Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence

Nicolau, David P.; Carmeli, Yehuda; Crank, Christopher W.; Goff, Debra A.; Graber, Christopher J.; Lima, Ana Lúcia Lei Munhoz; Goldstein, Ellie J. C.

doi:10.1016/j.ijantimicag.2011.08.018

Cited by 57 publications

(37 citation statements)

References 18 publications

(60 reference statements)

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“…Previous studies have shown that the use of agents with anti-Pseudomonas activity, such as meropenem and imipenem, is an independent risk factor associated with carbapenem-and multidrug-resistant P. aeruginosa (31,34,35). Meropenem and imipenem are used as empirical therapy for infections due to aerobic Gram-negative bacteria where coverage for P. aeruginosa is not necessary, and the lack of de-escalation of empirical therapy could lead to the elimination of susceptible colonizing microbiota, thus favoring the multiplication of carbapenem-resistant strains (36). Another antibiotic frequently used as empirical therapy in suspected P. aeruginosa infections is piperacillin-tazobactam; this antibiotic has also been associated with the emergence of carbapenem resistance in this pathogen (37,38).…”

Section: Discussionmentioning

confidence: 99%

Similar Frequencies of Pseudomonas aeruginosa Isolates Producing KPC and VIM Carbapenemases in Diverse Genetic Clones at Tertiary-Care Hospitals in Medellín, Colombia

et al. 2014

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g Carbapenem-resistant Pseudomonas aeruginosa has become a serious health threat worldwide due to the limited options available for its treatment. Understanding its epidemiology contributes to the control of antibiotic resistance. The aim of this study was to describe the clinical and molecular characteristics of infections caused by carbapenem-resistant P. aeruginosa isolates in five tertiary-care hospitals in Medellín, Colombia. A cross-sectional study was conducted in five tertiary-care hospitals from June 2012 to March 2014. All hospitalized patients infected by carbapenem-resistant P. aeruginosa were included. Clinical information was obtained from medical records. Molecular analyses included PCR for detection of bla VIM , bla IMP , bla NDM , bla OXA-48 , and bla KPC genes plus pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for molecular typing. A total of 235 patients were enrolled: 91.1% of them were adults (n ‫؍‬ 214), 88.1% (n ‫؍‬ 207) had prior antibiotic use, and 14.9% (n ‫؍‬ 35) had urinary tract infections. The bla VIM-2 and bla KPC-2 genes were detected in 13.6% (n ‫؍‬ 32) and 11.5% (n ‫؍‬ 27), respectively, of all isolates. Two isolates harbored both genes simultaneously. For KPC-producing isolates, PFGE revealed closely related strains within each hospital, and sequence types (STs) ST362 and ST235 and two new STs were found by MLST. With PFGE, VIM-producing isolates appeared highly diverse, and MLST revealed ST111 in four hospitals and five new STs. These results show that KPC-producing P. aeruginosa is currently disseminating rapidly and occurring at a frequency similar to that of VIM-producing P. aeruginosa isolates (approximately 1:1 ratio) in Medellín, Colombia. Diverse genetic backgrounds among resistant strains suggest an excessive antibiotic pressure resulting in the selection of resistant strains.

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Section: Discussionmentioning

confidence: 99%

Similar Frequencies of Pseudomonas aeruginosa Isolates Producing KPC and VIM Carbapenemases in Diverse Genetic Clones at Tertiary-Care Hospitals in Medellín, Colombia

et al. 2014

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“…Among carbapenems, most studies evaluated imipenem or meropenem. There is also some recent experience with ertapenem [Collins et al 2012;Wu et al 2012]; this antibiotic would be preferred for empirical therapy in community-acquired severe infections potentially caused by ESBL producers when coverage against Pseudomonas aeruginosa or Acinetobacter baumannii is not needed to avoid further selection pressure over these organisms [Nicolau et al 2012], since ertapenem lacks significant activity against them. It may also be useful for outpatient parenteral therapy because of the convenience of once daily dosing.…”

Section: Carbapenemsmentioning

confidence: 99%

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Delgado-Valverde

Sojo-Dorado

Pascual

2013

Therapeutic Advances in Infection

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Enterobacteriaceae showing resistance to cephalosporins due to extended-spectrum b-lactamases (ESBLs) or plasmid-mediated AmpC enzymes, and those producing carbapenemases have spread worldwide during the last decades. Many of these isolates are also resistant to other first-line agents such as fluoroquinolones or aminoglycosides, leaving few available options for therapy. Thus, older drugs such as colistin and fosfomycin are being increasingly used. Infections caused by these bacteria are associated with increased morbidity and mortality compared with those caused by their susceptible counterparts. Most of the evidence supporting the present recommendations is from in vitro data, animal studies, and observational studies. While carbapenems are considered the drugs of choice for ESBL and AmpC producers, recent data suggest that certain alternatives may be suitable for some types of infections. Combined therapy seems superior to monotherapy in the treatment of invasive infections caused by carbapenemase-producing Enterobacteriaceae. Optimization of dosage according to pharmacokinetics/pharmacodynamics data is important for the treatment of infections caused by isolates with borderline minimum inhibitory concentration due to lowlevel resistance mechanisms. The increasing frequency and the rapid spread of multidrug resistance among the Enterobacteriaceae is a true and complex public health problem. IntroductionThe traditional first-line available options for treating serious infections caused by enterobacteria include penicillins, cephalosporins, monobactams, carbapenems, fluorquinolones, and in certain situations, aminoglycosides. The frequency of resistance to these first-line agents has been rising worldwide during the last decades [Paterson 2006;Rhomberg and Jones 2009;Houghton et al. 2010;Nordmann, et al. 2011] and now reach high proportions in many areas of the world.

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“…The results of in vitro and clinical studies showed that the use of ertapenem did not decrease susceptibility of P. aeruginosa, Enterobacteriaceae or other gram-negative pathogens to carbapenems [7,12].…”

Section: Discussionmentioning

confidence: 97%

“…The basic strategies of modern approach consist of source control, identification of involved microorganisms, antimicrobial treatment and complex critical care. Postoperative peritonitis is usually classified with a 3 score value on the Carmeli scale and imposes the need for first-line therapy, using a combination of broad-spectrum antibiotics, which usually includes a 2nd generation carbapenem (such as imipenem, meropenem) [7,8]. …”

Section: Introductionmentioning

confidence: 99%

The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report

Gavril

Grosu²,

Amancei³

et al. 2014

Arch Clin Cases

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A 59 year-old male patient diagnosed with cecal cancer, surgically treated -right hemicolectomy with ileotransverse anastomosis suddenly presented in the 5th postoperative day fever, hypotension, abdominal pain, and vomiting faeces. The intraoperatory diagnosis was postoperative peritonitis due to anastomotic leak; exploratory laparotomy, segmental colectomy, transverse ileostomy, lavage and drainage were performed. Before surgical reintervention, blood cultures were performed and empirical antiinfective therapy was started using ertapenem, vancomycin and fluconazole. A postoperative ICU admission was decided due to septic shock and MODS: acute respiratory failure, acute cardio-circulatory failure, coagulopathy and metabolic acidosis, which required complex treatment: ventilatory support, haemodynamic optimization, antibiotics, analgesia, deep venous thromboembolism prophylaxis, nutrition. In the 3 rd day after reintervention, microbiological examination of the intraoperatory collected peritoneal fluid identified a triple germ association: Escherichia coli, Enterococcus faecalis and Proteus mirabilis, which were sensitive to the chosen antibiotics; the blood cultures were sterile. After 3 days of severe evolution, the multiple organ dysfunction gradually improved and the patient was discharged from ICU 10 days later.

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Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence

Cited by 57 publications

References 18 publications

Similar Frequencies of Pseudomonas aeruginosa Isolates Producing KPC and VIM Carbapenemases in Diverse Genetic Clones at Tertiary-Care Hospitals in Medellín, Colombia

Similar Frequencies of Pseudomonas aeruginosa Isolates Producing KPC and VIM Carbapenemases in Diverse Genetic Clones at Tertiary-Care Hospitals in Medellín, Colombia

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report

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