Clinical and Bacterial Risk Factors for Mortality in Children With Carbapenem-resistant Enterobacteriaceae Bloodstream Infections in India

Nabarro, Laura; Shankar, Chaitra; Pragasam, Agila Kumari; Mathew, Georgekutty; Jeyaseelan, Vishali; Veeraraghavan, Balaji; Verghese, Valsan Philip

doi:10.1097/inf.0000000000001499

Cited by 64 publications

(69 citation statements)

References 37 publications

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“…The mortality we observed was lower than in both a prior series of patients with CRE BSI and a smaller case-control study of healthcare-associated infections with NDM-1 positive organisms [10,12]. Mortality was similar between patients with NDM-1 positive infections and patients with infections with other MDRO.…”

Section: Discussioncontrasting

confidence: 68%

“…Prior studies of patients with CRE have identified ICU admission, prior antibiotic use and the presence of urinary and central vascular catheters as risk factors for CRE acquisition though patients with NDM-1 comprised only a small fraction of these subjects [9][10][11][12]. A significant proportion of patients with NDM-1 producing Enterobacteriaceae, however, do not have identified risk factors and appear to be community-acquired [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producingEnterobacteriaceae

et al. 2019

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Carbapenem-resistantEnterobacteriaceaeconferred by New Delhi metallo-b-lactamase (NDM-1) resistance mechanism are endemic in India and Southeast Asia. An understanding of risk factors for NDM-1 infections is necessary to guide prevention strategies. We performed a retrospective case-control study of patients admitted at Christian Medical College Hospital, Vellore, India between May 2010 and August 2014 withKlebsiella pneumoniaeblood stream infection (BSI). We compared patients with BSI caused by NDM-1 producing strains to two control groups: BSI with other multidrug resistant (MDR) strains and BSI with pan-susceptible strains. The study groups were assessed for risk factors for the outcomes: (1) infection with any MDR strain compared to pan-susceptible; and, (2) infection with NDM-1 strain as compared with other MDR and (3) Mortality. A total of 101 patients with BSI with NDM-1 producingKlebsiella pneumoniaewere matched to two groups of controls: 112 with non-NDM-1 MDR strains and 101 with pan-susceptible strains. Medical (OR 10.4) and neonatal (OR 0.7) ICU admission, central venous catheter placement (CVC, OR 7.4) predicted MDR BSI. Prior carbapenem use (OR 8.4) and CVC (OR 4.8) predicted acquisition of an NDM-1 strain. Significant predictors for mortality included ICU stay (OR 3.0), mechanical ventilation (OR 3.2), female gender (OR 2.2), diabetes (OR 0.4). CVC placement, prior carbapenem use and ICU admission were significantly associated with BSI with NDM-1 producing and other MDR strains.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producingEnterobacteriaceae

et al. 2019

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“…Observational studies comparing the outcomes for patients treated with monotherapy or combination therapy were reviewed, and control for confounders was taken into account. Most studies focused on or supplied data for BSI (212)(213)(214)(215)(216)(217)(218)(219)(220)(221)(222)(223)(224)(225)(226)(227)(228)(229) (Table 4), while others included other types of infection (213,215,227,(230)(231)(232)(233)(234)(235)(236) (Table 5). Systematic reviews published in 2014 found major limitations in the studies analyzed and therefore could not draw strong conclusions (47,237).…”

Section: Monotherapy Versus Combination Therapymentioning

confidence: 99%

“…The most frequent type of bacteria included were KPC-producing K. pneumoniae, although some studies included mainly OXA-48 producers (212,220,235), NDM producers (219), or noncarbapenemase producers (230). Some studies focused on specific populations, such as intensive care unit (ICU) patients (221,230), hematological or cancer patients (224, 225, 233), or children (219,232). As Tables 4 and 5 show, some studies found combination therapy to be associated with lower mortality rates, while others did not.…”

Section: Monotherapy Versus Combination Therapymentioning

confidence: 99%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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Therapy of invasive infections due to multidrug-resistant (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.

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“…El uso de pautas optimizadas de meropenem (a doble dosis en perfusión extendida) posibilita alcan-zar los objetivos farmacodinámicos en el caso de aislamientos con una CMI de meropenem ≤ 8 mg/L, 22 y ha demostrado una efi cacia adecuada en estudios observacionales. 23,24 Por ello, consideramos que es actualmente el tratamiento de elección en combinación con un segundo antibiótico activo in vitro. 2,25 En el caso de aislamientos con CMI de meropenem > 8 mg/L, la alternativa de elección sería un β-lactámico activo basado en los resultados del antibiograma interpretado.…”

Section: Tratamientounclassified

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

Baquero-Artigao¹,

Ramos²,

Cercenado³

et al. 2020

Revista Latinoamericana De Infectología Pediátrica

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Recent years have seen an increase in the incidence of infections by multi-drug resistant bacteria. The main threats are the Gram-negative bacilli that produce β-spread-spectrum lactamases (BLEE), AmpC or carbapenemases, methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. To address this problem, it is essential to establish antimicrobial use optimization programs (AOP) specifi c to pediatrics, conduct active epidemiological surveillance and develop an appropriate infection control policy. Its therapeutic approach is often complex and multidisciplinary, often requiring the use of less experienced antibiotics. This position paper, prepared by the Spanish Association of Pediatrics and the Spanish Society of Pediatric Infectious Diseases, reviews the epidemiology and treatment of these infections according to the best available evidence.

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Clinical and Bacterial Risk Factors for Mortality in Children With Carbapenem-resistant Enterobacteriaceae Bloodstream Infections in India

Abstract: CRE BSI affects children with multiple comorbidities and repeated admissions to hospital. The mortality rate is high; combination therapy may be beneficial.

Cited by 64 publications

References 37 publications

Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producingEnterobacteriaceae

Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producingEnterobacteriaceae

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

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