Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study

Montravers, Philippe; Lepape, Alain; Dubreuil, L.; Gauzit, R.; Péan, Y.; Benchimol, Daniel; Dupont, Hervé

doi:10.1093/jac/dkp005

Cited by 181 publications

(189 citation statements)

References 24 publications

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“…In this study, nearly 10% of patients had P. aeruginosa infection, consistent with the findings in previous studies (13)(14)(15)(16), and previous antibacterial exposure was more frequent among those with P. aeruginosa. Prophylactic metronidazole and third-generation cephalosporins were common previous treatments, which potentially predisposed patients to P. aeruginosa infection.…”

supporting

confidence: 92%

Characteristics and Outcomes of Complicated Intra-abdominal Infections Involving Pseudomonas aeruginosa from a Randomized, Double-Blind, Phase 3 Ceftolozane-Tazobactam Study

Miller

Popejoy

Hershberger

et al. 2016

Antimicrob Agents Chemother

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c Ceftolozane-tazobactam is active against Gram-negative pathogens, including multidrug-resistant Pseudomonas aeruginosa. In a subgroup analysis of patients with complicated intra-abdominal infections (cIAIs) involving P. aeruginosa from a phase 3 program, ceftolozane-tazobactam demonstrated potent in vitro activity against P. aeruginosa. Clinical cure in the microbiologically evaluable population was 100% (26/26) for ceftolozane-tazobactam plus metronidazole and 93.1% (27/29) for meropenem. These findings support the use of ceftolozane-tazobactam in the management of cIAI when P. aeruginosa is suspected or confirmed. (This study has been registered at ClinicalTrials.gov under registration no. NCT01445665 and NCT01445678.) C omplicated intra-abdominal infections (cIAIs) are caused by Gram-negative bacteria, with Enterobacteriaceae being the most common pathogen. Pseudomonas aeruginosa is the thirdmost-common Gram-negative bacteria in cIAI (1), and increasing rates of P. aeruginosa resistance are a global concern (2, 3).Ceftolozane-tazobactam, in combination with metronidazole, is approved for the treatment of cIAI (4). Ceftolozane-tazobactam has potent activity against many drug-resistant Gram-negative pathogens, including most extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae (5, 6), and is minimally affected by common P. aeruginosa resistance mechanisms (7). Compared with approved ␤-lactam antibiotics, including meropenem and piperacillin-tazobactam, ceftolozane-tazobactam displays more potent in vitro activity against P. aeruginosa (8).The Assessment of the Safety Profile and Efficacy of Ceftolozane/Tazobactam in Complicated Intra-Abdominal Infections (ASPECT-cIAI) study was a global phase 3 program that demonstrated the efficacy of ceftolozane-tazobactam plus metronidazole to be similar to that of meropenem in patients with cIAI (NCT01445665 and NCT01445678) (9). This analysis was conducted to determine the characteristics and clinical outcomes of the subgroup of patients with P. aeruginosa infection.( In ASPECT-cIAI, patients (age, Ն18 years) with cIAI were randomly assigned 1:1 to receive intravenous ceftolozane-tazobactam (1.5 g containing 1,000 mg ceftolozane and 500 mg tazobactam) plus metronidazole (500 mg) every 8 h or intravenous meropenem (1 g every 8 h) plus placebo for 4 to 14 days. Efficacy was assessed at the test-of-cure visit 24 to 32 days after initiation of the study drug. Clinical cure was defined as the resolution of or significant improvement in signs and symptoms of the index infection, such that no additional antibacterial therapy or intervention was necessary. Descriptive statistics were used to compare baseline characteristics (microbiological intent-to-treat [MITT] population) and clinical outcomes (microbiologically evaluable [ME] population) of patients with and without P. aeruginosa infection. Descriptions of inclusion/exclusion criteria and study design were published previously (9).MIC cutoffs for susceptibility to ceftolozane-tazobactam and meropenem were based ...

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supporting

confidence: 92%

Characteristics and Outcomes of Complicated Intra-abdominal Infections Involving Pseudomonas aeruginosa from a Randomized, Double-Blind, Phase 3 Ceftolozane-Tazobactam Study

Miller

Popejoy

Hershberger

et al. 2016

Antimicrob Agents Chemother

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“…Recovery of P. aeruginosa or Proteus spp. in these patients at a rate of 16% is in line with other studies of a similar setting [14,15] M a n u s c r i p t M a n u s c r i p t M a n u s c r i p t M a n u s c r i p t M a n u s c r i p t Table 2 Results of in vitro susceptibility testing of recovered Gram-negative and Gram-positive A c c e p t e d M a n u s c r i p t …”

Section: A N U S C R I P Tsupporting

confidence: 92%

Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients

Secondo¹,

Vassallo²,

Solari³

et al. 2010

International Journal of Antimicrobial Agents

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Cancer patients with complicated infections following abdominal surgery represent one of the worst clinical scenarios that is useful for testing the efficacy of empirical antimicrobial therapy. No study so far has evaluated the performance of tigecycline (TIG) when administered as empirical first-line treatment in a homogeneous population of surgical cancer patients with a febrile episode. An observational review of the data records of 24 sequential patients receiving TIG for a febrile episode following a major abdominal procedure in a single cancer institute was performed. Large bowel surgery represented 68% of all procedures, followed by gastric surgery (16%) and urinary-gynaecologic-biliary surgery (16%). Complications following surgery were observed in 68% of febrile episodes, with peritonitis and sepsis accounting for 59% and 24% of complications, respectively.Eight patients needed repeat surgery for source control. The mean duration of TIG treatment was 8 days. Causative pathogens were detected in 16 episodes (64%), and a total of 44 microorganisms were recovered (29% Escherichia coli, 9% Enterococcus faecalis and 9% coagulase-negative staphylococci). TIG was effective in 12 episodes (48%). The success rate was 67% when infectious episodes sustained by intrinsically resistant bacteria and fungi were excluded. Treatment failure was associated with the presence of complications and with microbiologically documented infection. TIG may be useful as a first-line treatment option in cancer patients requiring antibiotic treatment following surgery when complications are not present or suspected on clinical grounds and when local microbial epidemiology shows a low incidence of primary resistant bacteria.

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“…These guidelines addressed the choice of antimicrobials for both empirical and directed antimicrobial therapy for both community-associated and hospitalassociated infections/pathogens. Several surveillance studies and reports have documented the increased levels of antimicrobial resistance to many of the recommended agents with significant awareness of the incidence of extended-spectrumbeta-lactamase (ESBL)-positive Escherichia coli and Klebsiella pneumoniae/oxytoca (2,5,7,8,10). In 2002, the Study for Monitoring Antimicrobial Resistance Trends (SMART) was initiated to monitor yearly the antimicrobial susceptibility of Gram-negative bacilli associated with both community-and hospital-associated IAIs.…”

mentioning

confidence: 99%

Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in the United States, 2007-2008: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Hoban¹,

Bouchillon²,

Hawser³

et al. 2010

Antimicrob Agents Chemother

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During 2007-2008, 1,036 Gram-negative bacilli were isolated from patients with complicated intra-abdominal infections in the United States. Against members of the family Enterobacteriaceae, the most active agents in vitro were ertapenem, imipenem, and amikacin, while the least active agent was ampicillin-sulbactam. Ertapenem and imipenem were active against all extended-spectrum-beta-lactamase (ESBL)-positive Escherichia coli. Antimicrobial resistance in Gram-negative bacilli isolated from patients with complicated intraabdominal infections in the United States continues to increase.

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Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study

Abstract: The principal results of EBIIA are a higher diversity of microorganisms isolated in nosocomial infections and decreased susceptibility among these strains. Despite this, the adequacy of treatment is comparable in the two groups.

Cited by 181 publications

References 24 publications

Characteristics and Outcomes of Complicated Intra-abdominal Infections Involving Pseudomonas aeruginosa from a Randomized, Double-Blind, Phase 3 Ceftolozane-Tazobactam Study

Characteristics and Outcomes of Complicated Intra-abdominal Infections Involving Pseudomonas aeruginosa from a Randomized, Double-Blind, Phase 3 Ceftolozane-Tazobactam Study

Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients

Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in the United States, 2007-2008: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART)

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