Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in the United States, 2007-2008: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Hoban, Daryl J.; Bouchillon, S.; Hawser, Stephen; Badal, R.; LaBombardi, Vincent J.; DiPersio, Joseph R.

doi:10.1128/aac.01808-09

Cited by 56 publications

(30 citation statements)

References 12 publications

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“…However, ESBL-E are frequently susceptible to PTZ in many areas of the world. Our data among the patients treated empirically with PTZ and AMC are similar to the rates of suscep-tibility reported by other authors (frequently higher than 70% for PTZ [6][7][8][9][10] and higher than 60% for AMC [11,30]). Finally, these results encourage the further investigation of newer BLBLI combinations that are active even against some carbapenemase-producing Enterobacteriaceae.…”

Section: Discussionsupporting

confidence: 78%

“…Although hyperproduction of ␤-lactamases or additional resistance mechanisms may hamper the activity of these compounds, ␤-lactam/␤-lactamase inhibitor combinations (BLBLIs) such as amoxicillin-clavulanate (AMC) or piperacillin-tazobactam (PTZ) remain active against a considerable proportion of ESBL-E in many areas of the world (6)(7)(8)(9)(10)(11). However, the efficacy of BLBLIs for treating serious infections caused by ESBL-E is controversial (11)(12)(13).…”

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confidence: 99%

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A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Gutiérrez‐Gutiérrez

Pérez-Galera

Salamanca

et al. 2016

Antimicrob Agents Chemother

146

111

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The spread of extended-spectrum-␤-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether ␤-lactam/␤-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.)

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Section: Discussionsupporting

confidence: 78%

mentioning

confidence: 99%

A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Gutiérrez‐Gutiérrez

Pérez-Galera

Salamanca

et al. 2016

Antimicrob Agents Chemother

146

111

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“…In this study, the most common baseline pathogens were Escherichia coli, Klebsiella spp., streptococci, enterococci, and Bacteroides spp., consistent with those associated typically with cIAI, although the recovery of anaerobic pathogens was lower in the present study than in some recent reports (20,21). These pathogens were eradicated at similar rates by both study drugs.…”

Section: Discussioncontrasting

confidence: 33%

Phase 2, Randomized, Double-Blind Study of the Efficacy and Safety of Two Dose Regimens of Eravacycline versus Ertapenem for Adult Community-Acquired Complicated Intra-Abdominal Infections

Solomkin

Ramesh

Česnauskas³

et al. 2014

Antimicrob Agents Chemother

108

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f Eravacycline is a novel fluorocycline, highly active against Gram-positive and Gram-negative pathogens in vitro, including those with tetracycline and multidrug resistance. This phase 2, randomized, double-blind study was conducted to evaluate the efficacy and safety of two dose regimens of eravacycline compared with ertapenem in adult hospitalized patients with complicated intraabdominal infections (cIAIs). Patients with confirmed cIAI requiring surgical or percutaneous intervention and antibacterial therapy were randomized (2:2:1) to receive eravacycline at 1.5 mg/kg of body weight every 24 h (q24h), eravacycline at 1.0 mg/kg every 12 h (q12h), or ertapenem at 1 g (q24h) for a minimum of 4 days and a maximum of 14 days. The primary efficacy endpoint was the clinical response in microbiologically evaluable (ME) patients at the test-of-cure (TOC) visit 10 to 14 days after the last dose of study drug therapy. Overall, 53 patients received eravacycline at 1.5 mg/kg q24h, 56 received eravacycline at 1.0 mg/kg q12h, and 30 received ertapenem. For the ME population, the clinical success rate at the TOC visit was 92.9% (39/42) in the group receiving eravacycline at 1.5 mg/kg q24h, 100% (41/41) in the group receiving eravacycline at 1.0 mg/kg q12h, and 92.3% (24/26) in the ertapenem group. The incidences of treatment-emergent adverse events were 35.8%, 28.6%, and 26.7%, respectively. Incidence rates of nausea and vomiting were low in both eravacycline groups. Both dose regimens of eravacycline were as efficacious as the comparator, ertapenem, in patients with cIAI and were well tolerated. These results support the continued development of eravacycline for the treatment of serious infections, including those caused by drug-resistant Gram-negative pathogens. (This study has been registered at ClinicalTrials.gov under registration no. NCT01265784.)

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“…A total of 3,160 clinical isolates of Escherichia coli from IAIs during 2008 and 2009 from 13 European countries were evaluated, and 11% were found to produce extended-spectrum ␤-lactamases (ESBLs) (107). The SMART report for 2008 U.S. E. coli strains from IAIs indicated that about 4.7% of strains produced ESBLs (113). Emphasizing the importance of geographic trends, the rate of ESBL-producing E. coli strains from the Asia-Pacific region was 36.8% using SMART data from this region (47).…”

Section: Intra-abdominal Infectionsmentioning

confidence: 99%

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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Susceptibility of Gram-Negative Pathogens Isolated from Patients with Complicated Intra-Abdominal Infections in the United States, 2007-2008: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Cited by 56 publications

References 12 publications

A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

Phase 2, Randomized, Double-Blind Study of the Efficacy and Safety of Two Dose Regimens of Eravacycline versus Ertapenem for Adult Community-Acquired Complicated Intra-Abdominal Infections

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

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