Simple bedside score to optimize the time and the decision to initiate appropriate therapy for carbapenem-resistant Enterobacteriaceae

Leibman, Violet; Martin, Emily T.; Tal-Jasper, Ruthy; Grin, Leonti; Hayakawa, Kayoko; Shefler, Coral; Azouri, Tal; Kaplansky, Tamir; Maskit, Moran; Lazarovitch, Tsilia; Kaye, Keith S.; Marchaim, Dror

doi:10.1186/s12941-015-0088-y

Cited by 20 publications

(14 citation statements)

References 9 publications

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“…A challenge in developing reliable scores for MDR and XDR infections, relates also to methodological issues [47]. Most studies to date have used the…”

Section: Prediction Scoresmentioning

confidence: 99%

“…More complex study designs, such as the matched case-case-control design are often more appropriate and necessary [48,49]. Developing such scores to differentiate MDROs from XDROs (for example, ESBLs from CRE) is methodologically very complex, in part, because the epidemiological features of ESKAPE-MDROs are often similar to ESKAPE-XDROs [47,50]. [42].…”

Section: Prediction Scoresmentioning

confidence: 99%

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Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

121

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The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities.

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“…A challenge in developing reliable scores for MDR and XDR infections, relates also to methodological issues [47]. Most studies to date have used the…”

Section: Prediction Scoresmentioning

confidence: 99%

Section: Prediction Scoresmentioning

confidence: 99%

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Pogue

Kaye

Cohen

et al. 2015

Clinical Microbiology and Infection

121

View full text Add to dashboard Cite

show abstract

“…In addition, there are no large and robust studies on well-selected patient populations and most available data on clinical outcome come from retrospective analyses, with heterogeneity of drugs and dosages and often without any significant contribution of PK/PD data, even in the setting of severe sepsis and septic shock. Among clinical variables, the time to initiation of appropriate therapy is the strongest modifiable independent predictor for mortality in infections due to MDR Enterobacteriaceae [13,14]; the delay with CRE may be as high as 120± 23 h, mainly due to current routine practices for identification in microbiology laboratories [15,16].…”

Section: Epidemiology Of Multi-drug Resistant (Mdr) Enterobacteriaceamentioning

confidence: 99%

Epidemiology and Treatment of MDR Enterobacteriaceae

Bassetti

Pecori

Sibani

et al. 2015

Curr Treat Options Infect Dis

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Opinion statementThe major progress in the history of medicine represented by the discovery of antibiotics is nowadays compromised by the universal spread of antibiotic resistance. World Health Organization (WHO) lists third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae and carbapenem-resistant K. pneumoniae in a group of seven bacteria of international concern, responsible for both healthcare-associated and community-acquired infections. Patients infected by these pathogens have limited therapeutic options, worse clinical outcomes, increased mortality rates, and a higher healthcare resources consumption. In infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, appropriate monotherapy is effective and carbapenems are the drugs of choice; however, β-lactams/β-lactamase inhibitors (BLBLIs) are regarded as an alternative mainly in patients without severe infections, with E. coli bacteremia with urinary source or with low minimum inhibitory concentrations (MICs). For infections caused by carbapenem-resistant Enterobacteriaceae (CRE), where the predicted mortality rate of patients is high, a combination antimicrobial treatment should be preferred. Many important variables in the treatment such as the role of high dosages and loading doses, the variable degrees of dosage reduction for impaired renal function, and the inclusion of carbapenems or tigecycline are a matter of debate. Despite the obscure vision provided by a notable number of meta-analyses, tigecycline is an effective and safe option for the treatment of MDR Enterobacteriaceae, as part of a combination regimen in case of infections caused by CRE, where a higher dosage (200 mg/daily) should be preferred. Colistin is the most active in vitro agent against CRE. Despite clinical data about the efficacy of fosfomycin against MDR Enterobacteriaceae are limited, this molecule represents an interesting option for the treatment of lower urinary tract and even systemic infections caused by difficult-to-treat Gram-negative pathogens. Based on in vitro studies, ceftolozane-tazobactam and ceftazidime-avibactam will represent very interesting new drugs for the treatment of ESBL-producing and CRE infections, respectively.

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“…With a total score ≥ 32 patients were considered as high risk for CRE BSI infections and required antimicrobial therapy targeted for CRE BSI infections. Although this test showed a lower sensitivity and specificity, its negative predictive value might prevent needless use of toxic antibiotics[ 28 ].…”

Section: Epidemiology Of Enterobacteriaceaementioning

confidence: 99%

Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistantEnterobacteriaceae?

Alhashem

Tiren-Verbeet

Alp

et al. 2017

WJCC

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Sepsis is one of the major challenges of today. Although gram-positive bacteria related infections are more prevalent in hospital setting, the highest mortality rate is associated with gram-negative microorganisms especially Enterobacteriaceae. Enterobacteriaceae, including Escherichia coli, Klebsiella spp., Proteus spp., Enterobacter spp. and Serratia spp. Resistance to β-lactams in Enterobacteriaceae is primarily attributed to the production of B-lactamase enzymes with subsequent antibiotic hydrolysis and to a lesser extent by alteration of efflux pump or porins expression. Carbapenem resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii are the most notorious pathogens due to the high incidence of morbidity and mortality especially in the immunocompromised patients in the intensive care unit. The most appropriate antimicrobial therapy to treat CRE is still controversial. Combination therapy is preferred over monotherapy due to its broad-spectrum coverage of micro-organisms, due to its synergetic effect and to prevent development of further resistance. Current suggested therapies for CRE resistance as well as promising antibiotics that are currently under investigation for winning the war against the emerging CRE resistance are reviewed and discussed.

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Simple bedside score to optimize the time and the decision to initiate appropriate therapy for carbapenem-resistant Enterobacteriaceae

Cited by 20 publications

References 9 publications

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens

Epidemiology and Treatment of MDR Enterobacteriaceae

Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistantEnterobacteriaceae?

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