Beta-Lactam/Beta-Lactamase Inhibitor Therapy for Potential AmpC-Producing Organisms: A Systematic Review and Meta-Analysis

Cheng, Matthew P.; Lee, Robyn S; Cheng, Alexandre Pellan; l’Étoile-Morel, Samuel De; Demir, Koray; Yansouni, Cédric P.; Harris, Patrick N A; McDonald, Emily G.; Lee, Todd C.

doi:10.1093/ofid/ofz248

Cited by 16 publications

(14 citation statements)

References 17 publications

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“…Antimicrobial treatment of patients with SPICE-BSI remains challenging in clinical practice. Although carbapenems are the gold standard for treatment of severe infections, alternative carbapenem-sparing treatment options are needed [10][11][12]14] to prevent increases in carbapenem resistance [15]. Whereas most previous studies have assessed treatment outcomes by comparing 30-day mortality rates among different treatment regimens [10,11,16,17], this study focused on early treatment response on day 3 as the primary outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Although carbapenems are the gold standard for treatment of severe infections, alternative carbapenem-sparing treatment options are needed [10][11][12]14] to prevent increases in carbapenem resistance [15]. Whereas most previous studies have assessed treatment outcomes by comparing 30-day mortality rates among different treatment regimens [10,11,16,17], this study focused on early treatment response on day 3 as the primary outcome. The main findings of our study were that early treatment response was significantly lower in the piperacillin/tazobactam group than in the carbapenem group (p = 0.006) despite similar disease severities (median SOFA score: 3.0 versus 4.5, p > 0.2) and that empiric piperacillin/tazobactam use (AOR 0.25, p < 0.001), baseline SOFA score (AOR 0.83, p < 0.001) and liver comorbidity (AOR 0.32, p = 0.018) were independently associated with early treatment failure.…”

Section: Discussionmentioning

confidence: 99%

“…SPICE organisms can cause a variety of severe, mostly hospitalacquired infections [5,6], including bloodstream infection (BSI), urinary tract infection, pneumonia, biliary and abdominal infection, surgical site infection and device-associated infection [7][8][9]. There is strong agreement that third-generation cephalosporin treatment should be avoided for SPICE infections irrespective of in vitro susceptibility; however, piperacillin/tazobactam treatment as a carbapenem-sparing regimen is still a matter of debate [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-Lactamase-Producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

et al. 2021

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The Gram-negative bacilli Serratia spp., Providencia spp., Morganella morganii, Citrobacter freundii complex, Enterobacter spp. and Klebsiella aerogenes are common Enterobacterales that may harbor inducible chromosomal AmpC beta-lactamase genes. The purpose of the present study was to evaluate treatment outcomes and identify predictors of early treatment response in patients with bloodstream infection caused by potential AmpC beta-lactamase-producing Enterobacterales (SPICE-BSI). This cohort study included adult patients with SPICE-BSI hospitalized between 01/2011 and 02/2019. The primary outcome was early treatment response 72 h after the start of active treatment, defined as survival, hemodynamic stability, improved or stable SOFA score, resolution of fever and leukocytosis and microbiologic resolution. Among 295 included patients, the most common focus was the lower respiratory tract (27.8%), and Enterobacter spp. (n = 155) was the main pathogen. The early treatment response rate was significantly lower (p = 0.006) in the piperacillin/tazobactam group (17/81 patients, 21.0%) than in the carbapenem group (40/82 patients, 48.8%). Independent negative predictors of early treatment response (p < 0.02) included initial SOFA score, liver comorbidity and empiric piperacillin/tazobactam treatment. In vitro piperacillin/tazobactam resistance was detected in three patients with relapsed Enterobacter-BSI and initial treatment with piperacillin/tazobactam. In conclusion, our findings show that piperacillin/tazobactam might be associated with early treatment failure in patients with SPICE-BSI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-Lactamase-Producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

et al. 2021

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“…This suggests that the use of piperacillin-tazobactam might be a promising alternative to carbapenems for the management of Enterobacteriaceae bloodstream infections, especially when MIC piperacillin-tazobactam is low (MIC ≤ 0.5/4 µgL) or the source of bloodstream infection is the genitourinary tract or abdomen [37]. Furthermore, some studies have also suggested that piperacillin-tazobactam may be a potential alternative to carbapenems in the treatment of AmpC-producing Enterobacteriaceae [41].However, further studies are essential to provide a more accurate and de nitive assessment of the effectiveness against beta lactambeta lactamase inhibitors versus carbapenems, especially since some studies still consider carbapenems to be superior to others regimes [37,41]. Furthermore, no studies have been conducted in this regard on pediatric LT until now.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Infections after Pediatric Liver Transplantation

Shafiekhani

Shahriarirad

parandvar

et al. 2020

Preprint

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Background: Liver transplantation (LT) is the only curative therapy for acute and chronic end-stage liver disease in pediatrics. Nevertheless, bacterial infection post-transplant account for one of the most significant causes of mortality which requires attention, along with appropriate antibacterial treatment. Therefor this study was designed to provide a multifaceted overview of bacterial infections during a one-year experience in the biggest pediatrics LT center in Iran.Methods: In this retrospective cohort study, records from all liver transplant pediatrics in Abu-Ali Sina hospital, Shiraz, Fars, Iran from April 2019 to February 2020 were assessed. Demographic, laboratory, and clinical data were extracted along with the administered therapeutic approach for the patient.Results: an incidence of 67.9% bacterial infection rate was observed, in which more than 64.06% of isolated pathogens were Gram-negative and 35.93% were gram-positive. The most isolated pathogens were E. coli sp. and pseudomonas sp. for gram negative, and enterococci and staph sp. for gram positive. Our study demonstrated that Intra-abdominal Surgical Site Infections (24.24%) was the most common site of infections in post LT pediatrics. According to the results of the sensitivity-resistance pattern of isolated pathogens, 24.39% of isolated gram-negative bacteria were Extensively drug resistant (XDR). Also, 30.43% of gram-positive bacteria were Vancomycin-resistant enterococci (VRE) and 8.69% of them were methicillin-resistant staphylococcus aureus (MRSA). Furthermore, multivariate regression analysis showed that the only risk factor for bacterial infections after LT is the length of stay in the ICU. The mortality rate in our study was 22%, which was significantly higher among the infection group (P = 0.008). Also, it was found that patients receiving colistin had a significantly shorter in length of stay in the ICU and hospital than those who did not receive colistin. There is no any significant difference between piperacillin-tazobactm versus meropenem as empirical treatment regarding clinical outcomes.Conclusion: a high rate of bacterial infection was detected among hospitalized pediatrics in the early period after LT. High antibacterial resistance of bacteria isolated from LT pediatrics is alarming. Furthermore, Replacement of piperacillin-tazobactam instead of carbapenems in empirical treatment should be considered.

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“…Algunos β-lactámicos no carbapenems, como la cefepima o la piperacilinatazobactam, se consideran inductores débiles, por lo que pueden ser una alternativa en algunas circunstancias mediante el uso de dosis alta y perfusión extendida. 15 Se recomienda evitar el uso de piperacilina-tazobactam en infecciones con inóculo alto o con aislamientos con CMI de piperacilina-tazobactam > 8 mg/L, y de cefepima en aislamientos con CMI de cefepima > 1 mg/L. 16 La cefepima generalmente no se hidroliza por las AmpC, por lo que es una excelente opción.…”

Section: Tratamientounclassified

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

Baquero-Artigao¹,

Ramos²,

Cercenado³

et al. 2020

Revista Latinoamericana De Infectología Pediátrica

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Recent years have seen an increase in the incidence of infections by multi-drug resistant bacteria. The main threats are the Gram-negative bacilli that produce β-spread-spectrum lactamases (BLEE), AmpC or carbapenemases, methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. To address this problem, it is essential to establish antimicrobial use optimization programs (AOP) specifi c to pediatrics, conduct active epidemiological surveillance and develop an appropriate infection control policy. Its therapeutic approach is often complex and multidisciplinary, often requiring the use of less experienced antibiotics. This position paper, prepared by the Spanish Association of Pediatrics and the Spanish Society of Pediatric Infectious Diseases, reviews the epidemiology and treatment of these infections according to the best available evidence.

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Beta-Lactam/Beta-Lactamase Inhibitor Therapy for Potential AmpC-Producing Organisms: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 17 publications

Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-Lactamase-Producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-Lactamase-Producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

Bacterial Infections after Pediatric Liver Transplantation

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

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