A post hoc subgroup analysis of meropenem versus imipenem/cilastatin in a multicenter, double-blind, randomized study of complicated skin and skin-structure infections in patients with diabetes mellitus

Embil, John M.; Soto, Norberto E.; Melnick, David

doi:10.1016/j.clinthera.2006.08.008

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…Finally, another treatment trial of patients with a complicated SSTI found that the 37% of patients with diabetes were older and more likely to have impaired renal function at enrolment. Complex abscesses were less common in diabetic than in non-diabetic patients, while cellulitis and infected ulcers were more common [45].…”

Section: Discussionmentioning

confidence: 87%

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Tabak²,

et al. 2010

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Aims/hypothesis Skin and soft tissue infections (SSTIs) cause substantial morbidity in persons with diabetes. There are few data on pathogens or risk factors associated with important outcomes in diabetic patients hospitalised with SSTIs. Methods Using a clinical research database from CareFusion, we identified 3,030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007. We classified the culture isolates and analysed their association with the anatomic location of infection, mortality, length of stay and hospital costs. Results The only culture isolate with a significantly increased prevalence was methicillin-resistant Staphylococcus aureus (MRSA); prevalence for infection of the foot was increased from 11.6 to 21.9% (p<0.0001) and for non-foot locations from 14.0% to 24.6% (p=0.006). Patients with non-foot (vs foot) infections were more severely ill at presentation and had higher mortality rates (2.2% vs 1.0%, p<0.05). Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa (OR 3

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Section: Discussionmentioning

confidence: 87%

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Tabak²,

et al. 2010

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“…Similar to the study by Lipsky and colleagues, most studies of skin infections in diabetics have included a relatively heterogeneous group of infections. [12][13][14][15] The present study therefore contributes to the literature by providing a focused comparison of the microbiology of inpatient cellulitis and abscess in the absence of complicating factors such as an infected ulcer or deep tissue involvement. We found that among cases with a positive culture (13% of cases in the cellulitis group and 73% in the abscess group), the microbiology was similar among diabetics and nondiabetics.…”

Section: Discussionmentioning

confidence: 96%

Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess

Jenkins

Knepper

Moore

et al. 2014

Journal of Hospital Medicine

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Background Among diabetics, complicated skin infections may involve gram-negative pathogens; however, the microbiology of cellulitis and cutaneous abscess is not well-established. Objective To compare the microbiology and prescribing patterns between diabetics and non-diabetics hospitalized for cellulitis or abscess Design Secondary analysis of two published retrospective cohorts Setting/Patients Adults hospitalized for cellulitis or abscess, excluding infected ulcers or deep tissue infections, at 7 academic and community facilities Methods Microbiological findings and antibiotic use were compared among diabetics and non-diabetics. Multivariable logistic regression was performed to identify factors associated with exposure to broad gram-negative therapy, defined as receipt of at least two calendar days of β-lactamase inhibitors, 2nd – 5th generation cephalosporins, fluoroquinolones, carbapenems, tigecycline, aminoglycosides, or colistin. Results Of 770 total patients with cellulitis or abscess, 167 (22%) had diabetes mellitus. Among the 38% of cases with a positive culture, an aerobic gram-positive organism was isolated in 90% of diabetics and 92% of non-diabetics (p = .59); aerobic gram-negative organisms were isolated in 7% and 12%, respectively (p = .28). Overall, diabetics were more likely than non-diabetics to be exposed to broad gram-negative therapy (54% vs 44% of cases, p = .02). By logistic regression, diabetes mellitus was independently associated with exposure to broad gram-negative therapy (OR 1.66, 95%CI 1.15 – 2.40). Conclusion In cases of cellulitis or abscess associated with a positive culture, gram-negative pathogens were not more common among diabetics compared with non-diabetics. However, diabetics were overall more likely to be exposed to broad gram-negative therapy suggesting this prescribing practice may not be not warranted.

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“…The cure rates for patients with and those without diabetes mellitus in the clinically evaluable population were 85.6% and 86.6%, respectively, with meropenem and 72.4% and 89.9%, respectively, with imipenem/cilastatin [15].…”

Section: Efficacymentioning

confidence: 95%

Update on the Efficacy and Tolerability of Meropenem in the Treatment of Serious Bacterial Infections

Mohr

2008

CLIN INFECT DIS

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Meropenem is a carbapenem antibiotic approved by the US Food and Drug Administration for the treatment of complicated skin and skin-structure infections, complicated intra-abdominal infections, and pediatric bacterial meningitis (in patients >or=3 months of age). In clinical trials, it also has shown efficacy as initial empirical therapy for the treatment of nosocomial pneumonia. Unlike other beta-lactam antibiotics, including third-generation cephalosporins, carbapenems have shown activity against extended-spectrum beta-lactamase-producing and AmpC chromosomal beta-lactamase-producing bacteria. Compared with imipenem, meropenem is more active against gram-negative pathogens and somewhat less active against gram-positive pathogens, and it does not require coadministration of a renal dehydropeptidase inhibitor. In most comparative trials, clinical and bacteriological response rates with imipenem and meropenem were similar. Compared with clindamycin/tobramycin, meropenem is associated with a reduced length of hospital stay and a shorter duration of therapy among patients with complicated intra-abdominal infections. Meropenem is well tolerated by children and adults and has an acceptable safety profile. Alternative meropenem dosing strategies for the optimization of outcomes are under investigation.

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A post hoc subgroup analysis of meropenem versus imipenem/cilastatin in a multicenter, double-blind, randomized study of complicated skin and skin-structure infections in patients with diabetes mellitus

Cited by 15 publications

References 21 publications

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess

Update on the Efficacy and Tolerability of Meropenem in the Treatment of Serious Bacterial Infections

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