Clinical syndromes and treatment location predict utility of carbapenem sparing therapies in ceftriaxone-non-susceptible Escherichia coli bloodstream infection

Abstract

Background Cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, intravenous fosfomycin and plazomicin represent potential carbapenem sparing agents for extended-spectrum-beta-lactamase or AmpC beta-lactamase producing Escherichia coli infection. However, available data is limited in predicting the volume of carbapenem therapy which could be substituted and real-world contraindications. Methods We determined the number of carbapenem days of therapy (DOT) which could be substituted and frequent contraindications accounting for antimicrobial susceptibility and site of infection in an unselected cohort with ceftriaxone-non-susceptible E. coli bacteremia at a single health network from 2015 to 2016. Individual patient data was used to calculate DOT and substitution for each agent. Results There were 108 episodes of E. coli bacteremia resulting in 67.2 carbapenem DOT/100 patient-days of antimicrobial therapy administered. Ceftazidime-avibactam could be used to substitute 36.2 DOT/100 patient-days (54%) for inpatient definitive therapy, ceftolozane-tazobactam for 34.7 DOT/100 patient-days (52%), cefiderocol for 27.1 DOT/100 patient-days (40%), fosfomycin for 23.3 DOT /100 patient-days (35%) and plazomicin for 27.1 DOT/100 patient-days (40%). Non-urinary tract source of infection was the most frequent contraindication to fosfomycin (25), plazomicin (26) and cefiderocol (26). Use in outpatient parenteral antimicrobial therapy (OPAT) programs accounted for 40% of DOT, all of which could be substituted if stability data allowed for ceftazidime-avibactam and ceftolozane-tazobactam. Conclusions All tested agents could be used to replace a significant volume of carbapenem therapy. Establishing stability of these agents for use in OPAT is required for maximizing their use as carbapenem sparing agents while randomized clinical data is awaited for some of these agents in resistant E. coli bacteremia.

Can precision antibiotic prescribing help prevent the spread of carbapenem-resistant organisms in the hospital setting?

“…Broader-spectrum antibiotics than carbapenems such as tigecycline, IV fosfomycin, or newer β-lactams, such as ceftolozane/tazobactam, ceftazidime/avibactam, or cefiderocol, can be potential carbapenem-sparing options for ESBL-E. 95 Large volumes of carbapenem consumption can be substituted by these potential agents. However, they also have greater potency to create a selective advantage for bacteria resistant to carbapenems.…”

Evaluating Knowledge, Preventive Measures, and Treatment Awareness Regarding Gonorrhea Among Adolescents and Adults in Sagbama, Bayelsa State

“…In prepubertal youngsters, transmission through home exposure happens seldom with house help. When a prepubertal kid is diagnosed with genital, rectal, or pharyngeal colonization or infection after the neonatal stage, sexual abuse should be seriously investigated [2,3].…”

“…If the sexual partners of women with PID are not also clinically assessed, the care of these women is deemed insufficient. Streptococci, N. gonorrhoeae, C. trachomatis, and Gram-negative facultative bacteria should all be covered by treatment plans [2].…”