Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli: an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals

Papst, Lea; Beović, Bojana; Pulcini, Céline; Durante‐Mangoni, Emanuele; Rodríguez-Baño, Jesús; Kaye, Keith S.; Daikos, George L.; Raka, Lul; Paul, Mical; Abbo, Lilian M.; Abgueguen, P.; Almirante, Benito; Azzini, Anna Maria; Bani-Sadr, Firouzé; Bassetti, Matteo; Ben‐Ami, Ronen; Béraud, Guillaume; Botelho-Nevers, Élisabeth; G, Bou; Boutoille, David; Cabie, André; Cacopardo, Bruno; Cascio, Antonio; Cassir, Nadim; Castelli, Francesco; Cecala, M.; Charmillon, Alexandre; Chirouze, Catherine; Cisneros, José Miguel; Colmenero, Jorde; Coppola, Nicola; Corcione, Silvia; Gasperina, Daniela Dalla; Cabrera, Carlos Alberto Gregório; Delobel, Pierre; Caprio, Domenico Di; Mangoni, Emanuele Durante; Dupon, M.; Ettahar, N.; Falagas, Matthew E.; Falcone, Marco; Fariñas, M.C.; Faure, Emmanuel; Forestier, E.; Foti, Giuseppe; Gallagher, Jason C; Gattuso, Gianni; Gendrin, Vincent; Gentile, Ivan; Giacobbe, Daniele Roberto; Gogos, Charalambos; Perez, Lucia; Hansmann, Yves; Horcajada, Juan Pablo; Iacobello, Carmelo; Jacob, Jesse T; Justo, Julie Ann; Kernéis, Solen; Komnos, Apostolos; Kevorkijan, Božena Kotnik; Lebeaux, David; Berre, Rozenn Le; Lechiche, Catherine; Moxing, V. Le; Lescure, François Xavier; Libanore, Marco; Martinot, M.; Merino, Esperanza; Mondain, V.; Mondello, Patrizia; Montejo, Miguel; Mootien, Joy; Muñóz, Patricia; Nir-Paz, Ran; Pan, Aihua; Paño‐Pardo, José Ramón; Patel, Gopi; Pérez-Rodríguez, M. Teresa; Piroth, Lionel; Pogue, Jason M.; Potoski, Brian A.; Pourcher, Valérie; Pyrpasopoulou, Athina; Rahav, Galia; Rizzi, Marco; Salavert, Miguel; Scheetz, Marc H.; Sims, Matthew; Spahija, Gazmend; Stefani, Stefania; Stefos, Aggelos; Tamma, Pranita D.; Tattevin, Pierre; Tedesco, Andrea; Torre-Cisneros, J; Tripolitsioti, P.; Tsiodras, Sotirios; Uomo, Generoso; Verdon, Renaud; Viale, Pierluigi; Vitrat, V.; Weinberger, Miriam; Wiener-Well, Yonit

doi:10.1016/j.cmi.2018.01.015

Cited by 68 publications

(47 citation statements)

References 29 publications

(21 reference statements)

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“…Combination therapies possess potential additional benefits of a wider activity spectrum and a synergistic effect and so may be effective in combating infections and improving clinical outcomes [31,32]. Real-life data in patients with multidrug-resistant Gram-negative infections seems to suggest that medical doctors use combination therapies to increase effectiveness and reduce resistance risk [33]. However, this evidence is strongly biased by the retrospective nature of most studies and the lack of randomized clinical trials and appropriate controls in cohort studies [34].…”

Section: Discussionmentioning

confidence: 99%

Estimating the association between antibiotic exposure and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria using machine learning methods: a multicentre, prospective cohort study

Tacconelli

Górska

Angelis

et al. 2020

Clinical Microbiology and Infection

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Extended-spectrum b-lactamaseIncidence rate Machine learning a b s t r a c t Objectives: The aim of the study was to measure the impact of antibiotic exposure on the acquisition of colonization with extended-spectrum b-lactamase-producing Gram-negative bacteria (ESBL-GNB) accounting for individual-and group-level confounding using machine-learning methods. Methods: Patients hospitalized between September 2010 and June 2013 at six medical and six surgical wards in Italy, Serbia and Romania were screened for ESBL-GNB at hospital admission, discharge, antibiotic start, and after 3, 7, 15 and 30 days. Primary outcomes were the incidence rate and predictive factors of new ESBL-GNB colonization. Random forest algorithm was used to rank antibiotics according to the risk of selection of ESBL-GNB colonization in patients not colonized before starting antibiotics. Results: We screened 10 034 patients collecting 28 322 rectal swab samples. New ESBL-GNB colonization incidence with and without antibiotic treatment was 22/1000 and 9/1000 exposure-days, respectively. In the adjusted regression analyses, antibiotic exposure (hazard ratio (HR) 2.38; 95% CI 1.29e4.40), age 60 e69 years (HR 1.19; 95% CI 1.05e1.34), and spring season (HR 1.25; 95% CI 1.14e1.38) were independently associated with new colonization. Monotherapy ranked higher als combination therapy in promoting ESBL-GNB colonization. Among monotherapy, cephalosporins ranked first followed by tetracycline (second), macrolide (fourth) and cotrimoxazole (seventh). Overall the ranking of cephalosporins was lower when used in combination. Among combinations not including cephalosporins, quinolones plus carbapenems ranked highest (eighth). Among sequential therapies, quinolones ranked highest (tenth) when prescribed within 30 days of therapy with cephalosporins. Conclusions: Impact of antibiotics on selecting ESBL-GNB at intestinal level varies if used in monotherapy or combination and according to previous antibiotic exposure. These finding should be explored in future clinical trials on antibiotic stewardship interventions.

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Section: Discussionmentioning

confidence: 99%

Estimating the association between antibiotic exposure and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria using machine learning methods: a multicentre, prospective cohort study

Tacconelli

Górska

Angelis

et al. 2020

Clinical Microbiology and Infection

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“…To counter the threat of resistance, RF should be preserved, as its use, in combination therapy for nonmycobacterial infections, is ever more frequent. In addition to the well‐known use in prosthetic valve endocarditis (PVE) therapy (Habib et al, ) (given its ability to penetrate through biofilm), other possible uses are either currently accepted or under investigation: RF use in MRSA infections (Purrello et al, ), antibiotic regimens with RF for targeted treatment of infections caused by extensively drug‐resistant carbapenem‐resistant Pseudomonas aeruginosa (XDR CRPa)/ Acinetobacter baumannii (XDR CRAb) (Papst et al, ), minocycline/rifampicin‐impregnated central venous catheters for preventing central line‐associated bloodstream infections (CLABSIs) in the intensive care unit (ICU) setting (Bonne et al, ), and telavancin combined with rifampicin against MRSA in an in vitro biofilm model (Jahanbakhsh, Singh, Yim, Rose, & Rybak, ) are just a few examples. for pharmacokinetic explanations, it is demonstrated that co‐treatment with RF reduces CL plasma concentrations, with a probable drug underexposure at the infection site (Curis et al, ; Join‐Lambert et al, ). This phenomenon is to be correlated with the RF ability to induce the cytochrome CYP3A4 (responsible for CL metabolism) (Sousa, Pozniak, & Boffito, ). for RF possible effect on the intestinal microbiota, nowadays, when considering a long‐lasting antibiotic therapy, the present authors cannot help but consider its effect on the intestinal microbiota.…”

Section: Discussionmentioning

confidence: 99%

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Rosi

Pescitelli

Ricceri

et al. 2018

Dermatologic Therapy

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The rifampicin (RF)–clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017–May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS‐PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF–CL combination in a selected group of patients.

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“…All the patients in our study were treated with effective antibiotics for at least one day (24h), and we accounted for the time when the effective antibiotics started. There is debate concerning which antibiotics are the most effective in CRGNB 26 or VRE. 7 This uncertainty hindered the exploration of treatment.…”

Section: Discussionmentioning

confidence: 99%

<p>Predictors of Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli or Vancomycin-Resistant Enterococci Bacteremia</p>

Shi

Lee

Cho

et al. 2020

IDR

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The incidences of carbapenem-resistant gram-negative bacilli (CRGNB) and vancomycin-resistant Enterococci (VRE) have increased rapidly in South Korea since 2000. The mortality rate for CRGNB or VRE bacteremia cases is higher than that for nonresistant bacteremia cases. The factors associated with higher mortality are unclear. We investigated the factors associated with mortality from CRGNB or VRE bacteremia and compared the relative risk of these factors. Patients and Methods: We retrospectively collected data from adult patients with CRGNB or VRE bacteremia. Patients were grouped according to whether they survived or died. The data from both groups were compared. Results: During the study period, 171 cases of CRGNB or VRE bacteremia were identified, of which 100 were CRGNB bacteremia cases and 71 were VRE bacteremia cases. Multivariate analysis revealed significant associations with Pitt bacteremia score (PBS) (odds ratio [OR] 1.329, 95% confidence interval [CI] 1.049-1.684). In the multivariate analysis, negative conversion of follow-up blood culture (FUBC) was related with oneweek mortality from CRGNB or VRE bacteremia (OR 17.623, 95% CI 5.726-54.244). In the multivariate analysis of risk factors for 28-day mortality for CRGNB or VRE bacteremia, the significant risk factors were bacteremia of respiratory origin (OR 4.491, 95% CI 1.622-12.435) and positive FUBC (OR 4.082, 95% CI 1.626-10.204). Conclusion: Despite the high mortality rate in patients with CRGNB or VRE bacteremia, the related mortality could be predicted by independent risk factors of PBS, positive FUBC, and bacteremia of respiratory origin.

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Antibiotic treatment of infections caused by carbapenem-resistant Gram-negative bacilli: an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals

Abstract: Combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant Gram-negative bacteria among hospital representatives, even though high-quality evidence for carbapenem-based combination therapy is lacking.

Cited by 68 publications

References 29 publications

Estimating the association between antibiotic exposure and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria using machine learning methods: a multicentre, prospective cohort study

Estimating the association between antibiotic exposure and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria using machine learning methods: a multicentre, prospective cohort study

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

<p>Predictors of Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli or Vancomycin-Resistant Enterococci Bacteremia</p>

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