Clinical outcomes after combination treatment with ceftazidime/avibactam and aztreonam for NDM-1/OXA-48/CTX-M-15-producing Klebsiella pneumoniae infection

Shaw, Evelyn; Rombauts, Alexander; Tubau, Fé; Padullés, Ariadna; Càmara, Jordi; Lozano, Toni; Cobo-Sacristán, Sara; Sabé, Núria; Grau, Inmaculada; Rigo-Bonnin, Raül; Domínguez, M. Ángeles; Carratalà, Jordi

doi:10.1093/jac/dkx496

Cited by 123 publications

(74 citation statements)

References 8 publications

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“…A small case series of 10 patients revealed that 7 of the patients survived after receiving the combination of aztreonam and ceftazidime-avibactam. The other three patients died as a result of other underlying conditions and therefore should not be considered a failure of the combination treatment (249). Several case reports have also demonstrated that the combination of aztreonam and ceftazidime-avibactam can successfully treat infections with NDM-positive CRE strains (247,250).…”

Section: Aztreonam-avibactam or Aztreonam Combined With Ceftazidime-amentioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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SUMMARYNew Delhi metallo-β-lactamase (NDM) is a metallo-β-lactamase able to hydrolyze almost all β-lactams. Twenty-four NDM variants have been identified in >60 species of 11 bacterial families, and several variants have enhanced carbapenemase activity.Klebsiella pneumoniaeandEscherichia coliare the predominant carriers ofblaNDM, with certain sequence types (STs) (forK. pneumoniae, ST11, ST14, ST15, or ST147; forE. coli, ST167, ST410, or ST617) being the most prevalent. NDM-positive strains have been identified worldwide, with the highest prevalence in the Indian subcontinent, the Middle East, and the Balkans. MostblaNDM-carrying plasmids belong to limited replicon types (IncX3, IncFII, or IncC). Commonly used phenotypic tests cannot specifically identify NDM. Lateral flow immunoassays specifically detect NDM, and molecular approaches remain the reference methods for detectingblaNDM. Polymyxins combined with other agents remain the mainstream options of antimicrobial treatment. Compounds able to inhibit NDM have been found, but none have been approved for clinical use. Outbreaks caused by NDM-positive strains have been reported worldwide, attributable to sources such as contaminated devices. Evidence-based guidelines on prevention and control of carbapenem-resistant Gram-negative bacteria are available, although none are specific for NDM-positive strains. NDM will remain a severe challenge in health care settings, and more studies on appropriate countermeasures are required.

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Section: Aztreonam-avibactam or Aztreonam Combined With Ceftazidime-amentioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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“…There is limited clinical experience with this treatment modality and even less in transplant recipients. 15,16 However, the few available reports support our assessment that this combination therapy can be successful in treating NDM-1 infections in this population.…”

Section: Discussionmentioning

confidence: 89%

Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection

Stewart

Newman

Jain

et al. 2019

American Journal of Transplantation

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Transplant tourism, the practice of traveling to other countries for transplantation, continues to be a major problem worldwide. We describe a patient who traveled to Pakistan and underwent commercial kidney transplantation. He developed life-threatening infections from New Delhi metallo-beta-lactamase-1-producing Enterobacter cloacae and Rhizopus oryzae resulting in a necrotizing kidney allograft infection and subsequent external iliac artery rupture. He survived after a prolonged course of non-standardized antimicrobial therapy, including a combination of aztreonam and ceftazidime/avibactam, and aggressive surgical debridement with allograft nephrectomy. The early timing of infection with these unusual organisms localized to the allograft suggests contamination and substandard care at the time of transplant. This case highlights the challenges of caring for these infections and serves as a cautionary tale for the potential complications of commercial transplant tourism.

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“…The use of aztreonam and ceftazidime-avibactam combination therapy was recently described in a case series from Spain involving 10 patients during a hospital outbreak of an NDM-1, OXA-48 and CTX-M-15 producing K. pneumoniae . Patients had infections including complicated bacteraemia, urinary tract infection, pneumonia or cholangitis 23. Using this antibiotic combination, six patients had clearance of their infection, which was defined as clearance of their cultures, lack of recurrence in 30 days or sustained resolution of signs and symptoms of infection.…”

Section: Discussionmentioning

confidence: 99%

Two for the price of one: emerging carbapenemases in a returning traveller to New York City

Mittal¹,

Szymczak

Guo

et al. 2018

BMJ Case Reports

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We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.

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Clinical outcomes after combination treatment with ceftazidime/avibactam and aztreonam for NDM-1/OXA-48/CTX-M-15-producing Klebsiella pneumoniae infection

Cited by 123 publications

References 8 publications

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

Transplant tourism complicated by life-threatening New Delhi metallo-β-lactamase-1 infection

Two for the price of one: emerging carbapenemases in a returning traveller to New York City

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