Piperacillin-Tazobactam versus Other Antibacterial Agents for Treatment of Bloodstream Infections Due to AmpC β-Lactamase-Producing Enterobacteriaceae

Cheng, Lucy; Nelson, Brian; Mehta, Mahima; Seval, Nikhil; Park, Sarah; Giddins, Marla J.; Shi, Qiuhu; Whittier, Susan; Gomez‐Simmonds, Angela; Uhlemann, Anne‐Catrin

doi:10.1128/aac.00276-17

Cited by 85 publications

(51 citation statements)

References 22 publications

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“…A retrospective cohort study studied 165 patients with BSI due to these microorganisms, 85% of which were in fact AmpC producers. Eighty-eight patients received targeted therapy with piperacillin-tazobactam and 77 with meropenem or cefepime (60). Mortality rates were 10% and 12%, respectively, while in 41 propensity-matched pairs, mortality rates were 15% and 7%, respectively (odds ratio [OR] ϭ 0.50; 95% CI ϭ 0.13 to 2.0).…”

Section: Classic Blblismentioning

confidence: 99%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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Therapy of invasive infections due to multidrug-resistant (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.

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Section: Classic Blblismentioning

confidence: 99%

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

et al. 2018

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“…bla DHA , bla OXY , bla MIR may prove useful for infection control management and treatment of multidrug-resistant Gram-negative infections. This is particularly true in the case of piperacillin-tazobactam, which may not be a stable or reliable antibiotic against AmpC producers[10, 36].…”

Section: Resultsmentioning

confidence: 99%

Molecular epidemiology of third-generation cephalosporin-resistant Enterobacteriaceae from Southeast Queensland, Australia

Stewart

Price

Schabacker

et al. 2020

Preprint

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27Third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae represent a major 28 threat to human health. Here, we captured 288 3GC-R Enterobacteriaceae clinical isolates 29 from 258 patients presenting at a regional Australian hospital over a 14-month period. 30Alongside routine mass spectrometry speciation and antibiotic sensitivity testing, isolates 31 were examined using a rapid (~40 min) pentaplex real-time PCR assay targeting the most 32 common extended spectrum β-lactamases (ESBLs; CTX-M-1 and CTX-M-9 groups, plus TEM, 33 SHV, and an internal 16S ribosomal DNA control). Additionally, AmpC CMY β-lactamase 34 prevalence was examined using a singleplex PCR. A subset of isolates, including all 3GC-R 35 isolates obtained from the intensive care unit, were subjected to whole-genome sequencing 36 (WGS) to assess transmission dynamics, the presence of unidentified resistance 37 determinants, and genotyping accuracy. Escherichia coli (80.2%) and Klebsiella pneumoniae 38 (17.0%) were dominant, with Klebsiella oxytoca, Klebsiella aerogenes and Enterobacter 39 cloacae infrequently identified. Ceftriaxone and cefoxitin resistance was identified in 97% 40 and 24.5% of E. coli and K. pneumoniae isolates, respectively. Consistent with global findings 41 in Enterobacteriaceae, the majority (98.3%) of isolates harbored at least one β-lactamase 42 gene, with 144 (50%) encoding blaCTX-M-1 group, 92 (31.9%) blaCTX-M-9 group, 48 (16.7%) blaSHV, 43 133 (46.2%) blaTEM, and 34 (11.8%) blaCMY genes. WGS of β-lactamase negative or 44 carbapenem-resistant isolates identified uncommon ESBLs and carbapenemases, including45 blaNDM and blaIMP, and confirmed all PCR-positive genotypes. No evidence of transmission 46 among intensive care unit patients was identified. We demonstrate that our PCR assays 47 enable the rapid and cost-effective identification of ESBLs in the hospital setting, which has 48 important infection control and therapeutic implications.49 52 determinants within and among bacterial populations [1]. Both infection and colonization 53 with these globally-disseminated organisms are associated with poor clinical outcomes and 54 death [2]. 3GC-R Enterobacteriaceae prevalence rates vary considerably among hospitals 55 and countries, with particularly high rates in India, Asia, and the Middle East [3]. Australia 56 has historically observed a relatively low frequency of 3GC-R Enterobacteriaceae. However, 57 this pattern may be changing, with an extended spectrum β-lactamase (ESBL) phenotype 58 detected in 13.3% of E. coli and 9.8% of K. pneumoniae in blood culture isolates in 2018 [4], 59 up from 2013 rates of 7.6% and 6.3%, respectively. Moreover, ceftriaxone resistance was 60 seen in 13.4% of E. coli and 9.4% of K. pneumoniae, with 86.3% and 82.6% containing CTX-M-61 type ESBL genes, respectively [4]. 62 63 AMR in 3GC-R Enterobacteriaceae is generally conferred by the presence of an ESBL or the 64 over-expression of a chromosomal or plasmid-borne AmpC β-lactamase; however, the 65 prevalence of these determinants var...

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“…Doctors often use ampicillin or cephalosporin empirically to treat bacteremia, but these antibiotics could induce high expression of Ampc and ESBLs, leading to the resistance to β-lactam antibiotics 21 . Piperacillin-tazobactam (TZP), a weak inducer of AmpC beta-lactamases and inhibitor of ESBLs may be a valuable treatment option for BSIs 22 .…”

Section: Discussionmentioning

confidence: 99%

Neonate Bloodstream Infections (BSI) in China: Emerging Threat of Multidrug-resistant (MDR) pathogens

Zhang

Zhou

Shen

et al. 2020

Preprint

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Background: Bloodstream Infections (BSIs) continue to be associated with significant morbidity and mortality worldwide, which multidrug-resistant (MDR) pathogens present an ever-growing burden in the hospital and community settings. Data on antimicrobial resistance and prevalence of BSIs pathogens among hospitalized neonates in China are few and not clearly defined. Methods: we retrospectively collected clinical and bacteria data about patients with BSI from 2013 to 2017 in Chongqing Health Center for Women and Children. The patients were divided into the early- and late-onset BSI groups according to if BSI occurred within or beyond 72 hours after admission.Results: 210 BSIs occurred from January 1st, 2014 to December 31th, 2019. Of all included 210 patients, there were 99(47.14%), 105 (50.00%), and 6 (2.86%) infected with gram-positive bacteria, gram-negative bacteria, and fungi, respectively. For early-onset BSI, the predominated pathogen was E. coli, accounting for 59.6% with 29.72% producing of extended-spectrum beta-lactamases (ESBLs). CNS (40.3%), K. pneumoniae (23.8%), and E. coli (20.9%) constitute the main causes of late-onset BSIs. Notably, 75.0% of K. pneumoniae produced ESBLs and 81.3% were MDR, which were higher than early-onset BSIs. Late onset BSIs and antibiotic exposure were significantly associated with MDR infection. Conclusion: Gram-negative bacteria gradually became the main pathogenic bacteria, among which E. coli and K. pneumoniae accounted for the largest proportion. The phenomenon of multi-drug resistance of bacteria is serious, and the first-line drug can't meet the practical needs. Late onset sepsis and antibiotic exposure were significantly associated with MDR infection.

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Piperacillin-Tazobactam versus Other Antibacterial Agents for Treatment of Bloodstream Infections Due to AmpC β-Lactamase-Producing Enterobacteriaceae

Cited by 85 publications

References 22 publications

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

Molecular epidemiology of third-generation cephalosporin-resistant Enterobacteriaceae from Southeast Queensland, Australia

Neonate Bloodstream Infections (BSI) in China: Emerging Threat of Multidrug-resistant (MDR) pathogens

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