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Meschiari M, Faltoni M, Kaleci S, Tassoni G, Orlando G, Franceschini E, Burastero G, Bedini A, Serio L, Biagioni E, Melegari G, Venturelli C, Sarti M, Bertellini E, Girardis M, Mussini C. Intravenous fosfomycin in combination regimens as a treatment option for difficult-to-treat infections due to multi-drug-resistant Gram-negative organisms: A real-life experience. Int J Antimicrob Agents 2024; 63:107134. [PMID: 38453094 DOI: 10.1016/j.ijantimicag.2024.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
AIM To investigate the efficacy of intravenous (IV) fosfomycin as combination therapy for treatment of difficult-to-treat (DTT) acute and subacute infections with multi-drug-resistant (MDR) Gram-negative bacteria (GNB), and risk factors associated with 90-day mortality. METHODS A retrospective, observational, monocentric study enrolled patients treated with IV fosfomycin in combination regimens (≥72 h) for proven DTT-MDR-GNB infection. Multi-variate regression analysis identified independent risk factors for 90-day mortality. A propensity score for receiving fosfomycin was performed to control for confounding factors. RESULTS In total, 70 patients were included in this study: 54.3% had carbapenem-resistant isolates, 31.4% had ceftazidime/avibactam-resistant isolates and 28.6% had ceftolozane/tazobactam-resistant isolates. The main pathogens were Pseudomonas aeruginosa (57.1%) and Klebsiella pneumoniae (22.9%). The most prevalent infections were nosocomial pneumonia (42.9%), osteomyelitis (17.1%) and intra-abdominal infections. All-cause 30- and 90-day mortality were 15.7% and 31.4%, respectively (18.9% and 50% considering acute DTT-MDR-GNB infections alone). Relapse at 30 days occurred in 22.9% of cases (29% with emergence of fosfomycin resistance). Mortality at 90 days was independently associated with septic shock and ceftolozane/tazobactam resistance. The relationship between resistance to ceftolozane/tazobactam and 90-day mortality was confirmed to be significant after adjustment by propensity score analysis (hazard ratio 5.84, 95% confidence interval 1.65-20.68; P=0.006). CONCLUSIONS Fosfomycin seems to be a promising salvage, combination treatment in DTT-MDR-GNB infections. Resistance to ceftolozane/tazobactam seems to be independently associated with treatment failure. Randomized clinical trials focusing on pathogen and infection sites are needed urgently to demonstrate the superiority of fosfomycin in combination with other agents for the resolution of DTT-MDR-GNB infections.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
| | - Matteo Faltoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Shaniko Kaleci
- Clinical and Experimental Medicine Department of Surgical, Medical , Dental and Morphological Sciences With Interest in Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Tassoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giulia Burastero
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Lucia Serio
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Emanuela Biagioni
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriele Melegari
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Claudia Venturelli
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Massimo Girardis
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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Ottino L, Bartalesi F, Borchi B, Bresci S, Cavallo A, Baccani I, Rossolini GM, Bartoloni A. Ceftolozane/tazobactam for Pseudomonas aeruginosa pulmonary exacerbations in cystic fibrosis adult patients: a case series. Eur J Clin Microbiol Infect Dis 2021. [PMID: 33709301 DOI: 10.1007/s10096-021-04218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Management of cystic fibrosis (CF) patients colonized with Pseudomonas aeruginosa is challenging due to its virulence and multi-drug resistance. Ceftolozane/tazobactam (C/T) is a promising new antipseudomonal agent, and clinical data on CF are limited. We describe our experience in the use of C/T for P. aeruginosa-related pulmonary exacerbations (PE) in CF adults admitted within 2016 and 2019 at Careggi Hospital, Florence, Italy. PE was diagnosed as deterioration of respiratory function, worsening cough, and increasing of sputum. C/T was given at the dose of 3 g every 8 h. C/T was used in ten patients. Mean length of C/T treatment was 16.3 days, and tobramycin was the most frequently combined antipseudomonal agent. All patients were successfully treated although susceptibility testing on sputum sample showed C/T resistance in two cases. No adverse effects related to C/T were reported. To our knowledge this is the largest case series on CF patients treated with C/T. Clinical responses were encouraging even where C/T resistant P. aeruginosa was isolated, probably due to multiple phenotypes colonizing CF lungs. C/T could play a promising role in combination therapy against P. aeruginosa as a part of a colistin-sparing regime.
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Rieg S, Hitzenbichler F, Hagel S, Suarez I, Kron F, Salzberger B, Pletz M, Kern WV, Fätkenheuer G, Jung N. Infectious disease services: a survey from four university hospitals in Germany. Infection 2018; 47:27-33. [PMID: 30120718 DOI: 10.1007/s15010-018-1191-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/09/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Involvement of infectious disease (ID) specialists in the care of hospitalized patients with infections through consultation services improves the quality of care and the outcome of patients. This survey aimed to describe activities and utilization of ID consultations at four German tertiary care hospitals. METHODS A 1-month (March 2016) retrospective cross-sectional study at four university hospitals (Freiburg, Jena, Cologne and Regensburg) was performed. Only ID consultations with written documentation and bedside patient evaluation were included. Consultations were analyzed with regard to requesting departments, infections, case severity, and diagnostic and therapeutic recommendations. RESULTS In the study period, 638 ID consultations were performed in 479 patients-corresponding to 3-4 consultations per 100 inpatient cases. Patients were characterized by a high disease complexity-the mean case mix index in patients with consultation was 10.1 compared to 1.6 for all patients. ID consultations were requested by many different specialties, with approximately half of the requests coming from surgical disciplines. ID consultations resulted in revised diagnoses in 34% of the cases, provided recommendations for additional diagnostic procedures in 66%, and for modifications of antimicrobial regimens in 70% of the cases. CONCLUSIONS Infectious disease consultations were requested for patients with severe and complicated diseases and resulted in recommendations that highly impacted the diagnostic work-up and therapeutic management of patients. The results of this survey may help to estimate requirements for establishment of such services in Germany.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | | | - Stefan Hagel
- Infectious Disease, University Hospital of Jena, Jena, Germany
| | - Isabelle Suarez
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernd Salzberger
- Infectious Diseases Unit, University Hospital of Regensburg, Regensburg, Germany
| | - Mathias Pletz
- Infectious Disease, University Hospital of Jena, Jena, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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