Clinical effectiveness of carbapenems versus alternative antibiotics for treating ESBL-producing Enterobacteriaceae bacteraemia: a systematic review and meta-analysis

Son, Soo Kyung; Lee, Na Rae; Ko, Jeong‐Hun; Choi, Jae-Ki; Moon, Soo-youn; Joo, Eun Jeong; Peck, Kyong Ran; Park, Dong Ah

doi:10.1093/jac/dky168

Cited by 45 publications

(34 citation statements)

References 51 publications

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“…The results of two metanalyses referring to carbapenems versus alternative antibiotics for treating ESBL-PE BSI, both published in 2018, are quite interesting [32,33]. In the first metanalysis, 35 publications (until 2016) fulfilled the inclusion criteria [32]. Whenever antibiotics were given empirically, no significant differences related to overall mortality were observed between carbapenems and non-carbapenems.…”

Section: Piperacillin-tazobactammentioning

confidence: 99%

“…A study from Canada including outpatients revealed quinolone resistance of 18.2% in urinary ESBL-positive E. coli [79], whereas in a study from Spain the prevalence of PMQR genes were found in 28.6% [80], limiting the activity of quinolones for the treatment of ESBL infections. A systemic review and meta-analysis illustrated that quinolones were not associated with increased mortality regarding empirical therapy and in relation to definitive treatment [32]. Limited data are available regarding the administration of fluoroquinolones as carbapenem-sparing agents.…”

Section: Quinolonesmentioning

confidence: 99%

“…An important issue to be mentioned was that patients treated with an aminoglycoside had less severe disease, lower burden of chronic illness and lower incidence of septic shock [92]. In a recent meta-analysis, aminoglycoside treatment was not associated with lower mortality rates regarding empiric and definite treatment compared to carbapenems for the treatment of ESBL-PE bacteremia [32]. Recently, plazomicin, a next-generation aminoglycoside synthetically derived from sisomicin designed to evade all clinically relevant aminoglycoside-modifying enzymes, was launched in market [93].…”

Section: Aminoglycosidesmentioning

confidence: 99%

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Carbapenem-Sparing Strategies for ESBL Producers: When and How

2020

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Extended spectrum β-lactamase (ESBL)-producing bacteria are prevalent worldwide and correlated with hospital infections, but they have been evolving as an increasing cause of community acquired infections. The spread of ESBL constitutes a major threat for public health, and infections with ESBL-producing organisms have been associated with poor outcomes. Established therapeutic options for severe infections caused by ESBL-producing organisms are considered the carbapenems. However, under the pressure of carbapenem overuse and the emergence of resistance, carbapenem-sparing strategies have been implemented. The administration of carbapenem-sparing antibiotics for the treatment of ESBL infections has yielded conflicting results. Herein, the current available knowledge regarding carbapenem-sparing strategies for ESBL producers is reviewed, and the optimal conditions for the “when and how” of carbapenem-sparing agents is discussed. An important point of the review focuses on piperacillin–tazobactam as the agent arousing the most debate. The most available data regarding non-carbapenem β-lactams (i.e., ceftolozane–tazobactam, ceftazidime–avibactam, temocillin, cephamycins and cefepime) are also thoroughly presented as well as non β-lactams (i.e., aminoglycosides, quinolones, tigecycline, eravacycline and fosfomycin).

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Section: Piperacillin-tazobactammentioning

confidence: 99%

Section: Quinolonesmentioning

confidence: 99%

Section: Aminoglycosidesmentioning

confidence: 99%

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Carbapenem-Sparing Strategies for ESBL Producers: When and How

2020

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“…Due to the lack of MIC values for the isolates in our study, the effect of MIC on treatment response could not be evaluated according to treatment option. In a meta-analysis of 35 studies, carbapenems were compared to other antibiotics active against ESBL-producing Enterobacteriaceae and it was reported that beta-lactam/beta-lactamase inhibitors were no less effective as definitive treatment than carbapenems if the microorganism is susceptible [30] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of Piperacillin-Tazobactam and Carbapenems in Nosocomial Infections with Extended-Spectrum Beta-lactamase-Producing Escherichia coli and Klebsiella pneumoniae

Ayhan¹,

Kayaaslan²,

Hasanoğlu³

et al. 2020

mjima

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Infections with extended-spectrum beta-lactamase (ESBL)-producing strains are seen at increasing rates, resulting in increased morbidity, mortality, length of hospitalization, and cost. Effective and safe treatment of these infections is important. The aim of this study was to compare the effectiveness of piperacillin-tazobactam (PTZ) and carbapenems in nosocomial infections with ESBL-producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients. Materials and Methods: This study was performed retrospectively on patients who were infected with ESBL-producing E. coli and K. pneumoniae while hospitalized in Ankara Atatürk Tranining and Research Hospital between 2014 and 2017. Both PTZ-and carbapenem-susceptible isolates were included in the study. Patients with signs of infection who were older than 18 years, hospitalized for at least 48 hours, and received PTZ or carbapenem therapy were included in the study. Patients who received PTZ and carbapenem antibiotics consecutively in same infectious episode, received another antibiotic active against ESBL-producing microorganisms, received the selected antibiotic for less than 48 hours, or had polymicrobial infection were excluded from the study. Demographic characteristics, comorbid diseases, antibiotics used and their dose/duration, mechanical ventilation, presence of central catheter, clinical and microbiological responses to treatment, and end-of-treatment and 30-day mortality were recorded and compared. Results: Of the total 113 patients, 60 (53.1%) were male and the mean age was 66.14±18.2 years. Of the patients, 73.5% had E. coli and 26.5% had K. pneumoniae. Seventy patients (61.9%) received carbapenem and 43 patients (38.1%) received PTZ treatment. Microbiological eradication rate was 71.7% (43/60) in patients with control cultures. Clinical response was observed in 72.6% of the cases. The overall mortality rate was 31.0% (n=35). There were no significant differences between the groups in clinical and microbiological response (p=0.055; p=0.303) or end-of-treatment and 30day mortality (p=0.180, p=0.288). Age and bacteremia was found to be independent risk factors for mortality (p=0.006 for both). Conclusion: PTZ is an important alternative for infections caused by ESBL-producing microorganisms. In recent years, the need for rational antibiotic use has increased and carbapenem-sparing treatments have became more important. Piperacillin-tazobactam is one of the best alternatives and has comparable effectiveness in infections caused by ESBL-producing E. coli and Klebsiella spp.

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“…The extensive use of new-generation cephalosporins has been a strong factor to assess newer b-lactamases. As these enzymes (b-lactamase) are coded by transferable conjugative plasmids, resistance to other antibiotics, such as aminoglycosides has been a concern (7). Although the distribution of CTX-M-producing strains seems to be limited to the particular areas of the world Copyright © 2020, Author(s).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of AmpC and Extended-Spectrum Beta-Lactamase Genes in Klebsiella pneumoniae and Escherichia coli Isolates

Jahantabi

Hosseini

Asgharzadeh

et al. 2020

Iran Red Crescent Med J

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Background: In recent years, the prevalence of antibiotic resistance has steadily increased and also the antibiotic-resistant strains producing extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases have emerged among the Enterobacteriaceae, predominantly in Escherichia coli and Klebsiella pneumoniae species. Objectives: This prospective study aimed at determining the production of ESBL or AmpC, phenotypically and also at the molecular level, in E. coli and K. pneumoniae isolates collected from various clinical specimens. Methods: In total, 78 K. pneumoniae and 92 E. coli isolates were collected from various clinical infectious sources available in different wards of the Imam Reza Hospital, Tabriz, Iran, from July 2017 to December 2018. All isolates were subjected to antimicrobial susceptibility testing. MAST 4-disc test and polymerase chain reaction (PCR) were applied for phenotypic and genotypic detection of ESBLs and plasmid-encoded AmpCs (pAmpCs) among isolates, respectively. Results: Overall, 78 K. pneumoniae and 92 E. coli isolates were evaluated, of which 46 K. pneumoniae (58.9%) and 51 E. coli (55.4%) isolates were resistant to cefotaxime/ceftazidime and included in the study. Among the K. pneumoniae and E. coli isolates resistant to cefotaxime/ceftazidime, 40 (86.9%) and 40 (78.4%) isolates were ESBL producers and 8 (17.3%) and 2 (3.9%) isolates were pAmpC producers, respectively. In addition, 40 E. coli (78.4%) isolates were positive for both CTX-M-14 and CTX-M-15 genes. Regarding K. pneumoniae isolates, 40 isolates (86.9%) were positive for CTX-M-15 gene and 18 isolates (39.1%) for CTX-M-14 gene. Among 51 ceftazidime/cefotaximeresistant E. coli isolates, 32 isolates (62.7%) were positive for DHA-1 gene and 33 isolates (64.7%) isolates for CMY-2 gene. Also, among 46 ceftazidime/cefotaxime-resistant K. pneumoniae isolates, 15 isolates (32.6%) had DHA-1 gene and 27 isolates (58.7%) had CMY-2 gene in the genome. Conclusions: The high prevalence of ESBL and AmpC production among E. coil and K. pneumoniae isolates was a serious concern in the studied region. Therefore, a simple and rapid PCR-based technique is essential to detect and distinguish various pAmpC and ESBL genes to discriminate other resistance determinants.

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Clinical effectiveness of carbapenems versus alternative antibiotics for treating ESBL-producing Enterobacteriaceae bacteraemia: a systematic review and meta-analysis

Abstract: This meta-analysis showed that BL/BLIs may be promising alternative antibiotics for definitive therapy in patients with ESBL-B. However, the lack of robust data derived from randomized controlled trials limits the conclusions and inferences from the pooled data.

Cited by 45 publications

References 51 publications

Carbapenem-Sparing Strategies for ESBL Producers: When and How

Carbapenem-Sparing Strategies for ESBL Producers: When and How

Comparison of the Effectiveness of Piperacillin-Tazobactam and Carbapenems in Nosocomial Infections with Extended-Spectrum Beta-lactamase-Producing Escherichia coli and Klebsiella pneumoniae

Prevalence of AmpC and Extended-Spectrum Beta-Lactamase Genes in Klebsiella pneumoniae and Escherichia coli Isolates

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