In vitro Activity of Combination Therapy with Cefepime, Piperacillin-Tazobactam, or Meropenem with Ciprofloxacin against Multidrug-Resistant &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; Strains

Erdem, İlknur; Küçükercan, Metin; Ceran, Nurgül

doi:10.1159/000074529

Cited by 20 publications

(20 citation statements)

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“…El diseño se limita a un estudio epidemiológico, donde los mecanismos de resistencia y la clonalidad no fueron analizados, pudiendo ser que los factores de riesgo para cada uno de ellos fueran diferentes; sin embargo, en la literatura la consideración de multi-resistencia por su expresión fenotípica (in vitro) es comúnmente usada independientemente al mecanismo de resistencia 27,[31][32][33] . Otro aspecto a tener en cuenta es que existen múlti-ples definiciones de MR descritas y algunos consensos, habiendo adoptado para este estudio la definición de MR como la falta de sensibilidad a dos o más familias de antibacterianos o a carbapenémicos [33][34][35][36][37] ; esto posiblemente influyó en no encontrar asociación entre la MR y otros factores de riesgo que han sido descritos en estudios donde la MR es considerada como resistencia a tres o más familias de antibacterianos.…”

Section: Artículo Originalunclassified

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Ossa-Giraldo

Echeverri-Toro

Santos

et al. 2014

Rev. chil. infectol.

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Section: Artículo Originalunclassified

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Ossa-Giraldo

Echeverri-Toro

Santos

et al. 2014

Rev. chil. infectol.

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“…Combining carbapenems and ␤ -lactamase inhibitors with selected ratios or with other agents like polymyxin E could possibly slow this inevitable outcome. Combination therapy, once multidrug resistance has occurred, was not eff ective in a study by Erdem et al [10] .…”

Section: Discussionmentioning

confidence: 95%

Susceptibilities of ESBL-Producing Enterobacteriaceae to Ertapenem, Meropenem and Piperacillin-Tazobactam with and without Clavulanic Acid

Raveh

Yinnon²,

Broide³

et al. 2007

Chemotherapy

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Background: Faced with the extended-spectrum β-lactamase (ESBL) pandemic, we compared the susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanate. Methods: 121 strains of Escherichia coli and Klebsiella were studied. 70 strains were originally reported as resistant to ceftazidime based upon disk diffusion; 51 strains were originally reported as sensitive to ceftazidime based upon previous guidelines of the National Committee for Clinical Laboratory Standards, but subsequently shown to be ESBL producers. Minimal inhibitory concentrations (MICs) of the strains towards ertapenem, meropenem and piperacillin-tazobactam were determined by Etest. The effect of adding clavulanate on the MICs was determined by performing the Etest, using plates containing 2 µg/ml of clavulanate. Results: The MIC₉₀ of all isolates was 0.094 and 0.25 µg/ml for ertapenem, 0.032 and 0.064 µg/ml for meropenem, and 16 and 256 µg/ml for piperacillin-tazobactam with and without clavulanate, respectively. Conclusions: ESBL-producing organisms were more susceptible to meropenem than to ertapenem, although the MICs to ertapenem were well within clinically achievable levels. Piperacillin-tazobactam was ineffective in a large percentage of isolates. The presence of clavulanate resulted in a 5-fold decrease in the MIC of ertapenem and in a drastic reduction in the MIC of piperacillin-tazobactam. The decrease observed with ertapenem is unlikely to be of clinical significance. Thus, in our hospital, ertapenem could be a good meropenem-sparing agent for infections due to ESBL-producing organisms. Piperacillin-tazobactam appeared to be a poor choice, as our isolates produce ESBLs which are not successfully inhibited by tazobactam.

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“…However, the combination of different antifungal agents has been a matter of debate in fungal infections, and there is, so far, no evidence of superiority of combining different antifungal agents over monotherapy. However, even the so-called 'gold standard'-amphotericin B-results in poor survival rates, especially during HSCT [13][14][15]. Protracted neutropenia seems to be one of the most important causes of low success rate [16].…”

Section: Discussionmentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation in a Very High Risk Group of Patients with the Support of Granulocyte Transfusion

Yenicesu

Sucak

Dilsiz

et al. 2011

Indian J Hematol Blood Transfus

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High risk patients with active fungal infection who had undergone hematopoietic stem cell transplantation (HSCT) with the support of granulocyte transfusions (GTX) as an adjunct to antifungal agents are reviewed retrospectively. Patients requiring immediate allogeneic HSCT for their primary hematological disorders (two severe aplastic anemia, one T cell acute lymphoblastic leukemia (ALL) in second complete remission, one acute myeloid leukemia (AML)-in first complete remission, one T-ALL in refractory relapse) but were denied by other transplant programs due to active invasive fungal infections had undergone HSCT with the support of GTX at the stem cell transplantation unit of Gazi University. Five patients who had undergone six transplants were included in the study and received a total of 38 (3-13) granulocyte transfusions during these six transplants. The median granulocyte concentration was 3.4 × 10(11) per apheresis bag. Full clinical and radiological recovery was achieved in three of the five high risk patients with active invasive fungal infection with the combination of antifungal agents and GTX. Even a very high risk patient with aplastic anemia who had undergone two consecutive transplants due to secondary graft failure was also cured of his primary disease despite the presence of multiple pulmonary fungus balls. Three of the five patients with very high risk features due to the underlying hematological disease and the associated active fungal infection were rescued with allogeneic HSCT performed with the support of GTX combined with antifungal agents. Despite the limitations of this report due to its retrospective nature, it suggests that GTX might be an alternative in patients with active fungal infections who otherwise are denied by the transplant programs. However, prospective randomized studies are required to draw a solid conclusion regarding the role of GTX in HSCT recipients in desperate situations such as active fungal infections.

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In vitro Activity of Combination Therapy with Cefepime, Piperacillin-Tazobactam, or Meropenem with Ciprofloxacin against Multidrug-Resistant <i>Pseudomonas aeruginosa</i> Strains

Cited by 20 publications

References 10 publications

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad

Susceptibilities of ESBL-Producing Enterobacteriaceae to Ertapenem, Meropenem and Piperacillin-Tazobactam with and without Clavulanic Acid

Hematopoietic Stem Cell Transplantation in a Very High Risk Group of Patients with the Support of Granulocyte Transfusion

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