Blood stream infections due to OXA-48-like carbapenemase-producing Enterobacteriaceae: treatment and survival

Balkan, İ̇lker İnanç; Aygün, Gökhan; Aydın, Selda; Mutcali, Sibel Islak; Kara, Zehra; Kuşkucu, Mert Ahmet; Midilli, Kenan; Şemen, Vicdan; Aras, Şükrü; Yemişen, Mücahit; Mete, Bilgül; Özaras, Reşat; Saltoğlu, Neşe; Tabak, Fehmı; Öztürk, Recep

doi:10.1016/j.ijid.2014.05.012

Cited by 100 publications

(80 citation statements)

References 28 publications

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“…Some studies suggest that for infections due to KPC producers, the use of combination therapy that includes a carbapenem (e.g., polymyxin-carbapenem or aminoglycoside-carbapenem), may reduce the mortality rate (101). Clinical data on the treatment of infections due to OXA-48 and NDM infections are scant; a recent retrospective observational study suggested that for bacteremia due to OXA-48 producers, combination therapy that included colistin reduced the mortality rate (110).…”

Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Pitout

Nordmann

Poirel

2015

Antimicrob Agents Chemother

699

569

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The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of ␤-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with bla KPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.

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Section: Treatment Of Infections Due To K Pneumoniae With Carbapenemmentioning

confidence: 99%

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Pitout

Nordmann

Poirel

2015

Antimicrob Agents Chemother

699

569

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“…60 Most of the CRE in these reports are KPC producers, but OXA-48-and NDM-producing CRE are also emerging in patients with hematologic malignancies in locations where these carbapenem resistance mechanisms predominate. 61,62 In one oncology center in India, colistinresistant CRKP have emerged, leaving essentially no therapeutic options for patients infected by these pathogens. 63 CRE are also emerging pathogens in HSCT recipients, particularly after allogeneic transplantation.…”

Section: Cre In Patients With Hematologic Malignancies and Haematopoimentioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

2016

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Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.

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“…55 There is some evidence that non-colistin based regimens had worse outcomes than colistin-based regimens. 56 Antibiotics that are active against CRE depend on carbapenemase type, but include polymyxins B and E (colistin), tigecycline, fosfomycin, aminoglycosides, aztreonam, carbapenems (often administered at high doses using prolonged infusion), and the newly approved agent ceftazidime/avibactam. 57 Many of these drugs used in combination with each other or with adjunctive agents like rifampin or minocycline, demonstrate in vitro synergy against CRE.…”

Section: Treatment Implications Of Rapid Detection Of Crementioning

confidence: 99%

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

Banerjee

Humphries

2016

Virulence

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Carbapenem resistance among the Enterobacteriaceae has become a significant clinical and public health dilemma. Rapid administration of effective antimicrobials and implementation of supplemental infection control practices is required to both improve patient outcomes and limit the spread of these highly resistant organisms. However, carbapenem-resistant Enterobacteriaceae (CRE)-infected patients are predominantly identified by routine culture methods, which take days to perform. Rapid genomic and phenotypic methods are currently available to accelerate the identification of carbapenemaseproducing CRE. Effective use of these technologies is reliant on close collaboration between clinical microbiology, infection prevention, antimicrobial stewardship and infectious diseases specialists. This review discusses the performance characteristics of these technologies to date, and describes strategies for their optimal implementation.

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Blood stream infections due to OXA-48-like carbapenemase-producing Enterobacteriaceae: treatment and survival

Abstract: Earlier active treatment with colistin based regimens and microbiological and clinical response within 7 days are major predictors of survival in cases of BSIs due to CRE. Rectal screening offers the advantage of earlier recognition and prompt empirical treatment.

Cited by 100 publications

References 28 publications

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

Clinical and laboratory considerations for the rapid detection of carbapenem-resistant Enterobacteriaceae

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