Analysis of the Clinical Effect of Combined Drug Susceptibility to Guide Medication for Carbapenem-Resistant Klebsiella pneumoniae Patients Based on the Kirby–Bauer Disk Diffusion Method

Yao, Huijuan; Liu, Jingxian; Jiang, Xueyan; Chen, Feng; Lu, Xianghua; Zhang, Jian

doi:10.2147/idr.s282386

Cited by 23 publications

(17 citation statements)

References 21 publications

(34 reference statements)

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“…Since mortality is also influenced by other factors such as underlying diseases (apart from infectious factors), we used treatment efficiency as an outcome indicator to assess the efficacy of antimicrobial drugs. The results showed that ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP, which is consistent with the survival analysis and the findings of our previous study ( Yao et al., 2021 ). This observation suggests that in cases where CRKP is sensitive to these drugs, their use should be prioritized ( Shirley, 2018 ; Erturk Sengel et al., 2020 ).…”

Section: Discussionsupporting

confidence: 91%

Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

Chen

Yang

Yao

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with poor patient outcomes. We aimed to analyze the clinical information of adult patients with CRKP infection in order to establish a nomogram for mortality risk as well as to determine the treatment effectiveness of different antimicrobial regimens.MethodsAdult patients diagnosed with CRKP infection in a tertiary hospital in Shanghai between September 2019 and March 2021 were included. The clinical characteristics and clinical outcomes of these patients were analyzed.ResultsA total of 199 cases of CRKP infection were examined. Five factors, namely age ≥65 years, respiratory failure, Sequential Organ Failure Assessment score, serum procalcitonin ≥5 ng/mL, and appropriate treatments in 3 days, were found to be associated with 30-day mortality. Upon incorporating these factors, the nomogram achieved good concordance indexes of 0.85 (95% confidence interval [CI]: 0.80–0.90) and well-fitted calibration curves. Receiver-operating characteristic curves for 7-, 15-, and 30-day survival had areas under the curve of 0.90, 0.87, and 0.88, respectively. Three-drug combination therapy was observed to be associated with lower mortality in the high-risk group (adjusted hazard ratio = 0.24, 95% CI: 0.06–0.99) but not in the low-risk group. Ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP. Tigecycline improved the treatment efficiency in 7 days, but a trend toward increased mortality was seen (HR, 1.69; 95% CI: 0.98–2.94; P = 0.061).ConclusionThe antimicrobial regimen efficacy data and the predictive nomogram established in this study can help clinicians in identifying high-risk adult patients with CRKP infection, improving the therapeutic effect, and reducing mortality.

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Section: Discussionsupporting

confidence: 91%

Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

Chen

Yang

Yao

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Probably because of the qualitative character of the measurements in this type of testing, such ChEMBL data sets have not been very appealing to the QSAR community up to date. This reluctance may mirror the hesitation of some laboratories to use the disk diffusion method, partly because of reported issues associated with disk quality or the inability of this method to provide an MIC value that can guide clinicians in their therapeutic approach [31], but many settings in the world continue to use such data [32]. Our results have shown that models with reasonable performance can be built and employed for virtual screening purposes, although their performance may be lower than that of those built with MIC, MIC90 or IC50 (which may be less noisy).…”

Section: Discussionmentioning

confidence: 99%

QSAR Models for Active Substances against Pseudomonas aeruginosa Using Disk-Diffusion Test Data

2021

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Pseudomonas aeruginosa is a Gram-negative bacillus included among the six “ESKAPE” microbial species with an outstanding ability to “escape” currently used antibiotics and developing new antibiotics against it is of the highest priority. Whereas minimum inhibitory concentration (MIC) values against Pseudomonas aeruginosa have been used previously for QSAR model development, disk diffusion results (inhibition zones) have not been apparently used for this purpose in the literature and we decided to explore their use in this sense. We developed multiple QSAR methods using several machine learning algorithms (support vector classifier, K nearest neighbors, random forest classifier, decision tree classifier, AdaBoost classifier, logistic regression and naïve Bayes classifier). We used four sets of molecular descriptors and fingerprints and three different methods of data balancing, together with the “native” data set. In total, 32 models were built for each set of descriptors or fingerprint and balancing method, of which 28 were selected and stacked to create meta-models. In terms of balanced accuracy, the best performance was provided by KNN, logistic regression and decision tree classifier, but the ensemble method had slightly superior results in nested cross-validation.

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“…Due to the increasing number of in vitro. experiments in which synergistic and/or cumulative antimicrobial effects of TG+PB were observed [9,[23][24][25], it was hypothesized that TG combined with PB may improve the e cacy of patients with CRKP infection. On the contrary, the TG+PB group showed worse 30-day mortality and cumulative survival in univariate analyses.…”

Section: Tg+pb-based Therapymentioning

confidence: 99%

“…Another retrospective study found PB-based therapy had a better survival rate than TG-based therapy [8]. In vitro experiments, the synergistic and/or cumulative antibacterial effects of TG+ceftazidime avibatan or (imipenem, fosfomycin), PB+TG or (ceftazidime avibatan, fosfomycin) and TG+PB +imipenem were 87.5% (68.8%, 62.5%), 100.0% (75.0%, 68.8%) and 75.0% respectively [9].…”

Section: Introductionmentioning

confidence: 99%

Efficacy Comparison of Tigecycline and Polymyxin B Against Carbapenem-Resistant Klebsiella Pneumoniae Infection in Intensive Care Units, a Multicenter Retrospective Study

Zhang¹,

Hu²,

Deng³

et al. 2022

Preprint

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Aim: To investigate the efficacy of Tigecycline (TG) or polymyxin B(PB) against Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in ICUs. Method: Electronic medical record systems were used to capture CRKP-infected patients who were treated with TG- or PB-based therapies from ICUs of four academic hospitals in Hunan, China. Propensity-score matching and logistic regression were used to compare efficacy and find prognostic factors.Results: Of the 236 patients, 106 received TG-based therapy (TG), 102 received PB-based therapy (PB), and 28 received a combination of TG and PB (TG+PB). PB group showed higher CRKP clearance (46.6% vs. 22.4%, P = 0.011) and complete bacterial clearance (32.8% vs. 15.5%, P = 0.051) than TG group. CRKP clearance (OR 0.312, 95%CI 0.159-0.612, P= 0.001), longer duration of PB (4-8 vs. > 8 days, OR 2.974, 95%CI 1.297-6.820, P= 0.010), and less vasoactive agents (1-4 vs. 0 days, OR 2.903, 95%CI 1.146-7.352, P= 0.025) were independent protective factors for 30-day mortality. Conclusions: About CRKP treatment in ICUs, PB-based therapy showed better bacterial clearance than TG-based therapy. CRKP clearance, longer duration of PB, and less vasoactive agents were independent protective factors for 30-day mortalit.

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Analysis of the Clinical Effect of Combined Drug Susceptibility to Guide Medication for Carbapenem-Resistant Klebsiella pneumoniae Patients Based on the Kirby–Bauer Disk Diffusion Method

Cited by 23 publications

References 21 publications

Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

QSAR Models for Active Substances against Pseudomonas aeruginosa Using Disk-Diffusion Test Data

Efficacy Comparison of Tigecycline and Polymyxin B Against Carbapenem-Resistant Klebsiella Pneumoniae Infection in Intensive Care Units, a Multicenter Retrospective Study

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