Whittall Street Clinic, Birmingham, UK
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Imai S, Kadomura S, Momo K, Kashiwagi H, Sato Y, Miyai T, Sugawara M, Takekuma Y. Comparison of interactions between warfarin and cephalosporins with and without the N-methyl-thio-tetrazole side chain. J Infect Chemother 2020; 26:1224-1228. [PMID: 32800690 DOI: 10.1016/j.jiac.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/23/2020] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 01/21/2023]
Abstract
Cephalosporins with an N-methyl-thio-tetrazole (NMTT) side chain interact with warfarin by reducing the production of blood clotting factors. However, cephalosporins without the NMTT side chain also enhance the effects of warfarin. Thus, we aimed to compare the effects of warfarin modified by cephalosporins with and without the NMTT side chain, using a Japanese health insurance claims database. The inclusion criteria were patients who (1) intravenously received second- or third-generation cephalosporins between April 2010 and March 2017 and (2) received warfarin during cephalosporin therapy. Patients were administered either cephalosporins with the NMTT side chain (NMTT group) or those without NMTT (non-NMTT group). After matching patient data by propensity score, the following outcomes were compared between the two groups: (1) proportion of patients administered vitamin K, (2) proportion of bleeding events, and (3) changes in the daily dose of warfarin. Among 203 patients, 100 patients (50 per group) were matched by the propensity score. The proportion of patients administered vitamin K was 6.0% in both groups. These patients intravenously received a single dose of menatetrenone; no bleeding was observed. The proportion of patients subjected to a reduction in the daily dose of warfarin was 6.5% and 4.3% in the NMTT and non-NMTT groups, respectively. As our study had a small sample size, we could not determine whether the risk of over anticoagulation of warfarin is affected by cephalosporins with or without NMTT side chain. However, we showed the bleeding risk was sufficiently low regardless of the presence/absence of the NMTT side chain.
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Affiliation(s)
- Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Shota Kadomura
- Department of Pharmacy, Japan Community Healthcare Organization Sapporo Hokushin Hospital, 6-2-1, Atsubetsuchuo 2-jo, Atsubetsu-Ku, Sapporo, 004-8618, Japan; Graduate School of Life Science, Hokkaido University, Kita 10-jo Nishi 8-chome, Kita-ku, Sapporo, 060-0810, Japan
| | - Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Yuki Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Takayuki Miyai
- Graduate School of Life Science, Hokkaido University, Kita 10-jo Nishi 8-chome, Kita-ku, Sapporo, 060-0810, Japan
| | - Mitsuru Sugawara
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan; Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan; Global Station for Biosurfaces and Drug Discovery, Kita 8-jo Nishi 5-chome, Kita-ku, Sapporo, 060-0808, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
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Dubinsky-Pertzov B, Temkin E, Harbarth S, Fankhauser-Rodriguez C, Carevic B, Radovanovic I, Ris F, Kariv Y, Buchs NC, Schiffer E, Cohen Percia S, Nutman A, Fallach N, Klausner J, Carmeli Y. Carriage of Extended-spectrum Beta-lactamase-producing Enterobacteriaceae and the Risk of Surgical Site Infection After Colorectal Surgery: A Prospective Cohort Study. Clin Infect Dis 2020; 68:1699-1704. [PMID: 30204851 DOI: 10.1093/cid/ciy768] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 06/17/2018] [Accepted: 09/07/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. METHODS We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE-positive patients. The unexposed group was a random sample of ESBL-PE-negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. RESULTS A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50-3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27-3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70-10.56). CONCLUSIONS ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland
| | - Carolina Fankhauser-Rodriguez
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Switzerland
| | - Biljana Carevic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Ivana Radovanovic
- Department of Hospital Epidemiology, Clinical Center of Serbia, Belgrade
| | - Frederic Ris
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Yehuda Kariv
- Department of Surgery, Tel Aviv Sourasky Medical Center, Israel
| | - Nicolas C Buchs
- Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Eduardo Schiffer
- Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Shimrit Cohen Percia
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Noga Fallach
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
| | - Joseph Klausner
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Surgery, Tel Aviv Sourasky Medical Center, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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49
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Lambregts MM, Hendriks BJ, Sijbom M, Sigaloff K, Nieuwhof C, de Boer MG. [Cross-allergy to penicillins and cephalosporins: problematic when prescribing cephalosporins?]. Ned Tijdschr Geneeskd 2020; 164:D4253. [PMID: 32395967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Penicillin allergy is commonly reported and often influences selection of antimicrobial treatment. Due to concerns about cross-allergic reactions, other beta-lactams - particularly cephalosporins - may also be avoided. This too often results in less effective treatment, more side effects and overconsumption of reserve antimicrobial agents. Most patients (> 90%) with a penicillin allergy label are not truly allergic, i.e., they do not have an 'immediate type' (IgE-mediated) allergy when tested. Based on current data, even in patients with a true penicillin allergy, the risk of severe cross-allergic reactions to cephalosporins is very low. Clinicians tend to overestimate this risk: this dilemma can be resolved with a systematic appraisal of risk probabilities. The limited risk of a true penicillin allergy being present and the subsequent low risk of a cross-allergic reaction to cephalosporins generally outweighs the disadvantages of selecting an alternative (non-beta-lactam) antimicrobial regimen.
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Affiliation(s)
| | | | - M Sijbom
- Leids Universitair Medisch Centrum
| | | | | | - M Gj de Boer
- Leids Universitair Medisch Centrum
- Contact: M GJ de Boer
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50
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Martin TCS, Chow S, Johns ST, Mehta SR. Ceftaroline-associated Encephalopathy in Patients With Severe Renal Impairment. Clin Infect Dis 2020; 70:2002-2004. [PMID: 31504321 PMCID: PMC7156771 DOI: 10.1093/cid/ciz857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022] Open
Abstract
Encephalopathy complicates beta-lactam therapy, particularly with impaired renal function, though no studies have reported ceftaroline-associated encephalopathy. Among 28 patients with estimated glomerular filtration rates <30 mL/min who received ≥5 days of ceftaroline, 3 developed encephalopathy. Ceftaroline, when dosed supra-therapeutically for serious infections, may be a cause of antibiotic-associated encephalopathy.
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Affiliation(s)
- Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California
| | - Sean Chow
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Scott T Johns
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
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