Monotherapy versus combination therapy against nonbacteremic carbapenem-resistant gram-negative infections: a retrospective observational study

Ghafur, Abdul; Devarajan, Vidyalakshmi; Raja, T; Easow, Jose; Raja, MA; Sreenivas, Sankar; Balasubramaniam, R.; Raman, SG; Devaprasad, Dedeepiya; Venkatachalam, Balaji; Nimmagadda, Ramesh

doi:10.4103/ijccm.ijccm_243_17

Cited by 3 publications

(1 citation statement)

References 18 publications

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“… 15 Pitt bacteremia score was calculated at the time of fever onset. 17 The date of BSI onset was represented by the collection date of the first positive blood culture (index culture). BSIs were classified as nosocomial if the index blood culture was drawn more than 48h after hospital admission.…”

Section: Methodsmentioning

confidence: 99%

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies – The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study

Tang¹,

Xu²,

Xiao³

et al. 2021

IDR

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Background Enterobacteriaceae (EB) and non-fermentative bacteria (NFB) are the main pathogens responsible for gram-negative bloodstream infections (GN-BSI) in patients with hematological malignancies (HMs). These two pathogen types have heterogeneous resistance mechanisms to antibiotics. However, the impact of pathogen species and pattern of antibiotic resistance on the outcomes of patients with HMs remains unclear. Methods We retrospectively collected clinical data of patients with HMs at three comprehensive hospitals in Hunan Province, China, between January 2010 and May 2018. The data analyzed the impact that different species and patterns of antibiotic resistance had on the outcome of patients with HMs. Results The majority of the 835 monomicrobial isolates collected from patients with HMs and GN-BSIs were Enterobacteriaceae (75.7%). While detections of MDR pathogens in BSIs as a whole are decreasing, sub-analysis shows that detections of extended spectrum β-lactamase-producing (ESBL) Enterobacteriaceae and carbapenem-resistant pathogens in BISs are rising. Comparing different species, the early mortality rate associated with infections caused by NFB was significantly higher than infections caused by Enterobacteriaceae (22.6% vs 9.7%, p < 0.001). Across different multidrug-resistant (MDR) patterns, ESBL bacteria did not have a significant impact on health outcomes. Carbapenem-resistant bacteria, on the other hand, were observed to significantly affect early mortality rate, such as carbapenem-resistant Klebsiella pneumoniae (36.0% vs 7.6%, P < 0.001) and carbapenem-resistant non-fermentative bacteria (44.7% vs 16.5%, P < 0.001). Conclusion Our findings suggest that both species and patterns of antibiotic resistance can affect the early mortality of patients with HMs during BSI.

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Section: Methodsmentioning

confidence: 99%

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies – The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study

Tang¹,

Xu²,

Xiao³

et al. 2021

IDR

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Colistin nephrotoxicity in the ICU: Is it different in the geriatric patients?

et al. 2017

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Time kill-assays of antibiotic combinations for multidrug resistant clinical isolates of OXA-48 carbapenemase producing Klebsiella pneumoniae

Erdem

Díez-Aguilar

Öksüz

et al. 2022

AMicr

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Treatment of infections caused by OXA-48 carbapenemase producing multidrug-resistant isolates often necessitates combination therapy. In vitro effect of different antibiotic combinations against multidrug-resistant (MDR) Klebsiella pneumoniae isolates were evaluated in this study. Meropenem-tobramycin (MER+TOB), meropenem-ciprofloxacin (MER+CIP), colistin-meropenem (COL+MER), colistin-ciprofloxacin (COL+CIP) and colistin-tobramycin (COL+TOB) combinations were tested by time kill-assays. Each antibiotic alone and in combination at their Cmax values were tested against 4 clinical K. pneumoniae isolates at 1, 2, 4, 6, 8, 12 and 24 h. Effect of colistin and its associations were also assessed at 30 min. Bactericidal activity was defined as ≥3log10 CFU mL−1 decrease compared with initial inoculum. Synergy was defined as ≥2log10CFU mL−1 decrease by the combination compared with the most active single agent. Presence of bla OXA-48, bla NDM, bla VIM, bla IMP, bla KPC and bla CTX-M-1 genes was screened by PCR using specific primers. The bla OXA-48 gene was identified together with bla CTXM-1 group gene in all isolates. COL+MER demonstrated to be synergistic and bactericidal. MER+TOB showed synergistic and bactericidal effect on two strains although, regrowth was seen on other two strains at 24 h. MER+CIP exhibited indifferent effect on the strains. Combination therapy could be a potential alternative to treat MDR K. pneumoniae infections. This combination might prevent resistance development and secondary effects of colistin monotherapy. MER+TOB and MER+CIP might have an isolate-dependent effect, that may not always result in synergism.

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Monotherapy versus combination therapy against nonbacteremic carbapenem-resistant gram-negative infections: a retrospective observational study

Cited by 3 publications

References 18 publications

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies – The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies – The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study

Colistin nephrotoxicity in the ICU: Is it different in the geriatric patients?

Time kill-assays of antibiotic combinations for multidrug resistant clinical isolates of OXA-48 carbapenemase producing Klebsiella pneumoniae

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