New evidence for managing Gram-negative bloodstream infections

Abstract

Purpose of reviewGram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findingsNew rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened ( 7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined. SummaryRDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.

Antimicrobial susceptibility to polymyxin B and other comparators against Gram-negative bacteria isolated from bloodstream infections in China: Results from CARVIS-NET program

“…Avibactam belongs to β-lactamase inhibitor. When ceftazidime and avibactam are applied simultaneously, the β-lactamases will be inhibited so that they no longer have the ability to degrade ceftazidime, thus they are still sensitive to ceftazidime ( Castanheira et al, 2021 ; Yahav et al, 2021 ). Besides, amikacin, an aminoglycoside, performed well against P. aeruginosa and E. cloacae in bloodstream infections as well.…”

“…Gram-negative bacteria bloodstream infection (GNBSI) has been a global public health problem ( Huh et al, 2020 ; Nutman et al, 2021 ). Drug resistance in Gram-negative bacteria, including those that cause bloodstream infections, has increased dramatically over the past 20 years ( Ergonul et al, 2016 ; Huh et al, 2020 ).…”

Evolution and development of potent monobactam sulfonate candidate IMBZ18g as a dual inhibitor against MDR Gram-negative bacteria producing ESBLs

“…As β -lactam resistance mainly lies in the high expression of β -lactamase in Gram-negative strains 4 , the microdilution checkerboard screening 20 was conducted between 33a and various β -lactamase inhibitors, including the classic clavulanic acid, sulbactam, tazobactam, and non-classic vaborbactam, avibactam and ETX2514 21 , 22 , 23 . The combination of 33a with avibactam showed promising synergistic effects against all tested ESBL and NDM-producing MDR Enterobacteria , especially the K. pneumoniae strains, with fractional inhibitory concentration index (FICI) values below 0.5, and the MIC values of 33a were reduced up to 4–512 folds, obviously lower than that of 1 ( Fig.…”

Prediction of carbapenem-resistant gram-negative bacterial bloodstream infection in intensive care unit based on machine learning

“…There are false positive and false negative, which is related to the level of hospitals, the timing of blood culture and the history of the use of antibiotics. Although there are next generation sequencing (NGS) and polymerase chain reaction (PCR) results as a supplement [ 34 ], the status of blood culture as a gold standard cannot be shaken in the short term. Whether we can include PCR or NGS results to enhance the diagnosis of bloodstream infection needs more literature support.…”