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Alosaimy S, Rybak MJ, Sakoulas G. Understanding vancomycin nephrotoxicity augmented by β-lactams: a synthesis of endosymbiosis, proximal renal tubule mitochondrial metabolism, and β-lactam chemistry. Lancet Infect Dis 2024; 24:e179-e188. [PMID: 37883984 DOI: 10.1016/s1473-3099(23)00432-2] [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] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/29/2023] [Indexed: 10/28/2023]
Abstract
The recent understanding that hydrophobic β-lactams have greater affinity for organic anion transporter-3 (OAT-3) of the proximal renal tubule could provide valuable insights for anticipating β-lactams that may exacerbate vancomycin-induced nephrotoxicity. Vancomycin alone provides oxidative stress on the highly metabolic proximal tubular cells. Hydrophobic β-lactams (eg, piperacillin and anti-staphylococcal β-lactams) could have greater OAT-3 mediated uptake into proximal tubular cells than hydrophilic β-lactams (eg, most cephalosporins and carbapenems), thereby causing greater mitochondrial stress on these susceptible cells. It remains to be seen whether concomitant drugs that inhibit OAT-3 mediated cellular uptake of β-lactams into proximal tubular cells or provide antioxidant effects might mitigate β-lactam augmented vancomycin nephrotoxicity. Furthermore, the serum creatinine rise seen with vancomycin and hydrophobic β-lactams might represent competition for creatinine-secreting transporters (of which OAT-3 is one), thus, indicating creatinine retention rather than renal injury. In the meantime, clinicians are advised to utilise less nephrotoxic combinations in both empirical and directed antibiotic selection settings until further research is conducted.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA; Nestlé Health Science, Bridgewater Township, NJ, USA
| | - Michael J Rybak
- Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA; Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI, USA.
| | - George Sakoulas
- University of California San Diego School of Medicine, Division of Host-Microbe Systems and Therapeutics, La Jolla, CA, USA; Sharp Rees-Stealy, San Diego, CA, USA
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Rebold N, Alosaimy S, Pearson JC, Dionne B, Taqi A, Lagnf A, Lucas K, Biagi M, Lombardo N, Eudy J, Anderson DT, Mahoney MV, Kufel WD, D'Antonio JA, Jones BM, Frens JJ, Baumeister T, Geriak M, Sakoulas G, Farmakiotis D, Delaportas D, Larew J, Veve MP, Rybak MJ. Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study. Infect Dis Ther 2024; 13:565-579. [PMID: 38427289 DOI: 10.1007/s40121-024-00933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Long-acting lipoglycopeptides such as dalbavancin may have utility in patients with Gram-positive bloodstream infections (BSI), particularly in those with barriers to discharge or who require prolonged parenteral antibiotic courses. A retrospective cohort study was performed to provide further multicenter real-world evidence on dalbavancin use as a sequential therapy for Gram-positive BSI. METHODS One hundred fifteen patients received dalbavancin with Gram-positive BSI, defined as any positive blood culture or diagnosed with infective endocarditis, from 13 centers geographically spread across the United States between July 2015 and July 2021. RESULTS Patients had a mean (SD) age of 48.5 (17.5) years, the majority were male (54%), with many who injected drugs (40%). The most common infection sources (non-exclusive) were primary BSI (89%), skin and soft tissue infection (SSTI) (25%), infective endocarditis (19%), and bone and joint infection (17%). Staphylococcus aureus accounted for 72% of index cultures, coagulase-negative Staphylococcus accounted for 18%, and Streptococcus species in 16%. Dalbavancin started a median (Q1-Q3) of 10 (6-19) days after index culture collection. The most common regimen administered was dalbavancin 1500 mg as one dose for 50% of cases. The primary outcome of composite clinical failure occurred at 12.2%, with 90-day mortality at 7.0% and 90-day BSI recurrence at 3.5%. CONCLUSIONS Dalbavancin may serve as a useful tool in facilitating hospital discharge in patients with Gram-positive BSI. Randomized controlled trials are anticipated to validate dalbavancin as a surrogate to current treatment standards.
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Affiliation(s)
- Nicholas Rebold
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, 2300 4th St NW, Office 114, Washington, DC, 20059, USA.
| | - Sara Alosaimy
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Jeffrey C Pearson
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Brandon Dionne
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Ahmad Taqi
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Abdalhamid Lagnf
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA
| | - Kristen Lucas
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Mark Biagi
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Pharmacy, Swedish American Health System, Rockford, IL, USA
| | - Nicholas Lombardo
- Department of Pharmacy, Swedish American Health System, Rockford, IL, USA
| | - Joshua Eudy
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Daniel T Anderson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Wesley D Kufel
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA
| | - Joseph A D'Antonio
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA
| | - Bruce M Jones
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA
| | - Jeremy J Frens
- Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA
| | - Tyler Baumeister
- Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, NC, USA
| | - Matthew Geriak
- Sharp Memorial Hospital, Sharp Healthcare, San Diego, CA, USA
| | - George Sakoulas
- Sharp Rees-Stealy Medical Group, San Diego, CA, USA
- University of California San Diego School of Medicine, Division of Host-Microbe Systems and Therapeutics, La Jolla, CA, USA
| | - Dimitrios Farmakiotis
- Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Transplant and Oncology Infectious Diseases, Rhode Island Hospital, Providence, RI, USA
| | | | | | - Michael P Veve
- Wayne State University, Detroit, MI, USA
- College of Pharmacy, University of Tennessee, Knoxville, TN, USA
- Department of Pharmacy, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Rybak
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI, USA.
- School of Medicine, Wayne State University, Detroit, MI, USA.
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3
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Kunz Coyne AJ, Alosaimy S, Lucas K, Lagnf AM, Morrisette T, Molina KC, DeKerlegand A, Schrack MR, Kang-Birken SL, Hobbs AL, Agee J, Perkins NB, Biagi M, Pierce M, Truong J, Andrade J, Bouchard J, Gore T, King MA, Pullinger BM, Claeys KC, Herbin S, Cosimi R, Tart S, Veve MP, Jones BM, Rojas LM, Feehan AK, Scipione MR, Zhao JJ, Witucki P, Rybak MJ. Eravacycline, the first four years: health outcomes and tolerability data for 19 hospitals in 5 U.S. regions from 2018 to 2022. Microbiol Spectr 2024; 12:e0235123. [PMID: 38018984 PMCID: PMC10782980 DOI: 10.1128/spectrum.02351-23] [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: 06/13/2023] [Accepted: 10/11/2023] [Indexed: 11/30/2023] Open
Abstract
IMPORTANCE The rise of multidrug-resistant (MDR) pathogens, especially MDR Gram-negatives, poses a significant challenge to clinicians and public health. These resilient bacteria have rendered many traditional antibiotics ineffective, underscoring the urgency for innovative therapeutic solutions. Eravacycline, a broad-spectrum fluorocycline tetracycline antibiotic approved by the FDA in 2018, emerges as a promising candidate, exhibiting potential against a diverse array of MDR bacteria, including Gram-negative, Gram-positive, anaerobic strains, and Mycobacterium. However, comprehensive data on its real-world application remain scarce. This retrospective cohort study, one of the largest of its kind, delves into the utilization of eravacycline across various infectious conditions in the USA during its initial 4 years post-FDA approval. Through assessing clinical, microbiological, and tolerability outcomes, the research offers pivotal insights into eravacycline's efficacy in addressing the pressing global challenge of MDR bacterial infections.
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Affiliation(s)
- Ashlan J. Kunz Coyne
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kristen Lucas
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M. Lagnf
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kyle C. Molina
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alaina DeKerlegand
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | | | | | | | - Jazmin Agee
- Methodist University Hospital, Memphis, Tennessee, USA
| | | | - Mark Biagi
- UW Health SwedishAmerican Hospital, Rockford, Illinois, USA
- University of Illinois at Chicago, Rockford, Illinois, USA
| | - Michael Pierce
- UW Health SwedishAmerican Hospital, Rockford, Illinois, USA
| | - James Truong
- NewYork-Presbyterian Hospital, Queens, New York, USA
| | - Justin Andrade
- Touro College of Pharmacy, The Brooklyn Hospital Center, New York, New York, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Madeline A. King
- Philadelphia College of Pharmacy, Saint Joseph’s University, Philadelphia, Pennsylvania, USA
- Cooper University Hospital, Camden, New Jersey, USA
| | - Benjamin M. Pullinger
- Philadelphia College of Pharmacy, Saint Joseph’s University, Philadelphia, Pennsylvania, USA
| | | | - Shelbye Herbin
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Reese Cosimi
- Ascension St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Serina Tart
- Cape Fear Valley Health, Fayetteville, North Carolina, USA
| | - Michael P. Veve
- University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA
- University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Bruce M. Jones
- St. Joseph’s/Candler Health System, Savannah, Georgia, USA
| | | | - Amy K. Feehan
- Ochsner Clinic Foundation, New Orleans, Louisiana, USA
- Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
| | - Marco R. Scipione
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
- Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Jing J. Zhao
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
- Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Paige Witucki
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael J. Rybak
- Department of Pharmacy Practice, Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
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4
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El Ghali A, Morrisette T, Alosaimy S, Lucas K, Tupayachi-Ortiz MG, Vemula R, Wadle C, Philley JV, Mejia-Chew C, Hamad Y, Stevens RW, Zeuli JD, Webb AJ, Fiske CT, Simonyan A, Cimino CL, Mammadova M, Umana VE, Hasbun R, Butt S, Molina KC, Thomas M, Kaip EA, Bouchard J, Gore TW, Howard C, Cabanilla MG, Holger DJ, Frens JJ, Barger M, Ong A, Cohen KA, Rybak MJ. Long-term evaluation of clinical success and safety of omadacycline in nontuberculous mycobacteria infections: a retrospective, multicenter cohort of real-world health outcomes. Antimicrob Agents Chemother 2023; 67:e0082423. [PMID: 37768312 PMCID: PMC10583686 DOI: 10.1128/aac.00824-23] [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: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/29/2023] Open
Abstract
Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49-67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4 - 14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75).
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Affiliation(s)
- Amer El Ghali
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Department of Clinical Pharmacy & Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
- Department of Pharmacy Services, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kristen Lucas
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Maria G. Tupayachi-Ortiz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Raaga Vemula
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carly Wadle
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Julie V. Philley
- University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yasir Hamad
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - John D. Zeuli
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J. Webb
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Christina T. Fiske
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anahit Simonyan
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christo L. Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mehriban Mammadova
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Virginia E. Umana
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Saira Butt
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kyle C. Molina
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Thomas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emily A. Kaip
- Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, North Carolina, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan W. Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Catessa Howard
- Department of Pharmacy, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - M. Gabriela Cabanilla
- Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Dana J. Holger
- Department of Pharmacy Practice, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jeremy J. Frens
- Department of Pharmacy Services, Cone Health, Greensboro, North Carolina, USA
| | - Melissa Barger
- Department of Medicine, Ventura County Medical Center, Ventura, California, USA
| | - Aaron Ong
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Keira A. Cohen
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
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5
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Alosaimy S, Rybak MJ, Sakoulas G. Reply to Scheetz et al. Clin Infect Dis 2023; 76:1522-1523. [PMID: 36550065 DOI: 10.1093/cid/ciac959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - George Sakoulas
- Division of Host-Microbe Systems and Therapeutics, University of California-San Diego School of Medicine, La Jolla, California, USA
- Infectious Diseases, Sharp Rees-Stealy, San Diego, California, USA
- Department of Pediatrics, UCSD School of Medicine, San Diego, California, USA
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6
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Rebold N, Lagnf AM, Alosaimy S, Holger DJ, Witucki P, Mannino A, Dierker M, Lucas K, Kunz Coyne AJ, El Ghali A, Caniff KE, Veve MP, Rybak MJ. Risk Factors for Carbapenem-Resistant Enterobacterales Clinical Treatment Failure. Microbiol Spectr 2023; 11:e0264722. [PMID: 36622246 PMCID: PMC9927167 DOI: 10.1128/spectrum.02647-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/29/2022] [Indexed: 01/10/2023] Open
Abstract
The Centers for Disease Control and Prevention (CDC) categorized carbapenem-resistant Enterobacterales (CRE) infections as an "urgent" health care threat requiring public attention and research. Certain patients with CRE infections may be at higher risk for poor clinical outcomes than others. Evidence on risk or protective factors for CRE infections are warranted in order to determine the most at-risk populations, especially with newer beta-lactam/beta-lactamase inhibitor (BL/BLI) antibiotics available to treat CRE. We aimed to identify specific variables involved in CRE treatment that are associated with clinical failure (either 30-day mortality, 30-day microbiologic recurrence, or clinical worsening/failure to improve throughout antibiotic treatment). We conducted a retrospective, observational cohort study of hospitalized patients with CRE infection sampled from 2010 to 2020 at two medical systems in Detroit, Michigan. Patients were included if they were ≥18 years old and culture positive for an organism in the Enterobacterales order causing clinical infection with in vitro resistance by Clinical and Laboratory Standards Institute (CLSI) breakpoints to at least one carbapenem. Overall, there were 140 confirmed CRE infections of which 39% had clinical failure. The most common infection sources were respiratory (38%), urinary (20%), intra-abdominal (16%), and primary bacteremia (14%). A multivariable logistic regression model was developed to identify statistically significant associated predictors with clinical failure, and they included Sequential Organ Failure Assessment (SOFA) score (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.06 to 1.32), chronic dialysis (aOR, 5.86; 95% CI, 1.51-22.7), and Klebsiella pneumoniae in index culture (aOR, 3.09; 95% CI, 1.28 to 7.47). Further research on CRE infections is needed to identify best practices to promote treatment success. IMPORTANCE This work compares carbapenem-resistant Enterobacterales (CRE) infections using patient, clinical, and treatment variables to understand which characteristics are associated with the highest risk of clinical failure. Knowing which risk factors are associated with CRE infection failure can provide clinicians better prognostic and targeted interventions. Research can also further investigate why certain risk factors cause more clinical failure and can help develop treatment strategies to mitigate associated risk factors.
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Affiliation(s)
- Nicholas Rebold
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M. Lagnf
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Dana J. Holger
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Paige Witucki
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Andrew Mannino
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michelle Dierker
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kristen Lucas
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ashlan J. Kunz Coyne
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Amer El Ghali
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kaylee E. Caniff
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael P. Veve
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael J. Rybak
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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7
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Alosaimy S, Lagnf AM, Hobbs ALV, Mubarez M, Kufel WD, Morrisette T, Polisetty RS, Li D, Veve MP, Simon SP, Truong J, Finch N, Venugopalan V, Rico M, Amaya L, Yost C, Cubillos A, Chandler E, Patch M, Smith IMK, Biagi M, Wrin J, Moore WJ, Molina KC, Rebold N, Holger D, Kunz Coyne AJ, Jorgensen SCJ, Witucki P, Tran NN, Davis SL, Sakoulas G, Rybak MJ. Nephrotoxicity of Vancomycin in Combination With Beta-Lactam Agents: Ceftolozane-Tazobactam vs Piperacillin-Tazobactam. Clin Infect Dis 2023; 76:e1444-e1455. [PMID: 35982631 DOI: 10.1093/cid/ciac670] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vancomycin (VAN)-associated acute kidney injury (AKI) is increased when VAN is combined with certain beta-lactams (BLs) such as piperacillin-tazobactam (TZP) but has not been evaluated with ceftolozane-tazobactam (C/T). Our aim was to investigate the AKI incidence of VAN in combination with C/T (VAN/C/T) compared with VAN in combination to TZP (VAN-TZP). METHODS We conducted a multicenter, observational, comparative study across the United States. The primary analysis was a composite outcome of AKI and risk, injury, failure, loss, end stage renal disease; Acute Kidney Injury Network; or VAN-induced nephrotoxicity according to the consensus guidelines. Multivariable logistic regression analysis was conducted to adjust for confounding variables and stratified Kaplan-Meir analysis to assess the time to nephrotoxicity between the 2 groups. RESULTS We included VAN/C/T (n = 90) and VAN-TZP (n = 284) at an enrollment ratio of 3:1. The primary outcome occurred in 12.2% vs 25.0% in the VAN-C/T and VAN-TZP groups, respectively (P = .011). After adjusting for confounding variables, VAN-TZP was associated with increased odds of AKI compared with VAN-C/T; with an adjusted odds ratio of 3.308 (95% confidence interval, 1.560-6.993). Results of the stratified Kaplan-Meir analysis with log-rank time-to-nephrotoxicity analysis indicate that time to AKI was significantly shorter among patients who received VAN-TZP (P = .004). Cox proportional hazards analysis demonstrated that TZP was consistent with the primary analysis (P = .001). CONCLUSIONS Collectively, our results suggest that the AKI is not likely to be related to tazobactam but rather to piperacillin, which is a component in VAN-TZP but not in VAN-C/T.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Athena L V Hobbs
- Department of Pharmacy, Baptist Memorial Hospital-Memphis, Memphis, Tennessee, USA
| | - Musa Mubarez
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA
| | - Wesley D Kufel
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA.,Department of Pharmacy, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA.,Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Radhika S Polisetty
- Department of Pharmacy Practice, Midwestern University College of Pharmacy Downers Grove Campus, Downers Grove, Illinois, USA.,Department of Pharmacy, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois, USA
| | - David Li
- Department of Pharmacy, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois, USA
| | - Michael P Veve
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sam P Simon
- Maimonides Medical Center, Brooklyn, New York, USA
| | - James Truong
- Department of Pharmacy, Brooklyn Hospital, Brooklyn, New York, USA
| | - Natalie Finch
- Department of Pharmacy Services, Harris Health System, Bellaire, Texas, USA
| | - Veena Venugopalan
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, Florida, USA
| | - Matthew Rico
- Department of Pharmacy, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Lee Amaya
- Department of Pharmacy, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Christine Yost
- Department of Pharmacy, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ashley Cubillos
- Department of Pharmacy, Lee Memorial Health System, Fort Myers, Florida, USA
| | - Elisabeth Chandler
- Department of Pharmacy, Lee Memorial Health System, Fort Myers, Florida, USA
| | - Megan Patch
- Department of Pharmacy, Lee Memorial Health System, Fort Myers, Florida, USA
| | | | - Mark Biagi
- Department of Pharmacy, Swedish American Hospital, Rockford, Illinois, USA
| | - Justin Wrin
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - W Justin Moore
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Kyle C Molina
- Department of Pharmacy-Infectious Disease, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Nicholas Rebold
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Dana Holger
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ashlan J Kunz Coyne
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sarah C J Jorgensen
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Paige Witucki
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Nikki N Tran
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Pharmacy, Ohio State University Waxner Medical Center, Columbus, Ohio, USA
| | - Susan L Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - George Sakoulas
- Division of Host-Microbe Systems and Therapeutics, University of California San Diego School of Medicine, San Diego, California, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan, USA.,Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
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8
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Holger DJ, Lagnf AM, Belza AC, Alosaimy S, Rebold NS, Morrisette T, Kunz Coyne AJ, Ghali AE, Veve MP, Rybak MJ. 679. Traditional vs. Alternative Agents in Patients with Lower Respiratory Tract Infections Caused by Carbapenem-Resistant Pseudomonas aeruginosa Susceptible to Traditional Agents. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Comparative effectiveness studies to guide treatment decisions for infections caused by carbapenem-resistant P. aeruginosa (CRPA) susceptible to traditional agents (non-carbapenem β-lactams and fluoroquinolones) are unavailable. This study aims to compare clinical outcomes between patients treated with traditional and alternative treatment regimens for lower respiratory tract infection (LRTI) caused by CRPA that remain susceptible to traditional agents.
Methods
Multi-center, retrospective cohort from January 2016 to December 2019. We included adults with CRPA (resistant to ≥ 1 carbapenem; meropenem or imipenem) that were susceptible to ≥1 traditional agent (piperacillin-tazobactam, cefepime, ceftazidime, ciprofloxacin, or aztreonam) by CLSI breakpoints isolated from an LRTI sample. All other antibiotics were considered alternative agents. We excluded patients with known colonization, cystic fibrosis, or who expired ≤24 hours after antibiotic receipt. Primary outcome was 30-day mortality and secondary outcomes included 30-day readmission and 30-day recurrence.
Results
In total, 87 patients, ‘traditional’ treatment (n=53) and ‘alternative’ treatment (n=34), were included from 2 institutions in Detroit, MI, USA: median(IQR) age 59(20) years, 64.4% male, and 59.8% African American. Median(IQR) APACHE II and Charlson Comorbidity index scores were 24(10) and 4(5), respectively. Most patients received traditional therapy (n=53), most commonly with cefepime (60.4%) or piperacillin-tazobactam (41.5%). While 34(39.0%) were treated with alternative agents, most commonly ceftolozane-tazobactam (64.7%) or an aminoglycoside (29.4%) alone or in combination. Thirty-day mortality was not significantly different between traditional and alternative therapy groups (22.6% and 11.8%), respectively. There was no significant difference between 30-day recurrence (17.0% and 20.6%) or 30-day readmission (22.6% and 17.6%) between groups.
Conclusion
Clinical outcomes did not differ significantly between patients receiving traditional vs. alternative agents for LRTI caused by CRPA susceptible to traditional agents. Traditional agents may be considered for these infections. Further comparative studies are needed to guide treatment decisions for CRPA.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | - Taylor Morrisette
- Medical University of South Carolina College of Pharmacy , Charleston, South Carolina
| | | | | | - Michael P Veve
- Eugene Applebaum College of Pharmacy and Health Sciences , Detroit, Michigan
| | - Michael J Rybak
- Eugene Applebaum College of Pharmacy and Health Sciences , Detroit, Michigan
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9
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Alosaimy S, Morrisette T, Lagnf AM, Rojas LM, King MA, Pullinger BM, Hobbs ALV, Perkins NB, Veve MP, Bouchard J, Gore T, Jones B, Truong J, Andrade J, Huang G, Cosimi R, Kang-Birken SL, Molina KC, Biagi M, Pierce M, Scipione MR, Zhao JJ, Davis SL, Rybak MJ. Clinical Outcomes of Eravacycline in Patients Treated Predominately for Carbapenem-Resistant Acinetobacter baumannii. Microbiol Spectr 2022; 10:e0047922. [PMID: 36190427 PMCID: PMC9602915 DOI: 10.1128/spectrum.00479-22] [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: 04/01/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Forty-six patients were treated with eravacycline (ERV) for Acinetobacter baumannii infections, where 69.5% of isolates were carbapenem resistant (CRAB). Infections were primarily pulmonary (58.3%), and most patients received combination therapy (84.4%). The median (IQR) ERV duration was 6.9 days (5.1 to 11.1). Thirty-day mortality was 23.9% in the cohort and 21.9% in CRAB patients. One patient experienced an ERV-possible adverse event. IMPORTANCE Acinetobacter baumannii, particularly when carbapenem resistant (CRAB), is one of the most challenging pathogens in the health care setting. This is complicated by the fact that there is no consensus guideline regarding management of A. baumannii infections. However, the recent Infectious Diseases Society of America guidelines for treatment of resistant Gram-negative infections provided expert recommendations for CRAB management. The panel suggest using minocycline among tetracycline derivatives rather than eravacycline (ERV) until sufficient clinical data are available. Therefore, we present the largest multicenter real-world cohort in patients treated with ERV for A. baumannii, where the majority of isolates were CRAB (69.5%). Our analysis demonstrate that patients treated with ERV-based regimens achieved a 30-day mortality of 23.9% and had a low incidence of ERV-possible adverse events (2.1%). This study is important as it fills the gap in the literature regarding the use of a novel tetracycline (i.e., ERV) in the treatment of this challenging health care infection.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M. Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | | | - Madeline A. King
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
- Cooper University Hospital, Camden, New Jersey, USA
| | - Benjamin M. Pullinger
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
- Cooper University Hospital, Camden, New Jersey, USA
| | - Athena L. V. Hobbs
- Methodist University Hospital, Memphis, Tennessee, USA
- Cardinal Health, Memphis, Tennessee, USA
| | - Nicholson B. Perkins
- University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA
| | - Michael P. Veve
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- University of Tennessee Medical Center, Knoxville, Tennessee, USA
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Bruce Jones
- St. Joseph’s/Candler Health System, Savannah, Georgia, USA
| | | | | | - Glen Huang
- University of California Los Angeles, Los Angeles, California, USA
| | - Reese Cosimi
- Ascension St. Vincent Hospital, Indianapolis, Indiana, USA
| | | | - Kyle C. Molina
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Mark Biagi
- SwedishAmerican Hospital, Rockford, Illinois, USA
- University of Illinois at Chicago, Rockford, Illinois, USA
| | | | - Marco R. Scipione
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Jing J. Zhao
- Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Susan L. Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
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10
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Rebold N, Alosaimy S, Morrisette T, Holger D, Lagnf AM, Ansari I, Belza AC, Cheaney L, Hussain H, Herbin SR, Abdul-Mutakabbir J, Carron C, Sandhu A, Chopra T, Rybak MJ. Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19. Infect Dis Ther 2022; 11:1281-1296. [PMID: 35538335 PMCID: PMC9090596 DOI: 10.1007/s40121-022-00636-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Inappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited. METHODS We conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI (n = 25) and all other COVID-19 cases (n = 570). A secondary comparison was performed between positive blood cultures with true BSI (n = 25) and contaminants (n = 33) on antibiotic use. RESULTS Fever (> 38 °C) (as a COVID-19 symptom) was not different between true BSI (n = 25) and all other COVID-19 patients (n = 570) (p = 0.93), although it was different as a reason for emergency department (ED) admission (p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group (p < 0.01, p < 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p < 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15-19.9 × 109/L) white blood cell (WBC) count at admission was also higher in the true BSI group (p < 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI (p < 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different (p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period. CONCLUSION True BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes.
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Affiliation(s)
- Nicholas Rebold
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
| | - Sara Alosaimy
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Taylor Morrisette
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
- Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Dana Holger
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | | | | | | | | | - Shelbye R Herbin
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Pharmacy, Henry Ford Wyandotte Hospital, Henry Ford Health System, Wyandotte, MI, USA
| | - Jacinda Abdul-Mutakabbir
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Avnish Sandhu
- Wayne State University, Detroit, MI, USA
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Teena Chopra
- Wayne State University, Detroit, MI, USA
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael J Rybak
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA.
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
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11
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Morrisette T, Alosaimy S, Lagnf AM, Frens JJ, Webb AJ, Veve MP, Stevens R, Bouchard J, Gore TW, Ansari I, Rybak MJ. Real-World, Multicenter Case Series of Patients Treated with Oral Omadacycline for Resistant Gram-Negative Pathogens. Infect Dis Ther 2022; 11:1715-1723. [PMID: 35567718 PMCID: PMC9334473 DOI: 10.1007/s40121-022-00645-5] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Antibiotic-resistant Gram-negative bacteria have been associated with substantial morbidity and mortality and have limited treatment options available. Omadacycline (OMC) is an aminomethylcycline antibiotic that has been shown to exhibit broad in vitro activity against antibiotic-resistant Gram-negative bacteria. Given the lack of real-world data, the primary objective of our report was to describe early experience with OMC for the treatment of resistant Gram-negative infections. METHODS This was a real-world, multicenter, observational cases series/pilot study conducted in the USA. Inclusion criteria included any adult patient aged ≥ 18 years who received OMC for ≥ 72 h either in the inpatient and/or outpatient setting. Clinical success was defined as a composite of 90-day survival from initiation of OMC, lack of alteration in treatment/addition of other antibiotic due to concerns of OMC failure, and lack of microbiologic recurrence within 30 days from the end of therapy. RESULTS Oral OMC was used in nine cases primarily for multidrug-resistant (MDR)/extensively drug-resistant (XDR) Gram-negative bacterial infections (55.6% XDR and/or carbapenem-resistant Acinetobacter baumannii [CRAB]). The majority of infections were of bone/joint (55.6%) origin, followed by intra-abdominal (33.3%) origin. Clinical success occurred in 66.7% of cases, with 80.0% success each in infections of bone/joint origin or those caused by CRAB. One patient experienced an adverse effect that was not treatment limiting while on therapy (gastrointestinal). CONCLUSION The use of oral OMC in MDR/XDR Gram-negative infections exhibited a relatively high success rate with minimal adverse effects. Real-world studies with larger case numbers are needed to confirm our initial findings.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.,Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC, 29425, USA.,Department of Clinical Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC, 29425, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Jeremy J Frens
- Department of Pharmacy, Cone Health, 1121 North Church Street, Greensboro, NC, 27401, USA
| | - Andrew J Webb
- Department of Pharmacy, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Michael P Veve
- University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.,Department of Clinical Pharmacy and Transplational Science, College of Pharmacy, University of Tennessee Health Science Center, 1924 Alcoa Hwy, Knoxville, TN, 37920, USA.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48206, USA
| | - Ryan Stevens
- Department of Pharmacy, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Tristan W Gore
- College of Pharmacy, University of South Carolina, 715 Sumter Street, Columbia, SC, 29208, USA
| | - Iman Ansari
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. .,Division of Infectious Diseases, Department of Medicine, Wayne State University, 540 E Canfield Street, Detroit, MI, 48201, USA. .,Department of Pharmacy, Detroit Receiving Hospital, 4201 St Antoine, Detroit, MI, 48201, USA.
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12
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Alosaimy S, Mohammad I, Chahine EB, Saad A, Jaber LA, El‐Ghali A. Culturally Sensitive Recommendations for the Clinical Pharmacist to Engage the Arab American Patient. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara Alosaimy
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Insaf Mohammad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Elias B. Chahine
- Department of Pharmacy Practice Gregory School of Pharmacy, Palm Beach Atlantic University West Palm Beach Florida
| | - Aline Saad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Linda A. Jaber
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Amer El‐Ghali
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
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13
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Rebold N, Morrisette T, Lagnf AM, Alosaimy S, Holger D, Barber K, Justo JA, Antosz K, Carlson TJ, Frens JJ, Biagi M, Kufel WD, Moore WJ, Mercuro N, Raux BR, Rybak MJ. Early Multicenter Experience With Imipenem-Cilastatin-Relebactam for Multidrug-Resistant Gram-Negative Infections. Open Forum Infect Dis 2021; 8:ofab554. [PMID: 34901302 PMCID: PMC8661073 DOI: 10.1093/ofid/ofab554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 01/22/2023] Open
Abstract
A multicenter case series of 21 patients were treated with imipenem-cilastatin-relebactam. There were mixed infection sources, with pulmonary infections (11/21,52%) composing the majority. The primary pathogen was Pseudomonas aeruginosa (16/21, 76%), and 15/16 (94%) isolates were multidrug-resistant. Thirty-day survival occurred in 14/21 (67%) patients. Two patients experienced adverse effects.
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Affiliation(s)
- Nicholas Rebold
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Pharmacy & Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Dana Holger
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Katie Barber
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Julie Ann Justo
- Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina, USA.,Department of Pharmacy, Prisma Health-Midlands, Columbia, South Carolina, USA
| | - Kayla Antosz
- Department of Pharmacy, Prisma Health-Midlands, Columbia, South Carolina, USA
| | - Travis J Carlson
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, North Carolina, USA
| | - Jeremy J Frens
- Department of Pharmacy, Moses H. Cone Memorial Hospital, Cone Health, Greensboro, North Carolina, USA
| | - Mark Biagi
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Pharmacy, Swedish American Health System, Rockford, Illinois, USA
| | - Wesley D Kufel
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA.,Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - William J Moore
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Nicholas Mercuro
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Pharmacy, Maine Medical Center, Portland, Maine, USA
| | - Brian R Raux
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
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14
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Alosaimy S, Murray KP, Zasowski EJ, Morrisette T, Lagnf AM, Lodise TP, Rybak MJ. Vancomycin Area Under the Curve to Predict Timely Clinical Response in the Treatment of Methicillin-resistant Staphylococcus aureus Complicated Skin and Soft Tissue Infections. Clin Infect Dis 2021; 73:e4560-e4567. [PMID: 32716506 PMCID: PMC8662764 DOI: 10.1093/cid/ciaa1039] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/20/2020] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Although recent guidelines have recommended monitoring vancomycin (VAN) area under the curve (AUC)/minimum inhibitory concentration (MIC) to ensure clinical efficacy and minimize toxicity in methicillin-resistant Staphylococcus aureus (MRSA) for various infections, there are no recommendations regarding complicated skin and soft tissue infections (cSSTIs). We aimed to evaluate the association between VAN AUC and clinical outcomes in MRSA cSSTIs. METHODS This was a retrospective cohort study of adult patients treated with ≥72 hours of VAN for MRSA cSSTI from 2008 to 2013 at Detroit Medical Center. The primary outcome was timely clinical success (TCS) defined as (1) resolution of signs and symptoms of infection within 72 hours, (2) stabilization and/or reduction in lesion size, (3) alternative agents not required due to VAN failure or toxicity as elected by the prescribing clinician. Classification and regression tree (CART) analysis was performed to determine the AUC associated with TCS in the cohort. Multivariable logistic regression was used to evaluate the association between VAN-AUC and the primary outcome. RESULTS A total of 154 patients were included in this analysis. CART identifed an AUC ≥435 mg*hr/L for TCS. Overall, 60.9% of patients experienced TCS; 69.7% in the target-AUC group versus 52.5% in the below-target AUC group, (P = .013). Target-AUC attainment was independently associated with increased odds of TCS (adjusted odds ratio [aOR], 2.208; 95% confidence interval [CI], 1.047-4.659). CONCLUSIONS In adults treated with VAN for MRSA cSSTI, target-AUC attainment was independently associated with improved clinical outcomes and maybe most warranted for patients at high risk of VAN failure or VAN-associated toxicity.
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Affiliation(s)
- Sara Alosaimy
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kyle P Murray
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
| | - Evan J Zasowski
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Taylor Morrisette
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
- Albany Medical Center Hospital, Albany, New York, USA
| | - Michael J Rybak
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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15
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Rebold N, Alosaimy S, Lagnf AM, Holger D, Rybak MJ. 686. Comparing Treatments of Methicillin-Resistant Staphylococcus aureus Infective Endocarditis by People Who Inject Drugs. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People who inject drugs (PWID) are at high risk for infective endocarditis (IE) with high-mortality pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Stigma against PWID may cause differences in treatment and outcomes between these patients infected with MRSA IE.
Methods
Single center retrospective cohort study from August 2006 to February 2021 that includes adult patients diagnosed with IE. Primary outcomes included 90-day all-cause mortality, 60-day MRSA recurrence, 60-day readmission, and hospital length of stay (LOS). Statistical analysis was performed by chi-square, t-test, and Mann-Whitney-U as appropriate.
Results
A total of 214 patients were diagnosed with MRSA IE; 89 PWID and 125 non-PWID. The mean (SD) age was 47.4±12.4 years (PWID) vs 59.3 ±16.0 years (non-PWID) (p< 0.001). Patients were primarily male (56%), but differed in terms of race 34% African-American (AA) (PWID) vs 66% AA (non-PWID) (p< 0001). Mean APACHE II scores differed between groups: 16(±9.9) (PWID) vs 19(±8.1) (non-PWID) (p< 0.008). Among patients who cleared bacteremia, mean (SD) duration was 5.7(±3.9) days and was not significant between groups (p< 0.64). Valve-type was 93% native and 7% prosthetic and not different between groups (p< 0.16). Infectious Diseases consult did not differ at 96% overall (p< 0.31), but pursuit of source control nearly reached significance at 27% for PWID vs 41% non-PWID (p< 0.06). Similarly, use of combination therapy daptomycin and ceftaroline was nearly significant: 21% (PWID) vs 12% (non-PWID) (p< 0.09). Odds ratio of PWID and combination therapy remained non-significant after regression: 0.39(0.14-1.1,p< 0.07). Primary 90-day mortality was lower in PWID vs non-PWID (15% vs 30%) respectively (p< 0.01), but did not differ in 60-day MRSA recurrence (p< 1.0) at 9%, 60-day readmission (p< 1.0) at 33%, or median LOS (IQR) (p< 0.46) at 15 (10-24) days overall.
Conclusion
While PWID are significantly younger, less critically ill, and have lower mortality compared to non-PWID, they have similar LOS, MRSA recurrence, and readmission rates. Analyses suggest a potential difference in the pursuit of source control and combination therapy among PWID, however more studies may be needed to achieve significance.
Disclosures
Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)
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Affiliation(s)
| | | | | | - Dana Holger
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, detroit, Michigan
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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16
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Morrisette T, Alosaimy S, Lagnf AM, Philley JV, Sigler C, Butt S, Kaip EA, MacDougall C, Mejia-Chew C, Bouchard J, Frens JJ, Gore T, Hamad Y, Howard C, Barger M, Gabriela Cabanilla M, Ong A, Veve MP, Webb AJ, Stevens RW, Cohen KA, Rybak MJ. 1082. Real-World Experience with Omadacycline for Nontuberculous Mycobacterial Infections: A Multicenter Evaluation. Open Forum Infect Dis 2021. [PMCID: PMC8644900 DOI: 10.1093/ofid/ofab466.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Nontuberculous mycobacteria (NTM) are resistant to numerous antibiotics and lead to significant morbidity and mortality. Omadacycline (OMC) is an aminomethylcycline antibiotic that is Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. Furthermore, OMC has shown in vitro activity against NTM. Given that real-world evidence is lacking, our primary objective was to evaluate the clinical success and tolerability of OMC when used for a variety of NTM infections.
Methods
This was a multicenter, retrospective, observational study conducted from January 2020 to June 2021. We included all patients ≥ 18 years of age that received OMC of any indication for Mycobacterium spp. The primary outcome was clinical success, defined as a lack of all-cause mortality, lack of persistence or re-emergence of infection during or after therapy, and lack of alteration of OMC. Incidence of adverse effects potentially attributable to OMC and reasons for OMC utilization were also analyzed.
Results
A total of 31 patients were included from 12 geographically distinct academic health systems (median age: 57 (IQR, 45-63) years; 45% male; 81% Caucasian). The majority of isolated pathogens were Mycobacterium abscessus complex (84%) and of those with subspeciation performed (54%), the majority (86%) were subsp. abscessus. The primary infections were of pulmonary origin (67%) and the median (IQR) duration of OMC therapy was 5.3 (3.2-9.4) months. Most isolates did not have OMC susceptibility conducted (87%), while the majority did for tigecycline (90%). Clinical success was reported in 81% of the population. Most patients were on combination antimicrobial therapy, and 39% of patients reported an adverse effect while on OMC (58% gastrointestinal distress). The majority of patients were prescribed OMC due to ease of administration (61%) and antimicrobial resistance to previous antibiotics (42%).
Conclusion
OMC may be a potential option for the therapy of NTM infections. Prospective, randomized clinical trials are needed to confirm our preliminary findings.
Disclosures
Julie V. Philley, MD, Paratek Pharmaceuticals (Advisor or Review Panel member)Paratek Pharmaceuticals, Inc. (Consultant) Michael P. Veve, Pharm.D., Cumberland (Grant/Research Support)Paratek Pharmaceuticals (Research Grant or Support) Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support)
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Wayne State University, Detroit, Michigan
| | | | | | | | - Carly Sigler
- The University of Texas Health Science Center, Tyler, Texas
| | - Saira Butt
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily A Kaip
- University of California, San Francisco Medical Center, San Francisco, California
| | - Conan MacDougall
- University of California San Francisco School of Pharmacy, San Francisco, California
| | | | | | | | - Tristan Gore
- Univeristy of South Carolina, Columbia, South Carolina
| | | | | | | | | | - Aaron Ong
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Keira A Cohen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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17
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Alosaimy S, Lagnf AM, Morrisette T, Scipione MR, Zhao JJ, Jorgensen SCJ, Mynatt R, Carlson TJ, Jo J, Garey KW, Allen D, DeRonde K, Vega AD, Abbo LM, Venugopalan V, Athans V, Saw S, Claeys KC, Miller M, Molina KC, Veve M, Kufel WD, Amaya L, Yost C, Ortwine J, Davis SL, Rybak MJ. Real-world, Multicenter Experience With Meropenem-Vaborbactam for Gram-Negative Bacterial Infections Including Carbapenem-Resistant Enterobacterales and Pseudomonas aeruginosa. Open Forum Infect Dis 2021; 8:ofab371. [PMID: 34430671 PMCID: PMC8378588 DOI: 10.1093/ofid/ofab371] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background We aimed to describe the clinical characteristics and outcomes of patients treated with meropenem-vaborbactam (MEV) for a variety of gram-negative infections (GNIs), primarily including carbapenem-resistant Enterobacterales (CRE). Methods This is a real-world, multicenter, retrospective cohort within the United States between 2017 and 2020. Adult patients who received MEV for ≥72 hours were eligible for inclusion. The primary outcome was 30-day mortality. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineated the risk of negative clinical outcomes (NCOs) and was examined by multivariable logistic regression analysis (MLR). Results Overall, 126 patients were evaluated from 13 medical centers in 10 states. The most common infection sources were respiratory tract (38.1%) and intra-abdominal (19.0%) origin, while the most common isolated pathogens were CRE (78.6%). Thirty-day mortality and recurrence occurred in 18.3% and 11.9%, respectively. Adverse events occurred in 4 patients: nephrotoxicity (n = 2), hepatoxicity (n = 1), and rash (n = 1). CART-BP between early and delayed treatment was 48 hours (P = .04). MEV initiation within 48 hours was independently associated with reduced NCO following analysis by MLR (adusted odds ratio, 0.277; 95% CI, 0.081–0.941). Conclusions Our results support current evidence establishing positive clinical and safety outcomes of MEV in GNIs, including CRE. We suggest that delaying appropriate therapy for CRE significantly increases the risk of NCOs.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marco R Scipione
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Jing J Zhao
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ryan Mynatt
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,University of Kentucky, Lexington, Kentucky, USA
| | - Travis J Carlson
- College of Pharmacy, University of Houston, Houston, Texas, USA.,Fred Wilson School of Pharmacy, High Point University, High Point, North Carolina, USA
| | - Jinhee Jo
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Kevin W Garey
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - David Allen
- Department of Pharmacy, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | | | - Ana D Vega
- Jackson Health System, Miami, Florida, USA
| | | | - Veena Venugopalan
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Vasilios Athans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Saw
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberly C Claeys
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Mathew Miller
- University of Colorado Hospital, Aurora, Colorado, USA
| | - Kyle C Molina
- University of Colorado Hospital, Aurora, Colorado, USA
| | - Michael Veve
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,College of Pharmacy, University of Tennessee, Knoxville, Tennessee, USA.,University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Wesley D Kufel
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA.,State University of New York Update Medical University, Syracuse, New York, USA
| | - Lee Amaya
- Beaumont Hospital, Royal Oak, Michigan, USA.,Miami Cancer Institute, Miami, Florida, USA
| | | | - Jessica Ortwine
- Parkland Health and Health hospital system, Dallas, Texas, USA
| | - Susan L Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA.,Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
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18
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Moore WJ, Webb A, Morrisette T, Sullivan LK, Alosaimy S, Hossain S, Howe Z, Vlashyn OO, Paloucek FP, Rybak MJ, Wang SK. Impact of COVID-19 pandemic on training of pharmacy residents and fellows: Results from a national survey of postgraduate pharmacy trainees. Am J Health Syst Pharm 2021; 78:1104-1111. [PMID: 33740818 PMCID: PMC8083788 DOI: 10.1093/ajhp/zxab114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose The coronavirus disease 2019 (COVID-19) pandemic has impacted the activities of healthcare workers, including postgraduate pharmacy trainees. Quality training experiences must be maintained to produce competent pharmacy practitioners and maintain program standards. Methods A cross-sectional survey of postgraduate pharmacy trainees in the United States was conducted to evaluate training experience changes and assess perceived impacts on residents and fellows following the COVID-19 pandemic’s onset. Results From June 4 through June 22, 2020, 511 pharmacy trainees in 46 states completed the survey. Participants’ median age was 26 (interquartile range [IQR], 25-28) years, with included responses from postgraduate year 1 residents (54% of sample), postgraduate year 2 residents (40%), and postgraduate fellows (6%). Compared to experiences prior to the onset of the COVID-19 pandemic, fewer trainees conducted direct patient care (38.5% vs 91.4%, P < 0.001), more worked from home (31.7% vs 1.6%, P < 0.001), and less time was spent with preceptors per day (2 [IQR, 2-6] hours vs 4 [IQR, 1-4] hours, P < 0.001). Sixty-five percent of respondents reported experiencing changes in their training program, 39% reported being asked to work in areas outside of their routine training experience, and 89% stated their training shifted to focus on COVID-19 to some degree. Most respondents perceived either major (9.6%) or minor (52.0%) worsening in quality of experience, with major and minor improvement in quality of experience reported by 5.5% and 8.4% of respondents, respectively. Conclusion Pharmacy resident/fellow experiences were perceived to have been extensively impacted by the COVID-19 pandemic in varying ways. Our findings describe shifts in postgraduate training and may aid in the development of best practices for optimizing trainee experiences in future crises.
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Affiliation(s)
- W Justin Moore
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - Andrew Webb
- Department of Pharmacy, Oregon Health & Science University, Portland OR, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Louisa K Sullivan
- Department of Pharmacy, Arizona Burn Center - Valleywise Health, Phoenix, AZ, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Shahrier Hossain
- Department of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zachary Howe
- Department of Pharmacy, Indiana University Health AHC, Indianapolis, IN, USA
| | - Olga O Vlashyn
- Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Frank P Paloucek
- Department of Pharmacy Practice, University of Illinois-Chicago College of Pharmacy, Chicago, IL, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory & Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sheila K Wang
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
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19
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Alosaimy S, Lagnf AM, Morrisette T, Jorgensen SCJ, Trinh TD, Zasowski EJ, Scipione MR, Zhao JJ, Mynatt R, Herbin S, Dhar S, Chopra T, Janisse J, Rebold N, Pogue JM, Rybak MJ. Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study. Open Forum Infect Dis 2021; 8:ofab261. [PMID: 34258313 PMCID: PMC8271135 DOI: 10.1093/ofid/ofab261] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN) and daptomycin (DAP) are combined with beta-lactams (BLs), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality. Methods The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard of care (VAN or DAP) and a mandatory Infectious Diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013 and 2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables. Results Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared with prepathway (PRE) patients (n = 379), those treated postpathway (POST; n = 434) had a significant reduction in 30-day and 90-day mortality: 9.7% in POST vs 15.6% in PRE (P = .011) and 12.2% in POST vs 19.0% in PRE (P = .007), respectively. The incidence of acute kidney injury (AKI) was higher in the PRE compared with the POST group: 9.6% vs 7.2% (P = .282), respectively. After adjusting for confounding variables including Infectious Diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% CI, 0.375–0.986). Conclusions Implementation of an MRSA BSI treatment pathway with early use of BL reduced mortality with no increased rate of AKI. Further prospective evaluation of this pathway approach is warranted.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Trang D Trinh
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Evan J Zasowski
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marco R Scipione
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Jing J Zhao
- Harper University Hospital, Detroit, Michigan, USA
| | - Ryan Mynatt
- University of Kentucky, Lexington, Kentucky, USA
| | - Shelbye Herbin
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Sorabh Dhar
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Division of Infectious Diseases, John D. Dingell, Veterans Administration Medical Center, Detroit, Michigan, USA
| | - Teena Chopra
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Detroit Medical Center, Detroit, Michigan, USA
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Nicholas Rebold
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Jason M Pogue
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA.,Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
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20
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Jorgensen SCJ, Zasowski EJ, Trinh TD, Lagnf AM, Bhatia S, Sabagha N, Abdul-Mutakabbir JC, Alosaimy S, Mynatt RP, Davis SL, Rybak MJ. Daptomycin Plus β-Lactam Combination Therapy for Methicillin-resistant Staphylococcus aureus Bloodstream Infections: A Retrospective, Comparative Cohort Study. Clin Infect Dis 2021; 71:1-10. [PMID: 31404468 DOI: 10.1093/cid/ciz746] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mounting evidence suggests the addition of a β-lactam (BL) to daptomycin (DAP) results in synergistic in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and bolsters the innate immune response to infection. This study's objective was to provide clinical translation to these experimental data and determine if DAP+BL combination therapy results in improved clinical outcomes compared with treatment with DAP alone in patients with MRSA bloodstream infections (BSIs). METHODS This was a retrospective, comparative cohort study conducted at 2 academic medical centers between 2008 and 2018. Adults with MRSA BSI treated with DAP for ≥72 hours and initiated ≤5 days of culture collection were included. Patients who received a BL for ≥24 hours and initiated ≤24 hours of DAP comprised the DAP+BL group. The primary outcome was composite clinical failure (60-day all-cause mortality and/or 60-day recurrence). Analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW). RESULTS A total of 229 patients were included (72 DAP+BL and 157 DAP). In unadjusted and IPTW-adjusted analyses, DAP+BL was associated with significantly reduced odds of clinical failure (odds ratio [OR], 0.362; 95% confidence interval [CI], .164-.801; adjusted OR, 0.386; 95% CI, .175-.853). Adjusted analyses restricted to prespecified subgroups based on infection complexity and baseline health status were consistent with the main analysis. CONCLUSIONS The addition of a BL to DAP was associated with improved clinical outcomes in patients with MRSA BSI. This study provides support to ongoing and future studies evaluating the impact of combination therapy for invasive MRSA infections.Patients treated with daptomycin plus a β-lactam for MRSA bloodstream infection had lower odds of composite clinical failure defined as 60-day all-cause mortality and/or 60-day recurrence compared with patients treated with daptomycin monotherapy after adjusting for confounding variables using inverse probability of treatment weighting.
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Affiliation(s)
- Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Evan J Zasowski
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy, Touro University California College of Pharmacy, Vallejo, California, USA
| | - Trang D Trinh
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sahil Bhatia
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Noor Sabagha
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ryan P Mynatt
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
| | - Susan L Davis
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit; and
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA.,School of Medicine, Wayne State University, Detroit, Michigan, USA
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21
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Rebold N, Holger D, Alosaimy S, Morrisette T, Rybak M. COVID-19: Before the Fall, An Evidence-Based Narrative Review of Treatment Options. Infect Dis Ther 2021; 10:93-113. [PMID: 33495967 PMCID: PMC7831619 DOI: 10.1007/s40121-021-00399-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022] Open
Abstract
The 2019 novel coronavirus (COVID-19) has quickly become one of the most dire international pandemic crises since the 1918 Spanish flu. Evidence for COVID-19 pharmacological therapies has shown rapid growth and a diverse array of results, but an assessment of the value of each piece of evidence must be reinforced. This article aims to review utilized therapies, the evidence level supporting these therapies, as well as drugs under investigation for the treatment of COVID-19. Primary scrutinized therapies include antiviral regimens, such as remdesivir, hydroxychloroquine/chloroquine, lopinavir/ritonavir, immunomodulating drugs, such as corticosteroids and interleukin (IL) inhibitors, and other therapies including convalescent plasma. Only one therapy, dexamethasone, has shown a mortality benefit in randomized controlled trials and summarized evidence for other therapies show limited positive results. Reviewing these therapies in a historical way shows how limited evidence can drive therapy decisions. A broad summary of available evidence can assist clinicians in a return to hierarchical assessments of evidence which can lead to safer patient outcomes, improved distribution of resources, and better targets for appropriate therapy decisions.
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Affiliation(s)
- Nicholas Rebold
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Dana Holger
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Michael Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
- Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI, USA.
- Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
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22
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Morrisette T, Alosaimy S, Philley JV, Wadle C, Howard C, Webb AJ, Veve MP, Barger ML, Bouchard J, Gore TW, Lagnf AM, Ansari I, Mejia-Chew C, Cohen KA, Rybak MJ. Preliminary, Real-world, Multicenter Experience With Omadacycline for Mycobacterium abscessus Infections. Open Forum Infect Dis 2021; 8:ofab002. [PMID: 33628856 PMCID: PMC7890947 DOI: 10.1093/ofid/ofab002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
Twelve patients were treated with omadacycline (OMC) as part of a multidrug regimen for Mycobacterium abscessus. The majority of infections were of pulmonary origin (7/12; 58.3%). The median (interquartile range) duration of OMC was 6.2 (4.2-11.0) months. Clinical success occurred in 9/12 (75.0%) patients. Three patients experienced a possible adverse effect while on therapy.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Julie V Philley
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Carly Wadle
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, University of Texas, Tyler, Texas, USA
| | - Catessa Howard
- Department of Pharmacy, West Virginia University Medicine, Morgantown, West Virginia, USA
| | - Andrew J Webb
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Michael P Veve
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, Tennessee, USA
- Department of Pharmacy, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Melissa L Barger
- Department of Medicine, Ventura County Medical Center, Ventura, California, USA
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Tristan W Gore
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Iman Ansari
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keira A Cohen
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Marlyand, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
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23
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Alosaimy S, Lagnf AM, Jorgensen S, Carlson TJ, Jo J, Garey KW, Allen D, Abbo LM, Abbo LM, DeRonde K, Vega A, Venugopalan V, Saw S, Athans V, Claeys KC, Kufel W, Miller M, Veve M, Yost C, Amaya L, Ortwine J, Morrisette T, Davis SL, Davis SL, Rybak MJ. 1575. Predictors of Negative Clinical Outcomes among Patients treated with Meropenem-Vaborbactam for Serious Gram-Negative Bacterial Infections: Impact of Delayed Appropriate Antibiotic Selection. Open Forum Infect Dis 2020. [PMCID: PMC7778041 DOI: 10.1093/ofid/ofaa439.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Numerous number of studies have found a positive correlation between delayed appropriate antibiotic therapy and negative clinical outcomes (NCO) in Gram-negative bacterial infections (GNBI). The combination of meropenem with vaborbactam (MVB) received Food and Drug Administration approval for the treatment of complicated urinary tract infections and acute pyelonephritis caused by susceptible organisms in August 2017. We sought to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI.
Methods
Multi-center, retrospective cohort study from October 2017 to March 2020. We included adult patients treated with MVB for >72 hours. We excluded patients who received alternative appropriate antibiotics for GNB prior to MVB and patients with unknown dates for index culture. NCO were defined as 30-day mortality and/or microbiological recurrence. All outcomes were measured from MVB start date. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineates the risk of NCO. Multivariable logistic regression analysis (MLR) was used to examine the independent association between the CART-derived-BP and NCO. Variables were retained in the model if P< 0.2 and removed in a backward stepwise approach.
Results
A total of 86 patients were included from 13 institutions in the United States: median(IQR) age 55 (37-67) years, 67% male, and 48% Caucasian. Median(IQR) APACHE II and Charlson Comorbidity index scores were 18(11-26) and 4(2-6), respectively. Common sources of infection were respiratory (37%) and intra-abdominal (21%). The most common pathogens were carbapenem-resistant Enterobacterales (83%). CART-derived BP between early and delayed treatment was 48 hours, where NCO was increased (36% vs.7%; P=0.04). Delayed MVB initiation was independently associated with NCO in the MLR (aOR=7.4, P=0.02).
Results of Regression Analysis of Variables Associated With Negative Clinical Outcomes and Delayed Appropriate Therapy with Meropenem-vaborbactam
Conclusion
Our results suggest that delaying appropriate antibiotic therapy with MVB for >48 hours significantly increases the risk of NCO in patients with GNBI. Clinicians must ensure timely administration of MVB to assure best outcomes in patients with GNBI.
Disclosures
Kevin W. Garey, PharMD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)
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Affiliation(s)
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory; Wayne State University, Detroit, Michigan
| | | | | | - Jinhee Jo
- University of Houston, Houston, Texas
| | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, TX
| | | | - Lilian M Abbo
- University of Miami Miller School of Medicine & Jackson Health System, Miami, Florida
| | - Lilian M Abbo
- University of Miami Miller School of Medicine & Jackson Health System, Miami, Florida
| | | | - Ana Vega
- Jackson Memorial Hospital, Miami, FL
| | | | - Steven Saw
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vasilios Athans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Michael Veve
- University of Tennessee Medical Center, Knoxville, TN
| | | | | | | | | | - Susan L Davis
- Wayne State University / Henry Ford Hospital, Detroit, Michigan
| | - Susan L Davis
- Wayne State University / Henry Ford Hospital, Detroit, Michigan
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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24
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Morrisette T, Philley JV, Sigler C, Frens JJ, Webb AJ, Stevens RW, Howard C, Bouchard J, Bookstaver PB, Barger M, Lagnf AM, Alosaimy S, Rybak MJ. 1290. Real-World Experience with Omadacycline for Nontuberculous Mycobacterial and Gram-Negative Infections: A Multicenter Evaluation. Open Forum Infect Dis 2020. [PMCID: PMC7776159 DOI: 10.1093/ofid/ofaa439.1473] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Omadacycline (OMC) is an aminomethylcycline antibiotic in the tetracycline class that has been Food and Drug Administration-approved for acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia. OMC has been shown to have potent in vitro activity against a broad-spectrum of Gram-positive and Gram-negative organisms, as well as Nontuberculous Mycobacteria (NTM). Due to it’s unique activity and availability as an oral agent, off-label use of OMC has been increasing. We evaluated the real-world effectiveness and safety of OMC for a variety of infections. Methods This was a multicenter, retrospective, observational study that was conducted from January 2020 to June 2020. We included all patients ≥ 18 years of age that received OMC for ≥ 72 hours for any indication and/or pathogen. The primary outcome was clinical success, defined as a lack of 30-day (non-NTM) or 90-day (NTM) mortality or microbiologic recurrence and absence of therapy escalation or alteration. Reasons for OMC utilization and incidence of potential adverse effects attributable to OMC were also analyzed. Results A total of 18 patients were included from six geographically distinct academic health systems (median age: 56 (IQR, 49-60.5) years; 61% male; 72% Caucasian). The majority of OMC use was in NTM (61%; 100% Mycobacterium abscessus) and in Acinetobacter baumannii (22%) for bone/joint (39%) and respiratory tract (33%) infections. OMC was used primarily in the outpatient setting alone (83%) and most isolates did not have OMC susceptibility conducted (89%). Clinical success was reported in 83% of the total population (71% non-NTM and 91% NTM). The majority of patients were prescribed OMC due to antimicrobial resistance to previous antibiotic(s) (61%) and/or due to OMC’s availability as an oral agent (44%). Three patients experienced side effects while on therapy (serum creatinine elevation, AST/ALT increase, and gastrointestinal distress). Conclusion OMC appears to be effective and well-tolerated for a variety of infections caused by various pathogens, including M. abscessus and A. baumannii. Disclosures Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)
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Affiliation(s)
- Taylor Morrisette
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | | | - Carly Sigler
- The University of Texas Health Science Center, Tyler, Texas
| | | | | | | | | | | | - P B Bookstaver
- The University of South Carolina College of Pharmacy, Columbia, South Carolina
| | | | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory; Wayne State University, Detroit, Michigan
| | | | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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25
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Alosaimy S, Lagnf AM, Molina K, King M, Pullinger B, Tart S, Jones BM, Claeys KC, Truong J, Andrade JA, Biagi M, Pierce M, Cosimi R, Hobbs ALV, Perkins N, Huang G, Veve M, Morrisette T, Davis SL, Davis SL, Rybak MJ. 1577. Real-World, Multicenter Experience with Eravacycline for Various Infections. Open Forum Infect Dis 2020. [PMCID: PMC7777677 DOI: 10.1093/ofid/ofaa439.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Eravacycline (ERV) is Food and Drug Administration approved in patients for the treatment of adults complicated intra-abdominal infections in 2018. Real-world data regarding the indications for ERV use are is limited. We evaluated the clinical/safety outcomes of patients treated with ERV in FDA and non-FDA approved indications.
Methods
Multicenter, retrospective, observational study from September 2018 to June 2020. Adult patients treated with ERV for ³ 72 hours were included. The primary outcome was 30-day survival. Secondary outcomes included a lack of 30-day infection-recurrence, resolution of signs/symptoms of infection and safety. All outcomes were measured from ERV start date.
Results
Overall, 108 patients were included from 12 geographically-distinct medical centers across the United States. The median(IQR) age was 60(52-67) years and 60% were male. Median(IQR) APACHE II and Charlson Comorbidity scores were 15(11-21) and 3 (2-6), respectively. The most common sources of infection were intra-abdominal (32%), and respiratory (24%). Common pathogens included Acinetobacter baumannii (19%), Klebsiella pneumoniae and Enterococcus faecium (16%). Infectious diseases consultation was obtained in 98%, and surgical interventions in 51% of cases. Patients often received active therapy prior to ERV(40%). Median(IQR) ERV therapy duration was 7.7(4.4-14.0) days. Among cases with documented cultures, ERV was initiated within a median(IQR) of 4.8(2.5-9.9) days. Combination therapy ³ 48 hours was given in 45%. The primary endpoint was achieved in 79%(85/108). Of patients who died(n=23), 57% were on monotherapy, 39% were critically ill, 39% had intra-abdominal as a source, and 30% had positive blood cultures. For secondary outcomes, 94%(102/108) lacked 30-day infection-recurrence and 74%(80/108) resolved signs/symptoms of infection. ERV was selected primarily for consolidation of the regimen(40%). Eight patients experienced a probable ERV-related adverse event, mainly gastrointestinal(87.5%) and none experienced clostridium difficile.
Conclusion
30-day survival was achieved in the majority of patients treated with ERV. Studies with longer follow-up are required to confirm these findings.
Disclosures
Madeline King, PharmD, Tetraphase (Speaker’s Bureau) Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Michael J. Rybak, PharmD, MPH, PhD, Paratek (Grant/Research Support)
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Affiliation(s)
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory; Wayne State University, Detroit, Michigan
| | | | - Madeline King
- Philadelphia College of Pharmacy, Philadelphia, Pennsylvania
| | | | - Serina Tart
- Cape Fear Valley Medical Center, Fayetteville, North Carolina
| | | | | | - James Truong
- The Brooklyn Hospital Center, Brooklyn, New York
| | | | - Mark Biagi
- University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | | | | | | | | | | | - Michael Veve
- University of Tennessee Medical Center, Knoxville, TN
| | | | - Susan L Davis
- Wayne State University / Henry Ford Hospital, Detroit, Michigan
| | - Susan L Davis
- Wayne State University / Henry Ford Hospital, Detroit, Michigan
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
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26
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Abdul-Mutakabbir JC, Alosaimy S, Morrisette T, Kebriaei R, Rybak MJ. Cefiderocol: A Novel Siderophore Cephalosporin against Multidrug-Resistant Gram-Negative Pathogens. Pharmacotherapy 2020; 40:1228-1247. [PMID: 33068441 DOI: 10.1002/phar.2476] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cefiderocol (CFDC), (formerly S-649266), is a novel injectable siderophore cephalosporin developed by Shionogi & Co., Ltd., with potent in vitro activity against Gram-negative pathogens including multidrug-resistant (MDR) Enterobacteriaceae and non-fermenting organisms, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cepacia, and Stenotrophomonas maltophilia. Characterized by its siderophore catechol-moiety, CFDC uses a "trojan-horse approach" to navigate through the bacterial periplasmic space, thus evading various beta-lactam degrading enzymes and other mechanisms of resistance present in Gram-negative bacteria. More specifically in carbapenem-resistant Enterobacteriaceae, CFDC has been shown to have activity against extended spectrum beta-lactamases (ESBLs), such as CTX-type, SHV-type, and TEM-type, as well as the Ambler classes of beta-lactamases, including class A (KPC), class B (NDM, IMP, and VIM), class C (AmpC), and class D (OXA, OXA-24, OXA-48, and OXA-48-like). In addition to the strong activity that CFDC has been shown to have against MDR P. aeruginosa, it has also displayed activity against the OXA-23, OXA-24, and OXA-51, beta-lactamases commonly found in MDR A. baumannii. Cefiderocol was recently approved by the US Food and Drug Administration (FDA) for use in complicated urinary tract infections (cUTI), including pyelonephritis, for use in patients 18 years or older with limited or no alternative options for treatment, and is currently being evaluated in a phase III trial for use in nosocomial pneumonia caused by Gram-negative pathogens. The unique features and enhanced activity of CFDC suggest that it is likely to serve as a viable therapeutic option in the treatment of MDR Gram-negative infections. The purpose of this review is to provide an overview of previously published literature explaining CFDC's pharmacology, pharmacokinetic / pharmacodynamic (PK / PD) properties, microbiologic activity, resistance mechanisms, safety parameters, dosing and administration, clinical data, and potential place in therapy.
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Affiliation(s)
- Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Razieh Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan, USA
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27
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Morrisette T, Lagnf AM, Alosaimy S, Rybak MJ. A comparison of daptomycin alone and in combination with ceftaroline fosamil for methicillin-resistant Staphylococcus aureus bacteremia complicated by septic pulmonary emboli. Eur J Clin Microbiol Infect Dis 2020; 39:2199-2203. [PMID: 32535805 DOI: 10.1007/s10096-020-03941-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/18/2020] [Accepted: 06/02/2020] [Indexed: 10/23/2022]
Abstract
The use of daptomycin (DAP) in septic pulmonary emboli (SPE) remains controversial. We analyzed 29 cases of MRSA bacteremia complicated by SPE treated with DAP (n = 14) or DAP-ceftaroline fosamil (CPT; n = 15). Initial treatment with DAP monotherapy was found to have a success rate comparable with DAP-CPT (71% vs. 80%; p = 0.68).
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI, USA.
- Department of Pharmacy, Detroit Medical Center, Detroit, MI, USA.
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28
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Morrisette T, Alosaimy S, Abdul-Mutakabbir JC, Kebriaei R, Rybak MJ. The Evolving Reduction of Vancomycin and Daptomycin Susceptibility in MRSA-Salvaging the Gold Standards with Combination Therapy. Antibiotics (Basel) 2020; 9:antibiotics9110762. [PMID: 33143290 PMCID: PMC7692208 DOI: 10.3390/antibiotics9110762] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 01/27/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is associated with substantial morbidity and mortality. Vancomycin (VAN) has been used as the gold standard treatment for invasive MRSA infections for decades but, unfortunately, the reliance of VAN as the primary treatment option against these infections has led to a reduction in VAN susceptibility in MRSA isolates. Although daptomycin (DAP) is another common treatment option against invasive MRSA infections, it has been shown that the development of VAN resistance can lead to DAP nonsusceptibility. VAN or DAP backbone regimens in combination with other antibiotics has been advocated as an alternative approach to improve patient outcomes in VAN/DAP-susceptible infections, enhance outcomes in infections caused by isolates with reduced VAN/DAP susceptibility, and/or prevent the emergence of VAN/DAP resistance or further resistance. A peer-reviewed literature search was conducted using Medline, Google Scholar and PubMed databases. The primary purpose of this review is to describe the mechanisms and epidemiology of MRSA isolates with a reduction in VAN and/or DAP susceptibility, evaluate in vitro and in vivo literature describing combination therapy (CT) against MRSA isolates with reduced VAN and/or DAP susceptibility and describe studies involving the clinical outcomes of patients treated with CT against invasive MRSA infections.
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Affiliation(s)
- Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Jacinda C. Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Razieh Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA; (T.M.); (S.A.); (J.C.A.-M.); (R.K.)
- Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI 48201, USA
- Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI 48201, USA
- Correspondence: ; Tel.: +1-313-577-4376; Fax: +1-313-577-9310
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Alosaimy S, Sabagha NL, Lagnf AM, Zasowski EJ, Morrisette T, Jorgensen SCJ, Trinh TD, Mynatt RP, Rybak MJ. Monotherapy with Vancomycin or Daptomycin versus Combination Therapy with β-Lactams in the Treatment of Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections: A Retrospective Cohort Analysis. Infect Dis Ther 2020; 9:325-339. [PMID: 32248513 PMCID: PMC7237588 DOI: 10.1007/s40121-020-00292-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are associated with high morbidity and mortality. More in vitro, in vivo, and clinical data suggest that vancomycin (VAN) or daptomycin (DAP) combination therapy with β-lactams (BL) improves outcomes of MRSA infections. We hypothesize that BL combination with VAN or DAP would reduce the odds of clinical failure compared to VAN or DAP monotherapy. METHODS A retrospective cohort study of adult patients ≥ 18 years treated with VAN or DAP for MRSA BSI from 2006 to 2019 at Detroit Medical Center. Combination therapy (CT) was defined as VAN or DAP plus any BL for ≥ 24 h within 72 h of index culture. Monotherapy (MT) was defined as ≥ 72 h VAN or DAP within 72 h of index culture and no BL for ≥ 24 h up to 7 days following VAN/DAP initiation. Primary outcome was composite endpoint of clinical failure defined as: (1) 30-day mortality, (2) 60-day recurrence, or (3) persistent bacteremia (PB). PB was defined as bacteremia > 5 days. Multivariable logistic regression was used to evaluate the association between CT and the primary outcome. RESULTS Overall, 597 patients were included in this analysis, 153 in the MT group and 444 in the CT group. CT was independently associated with reduced odds of clinical failure (adjusted odds ratio, 0.523; 95% confidence interval, 0.348-0.787). The composite endpoint was driven by 60-day recurrence and PB but not 30-day mortality. There were no difference in adverse events including nephrotoxicity between the two study arms. CONCLUSIONS In hospitalized adults with MRSA BSI, CT with any BL was independently associated with improved clinical outcomes and may ultimately be selected as preferred therapy.
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Affiliation(s)
- Sara Alosaimy
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Noor L Sabagha
- Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Abdalhamid M Lagnf
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Evan J Zasowski
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, CA, USA
| | - Taylor Morrisette
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Trang D Trinh
- Department of Clinical Pharmacy, San Francisco School of Pharmacy, University of California, San Francisco, CA, USA
| | - Ryan P Mynatt
- University of Kentucky Healthcare, Lexington, KY, UK
| | - Michael J Rybak
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.
- Department of Pharmacy, Detroit Medical Center, Detroit, MI, USA.
- School of Medicine, Wayne State University, Detroit, MI, USA.
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Affiliation(s)
- Hisham A. Badreldin
- Department of Pharmacy Practice, College of Pharmacy King Saud bin Abdulaziz University for Health Sciences Riyadh Kingdom of Saudi Arabia
- Pharmaceutical Care Services King Abdulaziz Medical City Riyadh Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center Riyadh Kingdom of Saudi Arabia
| | - Sara Alosaimy
- Department of Clinical Pharmacy, College of Pharmacy King Saud University Riyadh Kingdom of Saudi Arabia
- College of Pharmacy Wayne State University Detroit Michigan United States
| | - Ahmed Al‐jedai
- Therapeutic Affairs Deputyship Ministry of Health Riyadh Kingdom of Saudi Arabia
- Colleges of Medicine and Pharmacy Al‐Faisal University Riyadh Kingdom of Saudi Arabia
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center Riyadh Kingdom of Saudi Arabia
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31
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Alosaimy S, Molina KC, Claeys KC, Andrade J, Truong J, King MA, Pullinger BM, Huang G, Morrisette T, Lagnf AM, Davis SL, Rybak MJ. Early Experience With Eravacycline for Complicated Infections. Open Forum Infect Dis 2020; 7:ofaa071. [PMID: 32411809 DOI: 10.1093/ofid/ofaa071] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
Eravacycline (ERV) was used in 35 patients for various infections. The most common pathogen was Klebsiella pneumoniae, and 30-day survival was 74%. Absence of 30-day recurrence and resolution of signs and symptoms of infection were 91% and 57%, respectively. ERV was well-tolerated, with adverse events leading to drug discontinuation in one patient.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit ,Michigan, USA
| | - Kyle C Molina
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | | | | | - James Truong
- The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Madeline A King
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA.,Cooper University Hospital, Camden, New Jersey, USA
| | - Benjamin M Pullinger
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA.,Cooper University Hospital, Camden, New Jersey, USA
| | - Glen Huang
- Univeristy of California Los Angeles, California, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit ,Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit ,Michigan, USA
| | - Susan L Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit ,Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit ,Michigan, USA.,Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA.,Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Abstract
Eravacycline (ERV), formerly known as TP-434, is a novel tetracycline (TET) antibiotic that exhibits in vitro activity against various gram-positive, gram-negative aerobic and anaerobic pathogens, including those exhibiting TET-specific acquired resistance mechanisms. Similar to other TETs, it inhibits protein synthesis through binding to the 30S ribosomal subunit. Eravacycline was approved by the United States Food and Drug Administration (FDA) in August 2018 for the treatment of complicated intraabdominal infections (cIAIs) in adults following the Investigating Gram-Negative Infections Treated with Eravacycline (IGNITE)1 and IGNITE4 phase III trials. In these two, double-blind, multicenter clinical trials, ERV was proven noninferior in terms of clinical response in comparison to ertapenem and meropenem, respectively. Eravacycline was well tolerated with nausea, vomiting, and infusion site reactions being the most commonly reported adverse reactions. Clinicians now have ERV as a novel therapeutic option for the treatment of adults with intraabdominal infections, allergies to β-lactam agents, Clostridioides difficile-associated diarrhea, or if tolerability to other agents is a concern.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Razie Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.,Department of Pharmacy, Detroit Medical Center, Detroit, Michigan.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan
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33
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Alosaimy S, Jorgensen SCJ, Lagnf AM, Melvin S, Mynatt RP, Carlson TJ, Garey KW, Allen D, Venugopalan V, Veve M, Athans V, Saw S, Yost CN, Davis SL, Rybak MJ. Real-world Multicenter Analysis of Clinical Outcomes and Safety of Meropenem-Vaborbactam in Patients Treated for Serious Gram-Negative Bacterial Infections. Open Forum Infect Dis 2020; 7:ofaa051. [PMID: 32161775 PMCID: PMC7060146 DOI: 10.1093/ofid/ofaa051] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Fourty patients were treated with meropenem-vaborbactam (MEV) for serious Gram-negative bacterial (GNB) infections. Carbapenem-resistant Enterobacteriaceae (CRE) comprised 80.0% of all GNB infections. Clinical success occurred in 70.0% of patients. Mortality and recurrence at 30 days were 7.5% and 12.5%, respectively. One patient experienced a probable rash due to MEV.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sarah Melvin
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ryan P Mynatt
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | | | - Kevin W Garey
- College of Pharmacy, University of Houston, Houston, Texas, USA
| | - David Allen
- Department of Pharmacy, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Veena Venugopalan
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Michael Veve
- College of Pharmacy, University of Tennessee, Knoxville, Tennessee, USA.,University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vasilios Athans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Saw
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Susan L Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Alosaimy S, Pearson J, Veve M, Dionne B, Aleissa M, Jorgensen SCJ, Rybak MJ. 200. Real-World Experience with Dalbavancin for Complicated Gram-Positive Infections: A Multicenter Evaluation. Open Forum Infect Dis 2019. [PMCID: PMC6809837 DOI: 10.1093/ofid/ofz360.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Dalbavancin (DAL) received Food and Drug Administration (FDA) approval for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by Gram-positive organisms including Methicillin-resistant Staphylococcus aureus (MRSA). Due to its unique activity and dosing schedule, use in non-FDA approved indications has been increasing. We evaluated the clinical and safety outcomes of patients treated with DAL for various infections. Methods A multicenter, retrospective observational study was conducted from April 2017 to February 2019. We included adult patients who received 1 dose of DAL for any indication. The primary outcome was clinical success defined as 30-day survival from DAL initiation, resolution of signs and symptoms of infection, and absence of therapy escalation/change. Reasons for DAL therapy selection were also investigated. Results A total of 30 patients were included. The median age was 49 (35–58) years, 50% were female and 93.3% were Caucasian. Median APACHE II score was 9 (5–12). Persons who inject drugs (PWID) comprised 50%. Common DAL indications were bacteremia (53.3%), bone and joint infections (33.3%) and ABSSSI (26.7%). Pathogens were MRSA (43.3%), coagulase-negative Staphylococci (23.3%) and methicillin-susceptible S. aureus (MSSA) (13.3%). Previous antibiotics were administered in 93.3% of patients for a median of 9 (7–15) days and (13.3%) received combination antibiotic therapy with DAL. In a subgroup of patients with confirmed microbiological eradication (73.3%), DAL was initiated at a median of 8 days (4–14) after clearance. Clinical success was achieved in 80% of patients and 10% were de-escalated to oral therapy. Rash/pruritus and hypotension occurred in two and one patient, respectively. DAL was selected because of ease of administration (60%), inability to be discharged with a line (43.3%), poor candidacy for outpatient therapy (36.7%), and/or inadequate adherence (30%). Conclusion DAL appears to be well tolerated and results in high clinical success. Larger studies with longer follow would be valuable to more precisely define the role of DAL in complicated Gram-positive infections, particularly in comparison to other long-acting lipoglycopeptides. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Michael Veve
- University of Tennessee Medical Center, Knoxville, Tennessee
| | | | | | | | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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Jorgensen SCJ, Alosaimy S, Lagnf AM, Murray KP, Melvin S, Shamim MD, Brade K, Simon S, Nagel J, Smith JR, Williams K, Huang DB, Davis SL, Rybak MJ. 442. Risk Score for Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809586 DOI: 10.1093/ofid/ofz360.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David B Huang
- Motif Bio/Rutgers New Jersey Medical School, Princeton, New Jersey
| | - Susan L Davis
- Wayne State University/Henry Ford Hospital, Detroit, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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36
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Alosaimy S, Jorgensen SCJ, Lagnf A, Zasowski EJ, Trinh TD, Mynatt R, Pogue JM, Rybak MJ. 1596. Impact of Vancomycin Area Under Curve on Persistent Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections (BSI). Open Forum Infect Dis 2019. [PMCID: PMC6809073 DOI: 10.1093/ofid/ofz360.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Persistent Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are associated with significant morbidity, mortality, and healthcare expenditures. Vancomycin (VAN) remains the treatment of choice for invasive MRSA BSI. Current guidelines for the treatment of MRSA BSI recommend a VAN AUC24h/MIC ratio ≥400. The Detroit Medical Center (DMC) implemented an AUC guided dosing strategy. However, data on the association between AUC24h and clinical outcomes in MRSA BSI are limited. We aimed to evaluate the association between VAN AUC24h and persistent bacteremia (PB) among patients with BSI. Methods Multi-center, retrospective cohort study from January 2015 to November 2018. We included adult patients with MRSA bacteremia treated with VAN for which AUC24h monitoring was performed. AUC was measured using 2-level guided dosing. The primary outcome was PB defined as continued positive cultures >72 hours after VAN initiation. Classification and Regression Tree (CART) analysis was performed to determine the AUC24h breakpoint (BP) most predictive of PB in the cohort. Mann–Whitney and Fischer exact tests were used for univariate analysis. The independent association between AUC24h, dichotomized at the CART-derived cut-point, was then examined through multivariable logistic regression analysis. Results Overall, 137 patients were included. The median age was 59 (18–85) years, 69.3% male, and 75.2% African American predominance. Most common sources of BSI were skin/soft tissue (39.4%), pneumonia (25.5%), and osteoarticular (16.8%). The median APACHE II score was 13 (8–20). Median time to microbiological clearance was 2.5 days (0.5–12). Patients with AUC24h ≤ 406.25 were more likely to have PB compared with those with AUC24h > 406.25 (59.4% and 35.2%, respectively; P = 0.002). After controlling for age, intensive care stay, and concomitant β-lactam therapy; AUC of ≤ 406.25 (aOR 2.767, 95% CI 1.212–6.318) and endocarditis (aOR 2.87, 95% CI 1.079–7.638) were independently associated with PB. Conclusion VAN AUC24h BP of <406.25 was independently associated with PB in patients with MRSA BSI. Our findings underscore the importance of VAN dose optimization to achieve timely bacterial clearance in MRSA bacteremia. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Abdulhamid Lagnf
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | | | - Trang D Trinh
- University of California San Francisco, San Francisco, California
| | | | - Jason M Pogue
- University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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Jorgensen SCJ, Trinh TD, Zasowski EJ, Alosaimy S, Lagnf AM, Bhatia S, Melvin S, Simon S, Steed ME, Rosenberg JR, Estrada SJ, Davis SL, Rybak MJ. 2254. Multicenter Evaluation of Ceftazidime–Avibactam for Multidrug-Resistant Pseudomonas aeruginosa Infections. Open Forum Infect Dis 2019. [PMCID: PMC6809679 DOI: 10.1093/ofid/ofz360.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ceftazidime–avibactam (CZA) is a novel cephalosporin/β-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae (CRE) and multidrug-resistant (MDR) Pseudomonas aeruginosa (PA). Real-world experience with CZA for CRE infections is accumulating but data on its use for MDR PA infections remains limited.
Methods
Retrospective, multicenter cohort study describing the clinical characteristics and outcomes of patients treated with CZA (≥ 72 hours) for MDR PA infections between 2015 and 2018.
Results
Fifty-one patients were included. The median (IQR) age was 61 (43, 71) years. Most patients had MDR risk factors including recent hospitalization (74.5%), recent antimicrobial exposure (84.3%), and/or previous infection or colonization with an MDR pathogen (58.8%). The median Charlson Comorbidity score was 4 (2, 6) and the median APACHE II score was 20 (12, 29). Infections were predominantly (68.6%) hospital-acquired and 52.9% of patients were in the ICU at infection onset. The common sources were respiratory tract (60.8%), osteoarticular (11.8%) and skin and soft tissue (11.8%). Two patients had positive blood cultures. PA antibiotic susceptibilities were as follows: ceftazidime 52.6% (n = 51), CZA 92.0% (n = 25), ciprofloxacin 10% (n = 30), meropenem 19.6% (n = 46), piperacillin–tazobactam 30.4% (n = 4) and tobramycin 72.9% (n = 48). Most (60.8%) infections were polymicrobial including 15 (29.4) CRE co-infections. CZA was started 97 (50, 170) hours after culture collection and continued for 9 (7, 14) days. Only 8 patients (15.7%) received active antibiotic therapy before CZA. Combination CZA therapy was used 35.3%, most often an aminoglycoside (8/18, 44.4%). Clinical cure or improvement was achieved in 40 patients (78.4%), and 42 (82.4%) were discharged alive. Among patients with repeat cultures (n = 11), CZA resistance development was not detected. Three patients (5.9%) experienced infection recurrence within 30 days of completing therapy.
Conclusion
The use of CZA was associated with high rates of favorable outcomes in complex patients with MDR PA infections. Future studies evaluating long-term outcomes and comparative studies are needed to more precisely define the role of CZA for MDR PA infections.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | - Trang D Trinh
- University of California - San Francisco, San Francisco, California
| | | | | | | | | | | | | | | | | | | | - Susan L Davis
- Wayne State University / Henry Ford Hospital, Detroit, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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Jorgensen SCJ, Trinh TD, Zasowski EJ, Alosaimy S, Melvin S, Bhatia S, Dhar S, Mynatt RP, Pogue JM, Rybak MJ. 2250. Combination Vancomycin Plus Cefazolin for Methicillin-Resistant Staphylococcus aureus Bloodstream Infections. Open Forum Infect Dis 2019. [PMCID: PMC6810267 DOI: 10.1093/ofid/ofz360.1928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Combination β-lactam and vancomycin (VAN) prevent the emergence of resistance and result in synergistic antimicrobial activity against methicillin-resistant Staphylococcus aureus (MRSA) in vitro. We sought to provide clinical translation to these data and determine if patients with MRSA bloodstream infection (BSI) treated with VAN + cefazolin (VAN/CFZ) via our MRSA BSI clinical pathway had improved clinical outcomes compared VAN alone.
Methods
Multicenter, retrospective, comparative cohort study from 2006 to 2019 in adults with MRSA BSI treated with VAN for ≥ 72 hours. VAN/CFZ was defined as VAN + CFZ within ≤ 72 hours of index culture for ≥ 24 hours. Other β-lactams were allowed for < 48 h in the VAN/CFZ group. The VAN alone group could not have other β-lactams within 7 days of treatment initiation. The primary outcome was clinical failure defined as a composite of 30-d all-cause mortality, 60-day recurrence, and persistent BSI (≥ 7 days). The independent effect of VAN/CFZ on clinical failure was evaluated with multivariable logistic regression. The primary safety endpoint was nephrotoxicity within 7 days of treatment initiation.
Results
A total of 237 patients were included (104 VAN/CFZ, 133 VAN). The most common BSI sources were skin/soft tissue (29.1%), IV catheter (21.9%), osteoarticular (20.3%) and infective endocarditis (16.0%). Demographic and clinical characteristics were similar between groups except VAN/CFZ had a higher median APACHE II score (18 vs. 13, P = 0.011). VAN/CFZ patients were also more likely to have received an infectious disease consult (100% vs. 81.2%, P < 0.001). Median (IQR) duration of CFZ was 115 (87–164) hours. After controlling for age, APACHE II score, ID consult and infection source, VAN/CFZ was associated with reduced odds of clinical failure (aOR 0.425, 95% CI 0.228, 0.792). Bivariate outcomes are shown in the table:
Conclusion
Patients with MRSA BSI treated with VAN/CFZ vs. VAN experienced fewer clinical failures, supporting additional studies evaluating the role of adjuvant CFZ for MRSA BSI.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | - Trang D Trinh
- University of California San Francisco, San Francisco, California
| | | | | | | | | | - Sorabh Dhar
- Detroit Medical Center, Wayne State University, John D Dingell VA medical center, Detroit, Michigan
| | | | - Jason M Pogue
- University of Michigan College fo Pharmacy, Ann Arbor, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
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Alosaimy S, Vaidya A, Day K, Stern G. Effect of a Pharmacist-Driven Medication Management Intervention Among Older Adults in an Inpatient Setting. Drugs Aging 2019; 36:371-378. [DOI: 10.1007/s40266-018-00634-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
- Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan
- School of Medicine, Wayne State University, Detroit, Michigan
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Alosaimy S, Santo RA, Fanikos J. Prescribing Naloxone: Managing and Preventing Opioid-Related Overdoses. Curr Emerg Hosp Med Rep 2017. [DOI: 10.1007/s40138-017-0124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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