Polymyxin B with dual carbapenem combination therapy against carbapenemase-producing Klebsiella pneumoniae

Chua, Nathalie Grace; Zhou, Yvonne Peijun; Tan, Thuan Tong; Lingegowda, Pushpalatha Bangalore; Lee, Winnie; Lim, Tze Peng; Teo, Jin Yao; Cai, Yiying; Kwa, Andrea Lay-Hoon

doi:10.1016/j.jinf.2014.10.001

Cited by 22 publications

(15 citation statements)

References 8 publications

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“…Recurrent infection with CP-Kp in the blood cultures was also reported in a patient with a history of adenocarcinoma and hepatocellular carcinoma after the successful completion of treatment with DCT and polymyxin B. 26 The DCT/polymyxin regimen was restarted, and blood cultures became negative for CP-Kp, but the patient subsequently died because of his underlying comorbidities, advanced age, and multiorgan failure. Finally, a case of an immune-compromised patient post-kidney transplant was described in which the patient developed recurrent infections caused by CP-Kp over 2 years.…”

Section: Resultsmentioning

confidence: 84%

“…Polymyxin therapy was added to the DCT in 4 patients. 24-26 In most cases, patients had clinical improvement, microbiological clearance, and no relapse during the follow-up period. In addition, none of the cases reported adverse events associated with DCT.…”

Section: Resultsmentioning

confidence: 97%

“…Subsequently, several other case reports were published describing DCT in 10 patients with CP-Kp [22][23][24][25][26][27][28] (Table 1). The blood and urine were the most common sites of infection, and the combination carbapenem regimens consisted of ertapenem with meropenem or doripenem.…”

Section: Resultsmentioning

confidence: 99%

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Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae

2018

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Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 97%

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Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae

2018

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“…The efficacy under these conditions was maintained in isolates for which doripenem MICs were 8 to 16 g/ml in immunocompetent infected mice and to a lesser degree in neutropenic mice. These findings were translated into the clinical setting (11,12,22,(25)(26)(27). At least 10 other patients with dual-carbapenem therapy have been reported, all of them treated with ertapenem plus doripenem or meropenem (Table 2).…”

Section: Commentarymentioning

confidence: 95%

Successful Treatment of Carbapenemase-Producing Pandrug-Resistant Klebsiella pneumoniae Bacteremia

Camargo

Simkins

Beduschi

et al. 2015

Antimicrob Agents Chemother

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New antibiotic options are urgently needed for the treatment of carbapenem-resistant Enterobacteriaceae infections. We report a 64-year-old female with prolonged hospitalization following an intestinal transplant who developed refractory bacteremia due to a serine carbapenemase-producing pandrug-resistant isolate of Klebsiella pneumoniae. After failing multiple antimicrobial regimens, the patient was successfully treated. CASE PRESENTATIONA 64-year-old female with a history of diabetes mellitus developed Clostridium difficile colitis with toxic megacolon requiring total colectomy. As a complication of the total colectomy, she had a volvulus requiring extensive resection of necrotic small bowel with resultant total parenteral nutrition-dependent short bowel syndrome (only 15 cm of small bowel left). The patient was referred to our institution for an intestinal transplant. Induction immunosuppression consisted of antithymocyte globulin at 2 mg/kg of body weight intravenously (i.v.) (5 doses), methylprednisolone at 500 mg i.v. every 24 h (q24h) (4 doses, followed by a slow taper over the first 2 weeks), and rituximab at 150 mg/m 2 i.v. (1 dose). Maintenance immunosuppression consisted of basiliximab at 40 mg i.v. every 4 weeks for the first 3 months, tacrolimus, and low-dose prednisone. The antimicrobial prophylaxis regimen consisted of ganciclovir (5 mg/kg i.v. q12h for 2 weeks, followed by valganciclovir at 900 mg per os [p.o.] daily) and trimethoprimsulfamethoxazole (80/400 mg p.o. three times a week) for cytomegalovirus and Pneumocystis jirovecii pneumonia prophylaxis, respectively. No multidrug-resistant organisms were identified by rectal and nasal surveillance cultures at the time of the transplant.The early posttransplant course was complicated by an intraabdominal hematoma on postoperative day 1, which required emergent surgical exploration and evacuation. Abdominal wound closure was performed on postoperative day 8. On postoperative day 12, the patient required another surgical exploration with intraoperative findings of pancreatitis with a small peripancreatic collection. Cultures from this collection obtained in the operating room yielded a heavy growth of Klebsiella pneumoniae. A Hodge test was positive, indicating carbapenemase production. The presence of the Klebsiella pneumoniae carbapenemase (KPC) gene was confirmed using the Verigene (Nanosphere, Inc., Northbrook, IL) Gram-negative blood culture nucleic acid test. The class B (IMP-type metallo-␤-lactamase, New Delhi metallo-␤-lactamase [NDM], and Verona integron-encoded metallo-␤-lactamase [VIM]) and class D (oxacillinase [OXA]-type) carbapenemase genes were not detected. The isolate was resistant to aminoglycosides but susceptible to tigecycline (MIC, 0.38 g/ml) and colistin (MIC, 0.19 g/ml). The patient was started on a combination of tigecycline (1 dose of 100 mg i.v., followed by 50 mg i.v. q12h) and colistin (2.5 mg i.v. q12h) and completed a 14-day course for complicated intra-abdominal infection (cIAI) due to carbapenem-resistant Klebsiella...

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“…Overall, 28 studies were selected for fulltext review, and 21 studies met our inclusion criteria. For these 21 studies, three trials [33][34][35] were cohort or casecontrol studies, and 18 reports [26,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] were case series or case reports. The flow diagram (Fig.…”

Section: Study Identificationmentioning

confidence: 99%

Double-carbapenem therapy in the treatment of multidrug resistant Gram-negative bacterial infections: a systematic review and meta-analysis

Wang

et al. 2020

BMC Infect Dis

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Background: To compare the efficacy and safety of double-carbapenem therapy (DCT) with other antibiotics for the treatment of multidrug resistant (MDR) Gram-negative bacterial infections. Methods: Cochrane Library, PubMed, Embase and Web of Science as well as Chinese databases were searched from database establishment to February 2019. All types of studies were included if they had evaluated efficacy and safety of DCT regimens in patients with MDR Gram-negative bacterial infections. Clinical response, microbiological response, adverse events and mortality were the main outcomes. The protocol was registered with PROSPERO No. CRD42019129979. Results: Three cohort or case-control studies consisting of 235 patients and 18 case series or case reports consisting of 90 patients were included. The clinical and microbiological responses were similar between DCT and other regimens in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection. DCT achieved a lower mortality than comparators in patients with CRE infection (OR = 0.44, 95% CI = 0.24-0.82, P = 0.009). Ertapenem was the most reported antibiotic in DCT regimens in case series or case reports. Moreover, clinical and microbiological improvements were found in 59 (65.6%) and 63 (70%) in total 90 cases, respectively. Conclusions: DCT was as effective as other antibiotics in treating MDR Gram-negative bacterial infections, with similar efficacy response and lower mortality. DCT could be an alternative therapeutic option in the treatment of MDR Gram-negative bacterial infections. High-quality randomized controlled trials were required to confirm the beneficial effects of DCT.

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Polymyxin B with dual carbapenem combination therapy against carbapenemase-producing Klebsiella pneumoniae

Cited by 22 publications

References 8 publications

Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae

Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae

Successful Treatment of Carbapenemase-Producing Pandrug-Resistant Klebsiella pneumoniae Bacteremia

Double-carbapenem therapy in the treatment of multidrug resistant Gram-negative bacterial infections: a systematic review and meta-analysis

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