Ceftazidime-Avibactam for the Treatment of Post-Neurosurgical Meningitis Caused by a Klebsiella pneumoniae carbapenemase (KPC)-Producing Klebsiella pneumoniae

Samuel, Sophie; Edwards, Nancy; Rojas, Laura; Rudin, Susan D.; Marshall, Steve H.; Cicco, Ignacio De; Arias, César A.; Tran, Truc T.

doi:10.1093/ofid/ofw172.885

Cited by 15 publications

(12 citation statements)

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“…In both cases, postneurosurgical meningitis was caused by CRKP (KPC production was not confirmed). Samuel et al [ 16 ] employed CAZ-AVI monotherapy dosed at 2.5 g every 6 hours, while Holyk et al [ 17 ] treated their patient with a combination of CAZ-AVI and intraventricular amikacin. Direct injection of antibiotics into the CNS is indicated with worsening infection or persistent pleocytosis.…”

Section: Discussionmentioning

confidence: 99%

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Yasmin

Hanrahan

Marshall

et al. 2020

Open Forum Infectious Diseases

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This report describes the treatment of KPC-3 producing multidrug-resistant (MDR) K. pneumoniae with CAZ-AVI in a patient who developed post-neurosurgical meningitis and bacteremia. Therapeutic drug monitoring (TDM) of CSF and blood samples demonstrated CAZ-AVI concentration levels 20-fold greater than the minimum inhibitory concentration (MIC) in the first 60 minutes post-infusion, providing evidence for its utility in treating KPC-KP CNS infections.

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Section: Discussionmentioning

confidence: 99%

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Yasmin

Hanrahan

Marshall

et al. 2020

Open Forum Infectious Diseases

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“…Avibactam penetration in rabbit CSF is about 38% (16). Six case reports have described the successful use of intravenous ceftazidime/avibactam for the treatment of CNS infections caused by multidrug-resistant bacteria (17)(18)(19)(20)(21)(22). Even if obvious publication bias may preclude the identification of therapeutic failure of avibactamcontaining regimens for CNS infections, these data suggest that avibactam penetration in CSF is sufficient for in situ ␤-lactamase inhibition.…”

Section: Discussionmentioning

confidence: 97%

Inhibition Activity of Avibactam against Nocardia farcinica β-Lactamase FAR _IFM10152

Lebeaux

Ourghanlian

Dorchêne

et al. 2020

Antimicrob Agents Chemother

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Nocardia farcinica, one of the most frequent pathogenic species responsible for nocardiosis, is characterized by frequent brain involvement and resistance to β-lactams mediated by a class A β-lactamase. Kinetic parameters for hydrolysis of various β-lactams by FARIFM10152 from strain IFM 10152 were determined by spectrophotometry revealing a high catalytic activity (kcat/Km) for amoxicillin, aztreonam, and nitrocefin. For cephems, kcat/Km was lower but remained greater than 104 M−1 s−1. A low catalytic activity was observed for meropenem, imipenem, and ceftazidime hydrolysis. FARIFM10152 inhibition by avibactam and clavulanate was compared using nitrocefin as a reporter substrate. FARIFM10152 was efficaciously inhibited by avibactam with a carbamoylation rate constant (k2/Ki) of (1.7 ± 0.3) × 104 M−1 s−1. The 50% effective concentrations (EC50s) of avibactam and clavulanate were 0.060 ± 0.007 μM and 0.28 ± 0.06 μM, respectively. Amoxicillin, cefotaxime, imipenem, and meropenem MICs were measured for ten clinical strains in the presence of avibactam and clavulanate. At 4 μg/ml, avibactam and clavulanate restored amoxicillin susceptibility in all but one of the tested strains but had no effect on the MICs of cefotaxime, imipenem, and meropenem. At 0.4 μg/ml, amoxicillin susceptibility (MIC ≤ 8 μg/ml) was restored for 9 out of 10 strains by avibactam but only for 4 out of 10 strains by clavulanate. Together, these results indicate that avibactam was at least as potent as clavulanate, suggesting that the amoxicillin-avibactam combination could be considered as an option for the rescue treatment of N. farcinica infections if clavulanate cannot be used.

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“…Besides, clinical efficacies of CAZ/AVI for CNS infections are limited to case reports. Based on a PubMed search, only 6 adult cases of CNS infections caused by MDR/XDR K. pneumoniae 5–8 or P. aeruginosa 8–10 were effectively treated using CAZ/AVI ( Table 8 ).…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Ventriculitis Caused by MDR/XDR Gram-Negative Bacillus Using Ceftazidime/Avibactam: Case Series and Literature Review

Zhou

Wang

Zhan

et al. 2021

IDR

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Ceftazidime-Avibactam for the Treatment of Post-Neurosurgical Meningitis Caused by a Klebsiella pneumoniae carbapenemase (KPC)-Producing Klebsiella pneumoniae

Cited by 15 publications

References 0 publications

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Inhibition Activity of Avibactam against Nocardia farcinica β-Lactamase FAR _IFM10152

Successful Treatment of Ventriculitis Caused by MDR/XDR Gram-Negative Bacillus Using Ceftazidime/Avibactam: Case Series and Literature Review

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Ceftazidime-Avibactam for the Treatment of Post-Neurosurgical Meningitis Caused by a Klebsiella pneumoniae carbapenemase (KPC)-Producing Klebsiella pneumoniae

Cited by 15 publications

References 0 publications

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Using Therapeutic Drug Monitoring to Treat KPC-Producing Klebsiella pneumoniae Central Nervous System Infection With Ceftazidime/Avibactam

Inhibition Activity of Avibactam against Nocardia farcinica β-Lactamase FAR IFM10152

Successful Treatment of Ventriculitis Caused by MDR/XDR Gram-Negative Bacillus Using Ceftazidime/Avibactam: Case Series and Literature Review

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Inhibition Activity of Avibactam against Nocardia farcinica β-Lactamase FAR _IFM10152