Combination therapy with polymyxin B for carbapenemase-producing Klebsiella pneumoniae bloodstream infection

Medeiros, Gregory Saraiva; Rigatto, Maria Helena; Falci, Diego Rodrigues; Zavascki, Alexandre Prehn

doi:10.1016/j.ijantimicag.2018.10.010

Cited by 45 publications

(32 citation statements)

References 30 publications

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“…Increasing reports about heterologous resistance to polymyxin B of several gram-negative bacteria indicate that rapid resistance to polymyxins can develop as a result of polymyxin B monotherapy. 32 Notably, with the emergence of mcr-1-positive E. cloacae, which may lead to resistance to colistin, the treatment of CR-ECL infection is increasingly diffcult. Therefore, combined antibiotic therapy should be considered as the optimal treatment option for severe infections caused by CR-ECL.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Enterobacter cloacae Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality

Tian¹,

Huang²,

Yang³

et al. 2020

IDR

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Background: The emergence and spread of carbapenem-resistant Enterobacter cloacae (CR-ECL) have posed a serious threat to clinical management. This retrospective study assessed the epidemiological characteristics of CR-ECL to explore the risk factors and predictors of mortality in patients with CR-ECL infection. Methods: We performed a retrospective 1:2 case-control study of hospitalized patients from January 2014 to December 2017. A total of 85 consecutive unique CR-ECL strains comprised the case group, and 170 matched patients with carbapenem-susceptible Enterobacter cloacae (CS-ECL) infection at the same period as the control group. Isolates were screened for potential resistance genes by polymerase chain reaction (PCR) and molecular typing was performed by multilocus sequence typing (MLST). Results: The results of drug resistance gene detection showed that blaNDM-1 was the most common carbapenem resistance gene. The MLST results showed that ST51 was the predominant epidemic type, followed by ST88. ICU admission (P<0.001), drainage tube (P=0.002), central venous catheter (P=0.005), and carbapenem exposure (P=0.003) were independent risk factors for CR-ECL infection. Significant predictors for 28-day mortality included solid tumours (P=0.005), septic shock (P=0.019), and mechanical ventilation (P=0.027). Conclusion: Our study indicated that ST51 and ST88, which are closely related, were the predominant epidemic types of CR-ECL producing blaNDM-1 in southwestern China. Strengthening the surveillance of patients with solid tumours, septic shock and mechanical ventilation is an urgent need.

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Section: Discussionmentioning

confidence: 99%

Carbapenem-Resistant Enterobacter cloacae Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality

Tian¹,

Huang²,

Yang³

et al. 2020

IDR

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“…Among the 209 remaining articles, 132 studies provided unclear antibiotic treatment, 17 included patients less than 10 people, 14 did not report clinical outcomes of interest, 12 treated all patients with monotherapy and/or double therapy, and 1 used duplicated data. Hence, a total of 33 eligible studies were included in this current meta-analysis (Souli et al, 2008;Maltezou et al, 2009;Zarkotou et al, 2011;Qureshi et al, 2012;Sanchez-Romero et al, 2012;Navarro-San Francisco et al, 2013;Balandin Moreno et al, 2014;Balkan et al, 2014;Daikos et al, 2014;Kontopidou et al, 2014;Papadimitriou-Olivgeris et al, 2014;Pontikis et al, 2014;Chang et al, 2015;de Oliveira et al, 2015;Freire et al, 2015;Ji et al, 2015;Katsiari et al, 2015;Oliveros Navarro et al, 2015;Tumbarello et al, 2015;Falcone et al, 2016;Satlin et al, 2016;Shields et al, 2016;Trecarichi et al, 2016;de Maio Carrillho et al, 2017;Forcina et al, 2017;Kaur et al, 2017;Liao et al, 2017;Machuca et al, 2017;Wang et al, 2018;Yang et al, 2018;Freire et al, 2019;Medeiros et al, 2019;Xu et al, 2019).…”

Section: Description Of the Search And Selection Of Trialsmentioning

confidence: 99%

Triple Versus Double Therapy for the Treatment of Severe Infections Caused by Carbapenem-Resistant Enterobacteriaceae: A Systematic Review and Meta-Analysis

et al. 2020

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Introduction: The role of combination treatment in the management of carbapenemresistant Enterobacteriaceae infections (CRE) is still unclear. There have been no metaanalysis comparing the efficiency of triple therapy in treating CRE infections with that of double therapy. In this perspective, we conducted a meta-analysis to clarify whether triple therapy is superior to double therapy in treating patients with CRE infections. Methods:We performed a systematic review, using PubMed and Embase without any restrictions until October 2019. Risk ratio (RR) with 95% CI were pooled to evaluate the effect of intervention.Results: A total of 33 studies with 1,441 subjects were identified. Pooled analysis showed that triple therapy was not associated with a reduced mortality compared with double therapy (HR 0.99 95% CI 0.85-1.14, P = 0.85). Conclusions:This meta-analysis suggests that triple therapy is not superior to double therapy in the treatment of patients with CRE infections, although the quality of evidence is generally low based on current literatures. Future well-defined, randomized controlled trials will be required to elucidate the role of triple therapy in the treatment of CRE infections.

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“…All patients who require intravenous PMB should receive dose of 1.25-1.5 mg/kg (equivalent to 12,500-15,000 IU/kg) PMB every 12 hours is infused over 1 hour [18]. In this study clinicians decide that combination therapy with at least two in vitro active agents as the de nitive treatment was associated with higher effective [6]. On isolation of strains of CRGNB that were resistant to carbapenem, intravenous antibiotic regimen were initiated at the discretion of the attending physician.…”

Section: Treatment Regimenmentioning

confidence: 99%

“…The most common identi ed CRGNB are Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa [2][3][4]. These bacteria can lead to bloodstream infection, respiratory tract infections, kin and soft tissue infections, surgical infections, urinary tract, intra-abdominal [3,[5][6][7]. Meanwhile, they cause nosocomial infections and outbreaks, particularly among critically ill patients hospitalized in intensive care unit (ICU) [8].…”

Section: Introductionmentioning

confidence: 99%

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

Zhang

Duan

et al. 2020

Preprint

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Background: High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CRGNB) was a challenge for clinicians has led to the resurgence of polymyxin B (PMB) use in the last decade. The goal of our multicenter, real-world study was to evaluate the efficacy and safety of PMB in the treatment of CRGNB.Methods: The real-world study included the patients with intravenous PMB at least 7 days during the period of October 2018 to June 2019. Data was collected from electronic patients register and follow-up. The primary outcome was 28-day mortality, the secondary outcomes included hospital mortality, occurrence of adverse events during PMB therapy. Associations between these variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. At the same time, therapeutic effects were observed. Results: The study included 100 patients. There were 39% presence of septic shock, 49% need mechanical ventilation at the beginning of therapy. The infection and condition improved after 7 days of PMB treatment. The major adverse reactions occurred in 16 cases (16%). The overall 28-day mortality was 40%. In terms of clinical characteristics, mean Sequential Organ Failure Assessment (6.77 versus 9.25，P = 0.004)，mean Acute Physiology and Chronic Health Evaluation II (APACHEII) scores (16.17 versus 19.78, P = 0.016) and the number of patient with mechanical ventilation (21 versus 30, P = 0.000) or septic shock (17 versus 32, P = 0.000) were lower in survivors group than nonsurvivors group. The mortality of 85 patients with identify pathogens was 38.82%, while the mortality of patients with negative pathogen culture results was 46.67% (P = 0.580). Multivariate analysis showed that mechanical ventilation (P = 0.023, OR = 3.5; CI: 1.194–10.739), septic shock (P = 0.002, OR = 5.960; CI: 1.923–18.473) were associated with 28-day mortality.Conclusion: Our research found that PMB may be as effective and safe as standard antibiotics for the treatment of CRGNB. Timely and appropriate use of PMB will have a positive impact on the clinical outcomes of patients with sepsis in CRGNB.

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Combination therapy with polymyxin B for carbapenemase-producing Klebsiella pneumoniae bloodstream infection

Cited by 45 publications

References 30 publications

<p>Carbapenem-Resistant <em>Enterobacter cloacae</em> Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality</p>

<p>Carbapenem-Resistant <em>Enterobacter cloacae</em> Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality</p>

Triple Versus Double Therapy for the Treatment of Severe Infections Caused by Carbapenem-Resistant Enterobacteriaceae: A Systematic Review and Meta-Analysis

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

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