The place of ceftazidime/avibactam and ceftolozane/tazobactam for therapy of haematological patients with febrile neutropenia

Clerici, Daniela; Oltolini, Chiara; Greco, Raffaella; Ripa, Marco; Giglio, Fabio; Mastaglio, Sara; Lorentino, Francesca; Pavesi, Francesca; Farina, Francesca; Liberatore, Carmine; Castiglion, Barbara; Din, Chiara Tassan; Bernardi, Massimo; Corti, Consuelo; Peccatori, Jacopo; Scarpellini, Paolo; Ciceri, Fabio; Castagna, Antonella

doi:10.1016/j.ijantimicag.2021.106335

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Overall, 13 patients underwent treatment with cefiderocol. Median (q1-q3) age was 63 (53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69) years, and 11 subjects (84%) were males. Importantly, cefiderocol was used in three specific settings in our series:…”

Section: Case Seriesmentioning

confidence: 99%

“…Starting from these considerations, a possible future place in therapy of cefiderocol, along with the treatment of severe infections caused by CRAB, XDR P.aeruginosa or metallo-beta-lactamase producing Enterobacterales, may represent an option as empirical therapy for the management of febrile neutropenia in hematological patients colonized by these pathogens or in the perioperative prophylaxis of donor-derived infections (DDIs) in transplant recipients when the donor was colonized or infected by XDR GNB [68]. For instance, recent studies suggested the efficacy and safety of ceftazidime/avibactam or ceftolozane/tazobactam as empiric therapies of febrile neutropenia in hematological patients colonized by multidrug-resistant organisms [69,70]; however, using this approach, a rapid, programmed and structured de-escalation approach needs to be implemented in order to reduce the risk of developing resistance as well as to preserve the activity of these new antibiotics. Similarly, as discussed before, an important role of new cephalosporins will be played in the treatment of XDR GNB that caused DDIs [68].…”

Section: Place In the Therapy Of Immunocompromised Hostsmentioning

confidence: 99%

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Cefiderocol-Based Combination Therapy for “Difficult-to-Treat” Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives

et al. 2021

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Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.

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Section: Case Seriesmentioning

confidence: 99%

Section: Place In the Therapy Of Immunocompromised Hostsmentioning

confidence: 99%

Cefiderocol-Based Combination Therapy for “Difficult-to-Treat” Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives

et al. 2021

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“…Ceftazidime avibactam (CTV) is a b-lactam/b-lactamase inhibitor combination. At present, many investigations have confirmed that CTV has excellent performance on CRGNB, especially CRKP, infected in the population after HSCT and solid organ transplantation (Chen et al, 2021;Clerici et al, 2021). However, in an in vitro experiment, researchers found that CRGNB isolated from patients' blood and stool samples was resistant to CTV at a rate of 91% (Niyazi et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, antimicrobial resistance, and mortality risk factors of carbapenem resistant gram-negative bacteria in hematopoietic stem cell transplantation recipients

Jia

Liu

et al. 2023

Front. Cell. Infect. Microbiol.

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IntroductionCarbapenem resistant gram-negative bacteria (CRGNB) infection is more and more frequent in patients after hematopoietic stem cell transplantation (HSCT), and the prognosis is very poor. The purpose of this study was to investigate the clinical characteristics and risk factors for mortality with CRGNB infection in HSCT recipients, and to provide useful information for guiding the application of antibiotics and improving the prognosis in the future.MethodsElectronic medical records of CRGNB infected patients who underwent HSCT in Xiangya Hospital from January 1, 2015 to June 30, 2022 were collected. At the same time, 1:1 case-control matching was performed according to gender, age and disease type. The epidemiological characteristics and drug resistance of patients with CRGNB infection and non-CRGNB infection were compared. Logistic regression and Cox regression analysis were used to determine the risk factors for CRGNB acquisition and death respectively, and a prediction model of overall survival was constructed by R language.Results and DiscussionThe crude infection rate of CRGNB in HSCT recipients was 7.42%, and the mortality rate was 47.1%. CRGNB was resistant to most commonly used antibiotics. Time interval from diagnosis to transplantation >180 days (HR=7.886, 95% CI 2.624-23.703, P=0.000), septic shock (HR=6.182, 95% CI 2.605-14.671, P=0.000), platelet count < 20 × 109/L (HR=2.615, 95% CI 1.152-5.934, P=0.022) and total bilirubin > 34.2 μmol/L (HR=7.348, 95% CI 2.966-18.202, P=0.000) at the initial stage of infection were 4 independent risk factors associated with mortality. CRGNB infection has become a serious threat to HSCT recipients. Clinicians should pay high attention to it and actively seek personalized treatment strategies suitable for local medical conditions.

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“…The targeted treatment of infections caused by CPE on the hematology ward was difficult because our center does not count with alternative drugs to colistin or tigecycline, which are recommended by some guidelines [ 33 , 37 ]. For example, ceftazidime/avibactam is recommended as an alternative for severe infections due to KPC-producing or OXA-48 producing Enterobacteriaceae for the management of FN in patients with hematological malignancies, despite the lack of well-designed comparative studies [ 33 , 38 ]. The ATLAS global surveillance program from 2017 to 2019 collected information from the Latin American region and reported in vitro susceptibility to ceftazidime/avibactam and colistin in 99.4% and 74.9% in non-metallo-ẞ-lactamase CPE (n = 358), respectively [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital

et al. 2023

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The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

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The place of ceftazidime/avibactam and ceftolozane/tazobactam for therapy of haematological patients with febrile neutropenia

Cited by 14 publications

References 22 publications

Cefiderocol-Based Combination Therapy for “Difficult-to-Treat” Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives

Cefiderocol-Based Combination Therapy for “Difficult-to-Treat” Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives

Epidemiology, antimicrobial resistance, and mortality risk factors of carbapenem resistant gram-negative bacteria in hematopoietic stem cell transplantation recipients

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital

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