Assessing antimicrobial stewardship initiatives: Clinical evaluation of cefepime or piperacillin/tazobactam in patients with bloodstream infections secondary to AmpC-producing organisms

McKamey, Lacie; Venugopalan, Veena; Cherabuddi, Kartikeya; Borgert, Samuel J.; Voils, Stacy A.; Shah, Kairav; Klinker, Kenneth P.

doi:10.1016/j.ijantimicag.2018.08.007

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…The only other cohort of BSIs caused by this group of bacteria that evaluated 7-day mortality we are aware did not analyze the determinant factors of death. 13 Thus, it was not possible to compare our findings with others. We consider 7-day mortality as an outcome related to the BSI if any other causes of death were not detected, and directly influenced by multidrug resistance.…”

Section: Discussionmentioning

confidence: 77%

“…Differently, an American cohort of BSIs caused by the ESCPM group published in 2018 found a lower 7-day mortality (3.8%) than ours. 13 Some differences between the characteristics of the population and BSI episodes included in both studies could explain the higher mortality found in the study we have done. The American cohort was carried out in a general hospital, included only 23.4% of immunosuppressed patients and the median Pitt score was 3 (2–3), denoting less serious infections.…”

Section: Discussionmentioning

confidence: 83%

“…Finally, an American cohort of BSI caused by AmpC-producing organisms published in 2018 found male predominance (60.0%) and median age of 57 years. 13 These data suggest that the occurrence of BSI caused by ESCPM may prefer elderly males.…”

Section: Discussionmentioning

confidence: 83%

“…Similarly, an Australian cohort of BSIs caused by ESBL and AmpC-producing bacteria published in 2019 17 found a frequency of polymicrobial infections of 11.8%. To our knowledge, other cohorts 1 , 13 , 15 of ESCPM group enterobacteria excluded BSIs caused by more than one germ, which precluded additional comparisons with ours. In fact, infections with source in sites colonized by several microorganisms can be polymicrobial, leading to the growth of more than one germ in blood culture.…”

Section: Discussionmentioning

confidence: 94%

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Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia

Ferreira¹,

Martins²

2021

IDR

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Purpose The infections caused by ESCPM Enterobacterales ( Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp. and Morganella spp.) have limited therapeutic options. Patients with neoplastic diseases are particularly vulnerable to bloodstream infections (BSIs). Objective To analyze determinant factors of death in patients with neoplasia complicated with BSI caused by ESCPM Enterobacterales . Patients and Methods A cohort study of patients aged 18 years or older with neoplasia and BSI due to ESCPM group was conducted at the Cancer Hospital I of the National Cancer Institute, Brazil, from September 2012 to December 2017. The variables associated with death were analyzed using multivariate logistic regression. Results Of the 103 patients included in the cohort, 67.0% were male, the median age was 63 years and 67.0% had solid tumors. Of the 107 BSI episodes evaluated, 70.1% were hospital-acquired infections, 54.2% were secondary to extravascular focus of infection, gastrointestinal tract (19.6%), mainly. Enterobacter spp. (n: 49, 45.4%) was the most frequent agent isolated followed by Serratia spp. (n: 34, 31.5%), Morganella morganii (n: 16, 14.9%), Citrobacter freundii . (n: 7, 6.5%) and Providencia spp. (n: 2, 1.8%). Ten (9.3%) BSI episodes were caused by multidrug-resistant ESCPM Enterobacterales (MDR-ESCPM). The 7-day and 30-day mortality were 9.3% and 21.5%, respectively. The BSIs caused by MDR-ESCPM were independently associated with 7-day death (OR = 21.62 95% CI: 1.81–258.51 P = 0.01). Monotherapy with piperacillin-tazobactam tended to be associated with 7-day death (OR = 10.46 95% CI: 0.97–112.91 P = 0.05) and 30-day death (OR = 2.73 95% CI: 0.96–7.70 P = 0.05). Conclusion BSIs due to ESCPM group have high mortality and when caused by MDR-ESCPM are independently associated with 7-day death. The possible association of piperacillin-tazobactam monotherapy for BSI-ESCPM with death needs to be better studied.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 94%

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Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia

Ferreira¹,

Martins²

2021

IDR

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“…The use of fourthgeneration cephalosporins (e.g., cefepime and cefpirome) seems to be more effective, mostly due to their activity against AmpC-hyperproducing Enterobacter strains (175). Compared to older cephalosporins, these molecules present (i) an efficient diffusion across the outer membrane porins, (ii) a significant stability against chromosomal ␤-lactamases, and (iii) an enhanced affinity for key penicillin-binding proteins located in the Enterobacter periplasm (176,177). Many publications have demonstrated interest in them (178,179).…”

Section: First-line Antibiotics and Treatmentmentioning

confidence: 99%

Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and Emerging Antimicrobial Resistance

2019

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SUMMARY The genus Enterobacter is a member of the ESKAPE group, which contains the major resistant bacterial pathogens. First described in 1960, this group member has proven to be more complex as a result of the exponential evolution of phenotypic and genotypic methods. Today, 22 species belong to the Enterobacter genus. These species are described in the environment and have been reported as opportunistic pathogens in plants, animals, and humans. The pathogenicity/virulence of this bacterium remains rather unclear due to the limited amount of work performed to date in this field. In contrast, its resistance against antibacterial agents has been extensively studied. In the face of antibiotic treatment, it is able to manage different mechanisms of resistance via various local and global regulator genes and the modulation of the expression of different proteins, including enzymes (β-lactamases, etc.) or membrane transporters, such as porins and efflux pumps. During various hospital outbreaks, the Enterobacter aerogenes and E. cloacae complex exhibited a multidrug-resistant phenotype, which has stimulated questions about the role of cascade regulation in the emergence of these well-adapted clones.

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Piperacillin/tazobactam vs. cefepime or carbapenems for the treatment of bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase: a systematic review and meta-analysis

Onorato,

de Luca,

Salvati

et al. 2024

Infection

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Assessing antimicrobial stewardship initiatives: Clinical evaluation of cefepime or piperacillin/tazobactam in patients with bloodstream infections secondary to AmpC-producing organisms

Cited by 16 publications

References 15 publications

Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia

Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia

Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and Emerging Antimicrobial Resistance

Piperacillin/tazobactam vs. cefepime or carbapenems for the treatment of bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase: a systematic review and meta-analysis

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