Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Collins, Vicki L.; Marchaim, Dror; Pogue, Jason M.; Moshos, Judy; Bheemreddy, Suchitha; Sunkara, Bharath; Shallal, Alex; Chugh, Neelu; Eiseler, Sara; Bhargava, Pragati; Blunden, Christopher; Lephart, Paul; Memon, Babar Irfan; Hayakawa, Kayoko; Abreu-Lanfranco, Odaliz; Chopra, Teena; Munoz-Price, L. Silvia; Carmeli, Yehuda; Kaye, Keith S.

doi:10.1128/aac.05913-11

Cited by 55 publications

(42 citation statements)

References 31 publications

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“…Most studies evaluated imipenem or meropenem, but some experiences with ertapenem are also reported, especially as empirical therapy in community-acquired severe infections when coverage against Pseudomonas aeruginosa or Acinetobacter baumannii is not needed [46]. Some concerns are rising regarding the resistance to ertapenem in some Klebsiella and Enterobacter due to concurrent loss of porins [47,48].…”

Section: Role Of Carbapenemsmentioning

confidence: 95%

Epidemiology and Treatment of MDR Enterobacteriaceae

Bassetti

Pecori

Sibani

et al. 2015

Curr Treat Options Infect Dis

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Opinion statementThe major progress in the history of medicine represented by the discovery of antibiotics is nowadays compromised by the universal spread of antibiotic resistance. World Health Organization (WHO) lists third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae and carbapenem-resistant K. pneumoniae in a group of seven bacteria of international concern, responsible for both healthcare-associated and community-acquired infections. Patients infected by these pathogens have limited therapeutic options, worse clinical outcomes, increased mortality rates, and a higher healthcare resources consumption. In infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, appropriate monotherapy is effective and carbapenems are the drugs of choice; however, β-lactams/β-lactamase inhibitors (BLBLIs) are regarded as an alternative mainly in patients without severe infections, with E. coli bacteremia with urinary source or with low minimum inhibitory concentrations (MICs). For infections caused by carbapenem-resistant Enterobacteriaceae (CRE), where the predicted mortality rate of patients is high, a combination antimicrobial treatment should be preferred. Many important variables in the treatment such as the role of high dosages and loading doses, the variable degrees of dosage reduction for impaired renal function, and the inclusion of carbapenems or tigecycline are a matter of debate. Despite the obscure vision provided by a notable number of meta-analyses, tigecycline is an effective and safe option for the treatment of MDR Enterobacteriaceae, as part of a combination regimen in case of infections caused by CRE, where a higher dosage (200 mg/daily) should be preferred. Colistin is the most active in vitro agent against CRE. Despite clinical data about the efficacy of fosfomycin against MDR Enterobacteriaceae are limited, this molecule represents an interesting option for the treatment of lower urinary tract and even systemic infections caused by difficult-to-treat Gram-negative pathogens. Based on in vitro studies, ceftolozane-tazobactam and ceftazidime-avibactam will represent very interesting new drugs for the treatment of ESBL-producing and CRE infections, respectively.

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Section: Role Of Carbapenemsmentioning

confidence: 95%

Epidemiology and Treatment of MDR Enterobacteriaceae

Bassetti

Pecori

Sibani

et al. 2015

Curr Treat Options Infect Dis

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“…Interestingly, the interpretation error rates for ESBL and AmpC resistotypes were also significantly increased for ertapenem (Table 1), despite the fact that ertapenem is considered a therapy of choice for ESBL and AmpC producers (32). For E. coli, 79% of all expected ertapenem interpretation errors were caused by the ESBL resistotype (Table 1).…”

Section: Fig 1 Schematic Representation Of Variables Influencing Intementioning

confidence: 99%

Integrating Forecast Probabilities in Antibiograms: a Way To Guide Antimicrobial Prescriptions More Reliably?

Maurer¹,

Courvalin²,

Böttger³

et al. 2014

J Clin Microbiol

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bAntimicrobial susceptibility testing (AST) assigns pathogens to "susceptible" or "resistant" clinical categories based on clinical breakpoints (CBPs) derived from MICs or inhibition zone diameters and indicates the likelihood for therapeutic success. AST reports do not provide quantitative measures for the reliability of such categorization. Thus, it is currently impossible for clinicians to estimate the technical forecast uncertainty of an AST result regarding clinical categorization. AST error rates depend on the localization of pathogen populations in relation to CBPs. Bacterial species are, however, not homogeneous, and subpopulations behave differently with respect to AST results. We addressed how AST reporting errors differ between isolates with and without acquired drug resistance determinants. Using as an example the beta-lactams and their most important resistance mechanisms, we analyzed different pathogen populations for their individual reporting error probabilities. Categorization error rates were significantly higher for bacterial populations harboring resistance mechanisms than for the wild-type population. Reporting errors for amoxicillin-clavulanic acid and piperacillin-tazobactam in Escherichia coli infection cases were almost exclusively due to the presence of broad-spectrum-and extended-spectrum-beta-lactamase (ESBL)-producing microorganisms (79% and 20% of all errors, respectively). Clinicians should be aware of the significantly increased risk of erroneous AST reports for isolates producing beta-lactamases, particularly ESBL and AmpC. Including probability indicators for interpretation would improve AST reports.

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“…[1]. The isolation rate of resistant bacteria in BSIs has increased significantly with the rampant use of beta-lactams and aminoglycoside antibiotics, as well as the development of more invasive procedures and treatments [2]. The Chinese Ministry of Health National Antimicrobial Resistance Investigation Net annual reports of 2010 and 2011 estimated that the isolation rate of K. pneumoniae, which has become one of the most common pathogenic bacteria in BSIs, was 7.7% and 8.3%, respectively [3,4].…”

Section: Introductionmentioning

confidence: 99%

Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumoniae isolated from bloodstream infections

Zhao

Zhang

et al. 2015

J Infect Dev Ctries

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Introduction: Bloodstream infections (BSIs) are serious diseases associated with high mortality, especially when caused by extensively drugresistant (XDR) Klebsiella pneumoniae. The prevalence and pandemic strains of extended-spectrum beta-lactamase (ESBL)-producing K. pneumoniae isolated from blood cultures of patients with BSIs were determined at Sir Run Run Shaw Hospital, China. Methodology: A total of 24 XDR K. pneumoniae were isolated from blood cultures, and the clinical data of the patients were analyzed retrospectively. Bacterial species identification and antimicrobial susceptibility testing were performed using VITEK2 and E-test methods, respectively. Common ESBL-resistant genes were amplified and sequenced after the validation of a modified Hodge test. Strain homology was also analyzed by pulsed-field gel electrophoresis (PFGE). Results: All of the isolates were resistant to 10 antimicrobial agents. Several strains showed partial sensitivity to aminoglycosides, but all showed sensitivity to polymyxin and tigecycline. All strains were Klebsiella pneumoniae carbapenemase (KPC-2) producing, and carried two or three ESBL-resistant genes, which belonged to 13 PFGE clones (A-M). The overall mortality rate in patients was as high as 29.2%. Conclusions: KPC-2-producing K. pneumoniae BSIs are associated with high mortality rates. Our observations suggest that KPC-2 and ESBL-producing K. pneumoniae might be responsible for the clonal dissemination of extensively drug-resistant isolates in our hospital.

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Efficacy of Ertapenem for Treatment of Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Cited by 55 publications

References 31 publications

Epidemiology and Treatment of MDR Enterobacteriaceae

Epidemiology and Treatment of MDR Enterobacteriaceae

Integrating Forecast Probabilities in Antibiograms: a Way To Guide Antimicrobial Prescriptions More Reliably?

Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumoniae isolated from bloodstream infections

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