Diagnosis and management of infections caused by multidrug-resistant bacteria: guideline endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI) and the Italian Society of Microbiology (SIM)

Tiseo, Giusy; Brigante, Gioconda; Giacobbe, Daniele Roberto; Maraolo, Alberto Enrico; Gona, Floriana; Falcone, Marco; Giannella, Maddalena; Grossi, Paolo; Pea, Federico; Rossolini, Gian María; Sanguinetti, Maurizio; Sarti, Mario; Scarparo, Claudio; Tumbarello, Mario; Venditti, Mario; Viale, Pierluigi; Bassetti, Matteo; Luzzaro, Francesco; Menichetti, Francesco; Stefani, Stefania; Tinelli, M.

doi:10.1016/j.ijantimicag.2022.106611

Cited by 55 publications

(54 citation statements)

References 193 publications

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“…Subsequent European guidelines, endorsed by both the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Society of Intensive Care Medicine (ESICM), referred to DTR-CRPA [ 13 ]. Eventually, the very recent Italian guidelines addressing infections by MDR bacteria also focused on DTR-PA [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…All the current guidelines [ 12 , 13 , 14 ] have tried to answer two fundamental questions: (i) the place in therapy of novel anti-pseudomonal agents, such as ceftolozane/tazobactam, ceftazidime/avibactam and imipenem/cilastatin/relebactam, cefiderocol; and (ii) the potential role of targeted combination therapy. The conclusions among the afore-mentioned documents are not uniform but the premises are the same: there is a lack of head-to-head trials comparing the novel available anti-pseudomonal agents against each other, and the evidence is substantially rooted in pre-clinical data, observational studies and randomized controlled trials (RCTs) of limited sample size [ 12 , 13 , 14 ].…”

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

“…For instance, ceftolozane/tazobactam is acknowledged as one of the most powerful new-generation anti-pseudomonal antibiotics; nevertheless, the pivotal RCTs allowing its introduction in clinical practice were not aimed at including carbapenem-resistant strains; in the ASPECT-NP study on nosocomial pneumonia, a small fraction of patients (15 out of 726 enrolled) were affected by XDR P. aeruginosa , and no information on CRPA was available [ 31 ]. Still, although the important limitations of polymyxins in terms of toxicity and suboptimal efficacy are widely known [ 137 ], no sufficiently powered RCT has been published demonstrating the clear-as-day inferiority of colistin-based therapy versus new anti-pseudomonal beta-lactams [ 13 , 14 ]. To this purpose, it is worth citing the pivotal RCTs regarding imipenem/cilastatin/relebactam and cefiderocol: the RESTORE-IMI trial and the CREDIBLE-CR study, respectively, both designed to assess the efficacy against carbapenem-resistant organisms of the novel drugs, the first having colistin (plus imipenem) as the comparator, the second a “best available therapy” based on colistin in two-thirds of cases concerning the carbapenem-resistant mITT population.…”

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

“…Nevertheless, beta-lactams have traditionally represented the mainstay of anti-pseudomonal treatment [ 139 ]; their convenient safety profile and their wide therapeutic window also make them preferable to other options in the setting of DTR-PA [ 12 , 13 , 14 ].…”

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

“…In Table 3 a summary of the current guidelines on DTR-PA infections is provided [ 12 , 13 , 14 ]. In the absence of head-to-head trials or robust observational data, it is difficult to prioritize one novel anti-pseudomonal beta-lactam over the others [ 12 ].…”

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

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Epidemiology, Mechanisms of Resistance and Treatment Algorithm for Infections Due to Carbapenem-Resistant Gram-Negative Bacteria: An Expert Panel Opinion

et al. 2022

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Antimicrobial resistance represents a serious threat for global health, causing an unacceptable burden in terms of morbidity, mortality and healthcare costs. In particular, in 2017, carbapenem-resistant organisms were listed by the WHO among the group of pathogens for which novel treatment strategies are urgently needed. Fortunately, several drugs and combinations have been introduced in recent years to treat multi-drug-resistant (MDR) bacteria. However, a correct use of these molecules is needed to preserve their efficacy. In the present paper, we will provide an overview on the epidemiology and mechanisms of resistance of the most common MDR Gram-negative bacteria, proposing a treatment algorithm for the management of infections due to carbapenem-resistant bacteria based on the most recent clinical evidence.

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Section: Methodsmentioning

confidence: 99%

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

Section: Available Treatments For Carbapenem-resistant Gram-negative ...mentioning

confidence: 99%

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Epidemiology, Mechanisms of Resistance and Treatment Algorithm for Infections Due to Carbapenem-Resistant Gram-Negative Bacteria: An Expert Panel Opinion

et al. 2022

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Real-world experience with meropenem/vaborbactam for the treatment of infections caused by ESBL-producing Enterobacterales and carbapenem-resistant Klebsiella pneumoniae

Tiseo,

Galfo,

Riccardi

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose Real-world experience with meropenem/vaborbactam (M/V) is limited. Our aim is to report a clinical experience of M/V in the treatment of resistant Gram-negative bacilli. Methods This is a prospective observational study including patients hospitalized in the University Hospital of Pisa (March 2021–Jan 2023) with infections by both extended-spectrum β-lactamases (ESBL)-producing Enterobacterales and carbapenem-resistant Klebsiella pneumoniae (Kp) treated with M/V. The primary outcome measure was clinical success, defined as a composite of survival, resolution of signs and symptoms and absence of microbiological failure at day 30 from infection onset. A multivariable regression analysis was performed to identify factors associated with clinical failure. Odds ratio (OR) with 95% confidence intervals (CI) was calculated. Results A total of 104 patients who received M/V were included: 24/104 (23.1%) infections were caused by ESBL non-hypervirulent Enterobacterales, 17/104 (16.3%) by ESBL-producing hypervirulent Klebsiella pneumoniae (hvKp) and 63/104 (60.6%) by CRE. The most common infections were bloodstream infections, followed by urinary tract infections, hospital-acquired pneumonia, intra-abdominal infections and others. Septic shock occurred in 16/104 (15.4%) patients. Clinical success was achieved in 77% of patients, and 30-day mortality rate was 15.4%. In patients with KPC-producing Kp infections, clinical success and 30-day mortality rates were 82% and 11.5%, respectively. On multivariable analysis, SOFA score (OR 1.32, 95% CI 1.02–1.7, p=0.032) was independently associated with clinical failure, while source control (OR 0.16, 95% CI 0.03–0.89, p=0.036) was protective. Conclusions M/V is a promising therapeutic option against infections caused by difficult-to-treat ESBL-producing Enterobacterales and CR-Kp.

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Clinical effectiveness of cefiderocol for the treatment of bloodstream infections due to carbapenem-resistant Acinetobacter baumannii during the COVID-19 era: a single center, observational study

Oliva,

Liguori,

Covino

et al. 2024

Eur J Clin Microbiol Infect Dis

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Background We assessed the clinical effectiveness of cefiderocol (CFDC) in comparison with colistin (COL) for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infections (BSI). Materials/methods Retrospective cohort study including adults with CRAB-BSI. Outcomes were mortality, clinical cure and adverse events during therapy. The average treatment effect of CFDC compared to COL was weighted with the inverse-probability treatment weight (IPTW). Results Overall, 104 patients were included (50 CFDC, 54 COL), median age 66.5 years, median Charlson Comorbidity Index 5, septic shock in 33.6% of patients. Primary BSI accounted for 43.3% of cases, followed by ventilator-associated pneumonia (VAP) (26%), catheter-related BSI (20.2%) and hospital-acquired pneumonia (HAP) (9.6%). Although not significantly, mortality at all time points was lower for CFDC than COL, while clinical cure was higher in CFDC than COL (66% vs. 44.4%, p = 0.027). Adverse events were more frequent in COL than CFDC-group (38.8% vs. 10%, p < 0.0001), primarily attributed to acute kidney injury (AKI) in the COL group. Patients with bacteremic HAP/VAP treated with CFDC had a significant lower 30-d mortality and higher clinical cure than COL (p = 0.008 and p = 0.0008, respectively). Increment of CCI (p = 0.005), ICU (p = 0.025), SARS-CoV2 (p = 0.006) and ECMO (p < 0.0001) were independently associated with 30-d mortality, while receiving CFDC was not associated with survival. Conclusions CFDC could represent an effective and safe treatment option for CRAB BSI, especially in patients with bacteremic HAP/VAP and frail patients where the risk of acute renal failure during therapy should be avoided.

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Cited by 55 publications

References 193 publications

Epidemiology, Mechanisms of Resistance and Treatment Algorithm for Infections Due to Carbapenem-Resistant Gram-Negative Bacteria: An Expert Panel Opinion

Epidemiology, Mechanisms of Resistance and Treatment Algorithm for Infections Due to Carbapenem-Resistant Gram-Negative Bacteria: An Expert Panel Opinion

Real-world experience with meropenem/vaborbactam for the treatment of infections caused by ESBL-producing Enterobacterales and carbapenem-resistant Klebsiella pneumoniae

Clinical effectiveness of cefiderocol for the treatment of bloodstream infections due to carbapenem-resistant Acinetobacter baumannii during the COVID-19 era: a single center, observational study

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