Empirical monotherapy with meropenem or combination therapy: the microbiological point of view

Abstract

The increase in the number of clinical isolates of multiresistant Enterobacteriaceae and Pseudomonas aeruginosa raises problems in decision-making on empirical treatments for severe Gram-negative bacilli-associated infections. The aim of our study is to determine the resistance of meropenem in our setting and the co-resistance of a combination of this compound with two antibiotics from different families: amikacin and ciprofloxacin. Between 2009 and 2013, a total of 81,310 clinical isolates belonging to the main species of Enterobacteriaceae and 39,191 clinical isolates of P. aeruginosa isolated in 28 hospitals in the Valencian Community on the South East Mediterranean Coast of Spain were analyzed using data provided by RedMiva (microbiological surveillance network of the Valencian Community). Meropenem resistance in Enterobacteriaceae increased from 0.16 % in 2009 to 1.25 % in 2013. Very few Enterobacteriaceae strains resistant to meropenem were sensitive to ciprofloxacin; in contrast, the combination of meropenem and amikacin led to a marked decrease in the risk of the microorganisms being resistant to both drugs (RR = 34 in 2013). In the case of P. aeruginosa, meropenem resistance also increased (from 14.32 % in 2009 to 24.52 % in 2013). Most meropenem-resistant P. aeruginosa isolates were also resistant to fluoroquinolones. However, the addition of amikacin led to a more than three-fold decrease in the risk of resistance. In our setting, empirical treatment with meropenem is adequate in enterobacterial infections, but poses difficulties when infection due to P. aeruginosa is suspected, in which case a combination of meropenem and amikacin has been shown to have a higher microbiological success rate.

Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications

“…(25.17%) ( Graph 2 ). This frequency was lower than the rates reported in Latin America in general (38.4%), Guatemala (75.8%), Peru (62.5%), and Ecuador (55.6%) in 2011 16 and in ICUs in India between 2015 and 2016 (56%), 15 and was more aligned with rates found in Spain in 2013 (24.52%) 19 and other countries such as Poland, Lithuania, Slovakia, Hungary, Croatia, Romania, Bulgaria, and Greece, where the frequency of carbapenem resistance ranges from 25% to 50%. 20 …”

Comparative study of manual conventional blood cultures versus automated blood culture system in cases of septicemia

“…Garcinuño P et al, in their study, showed a higher microbiological success rate with Amikacin and Meropenem. 18 Escherichia coli showed 100% sensitivity to Amikacin followed by Meropenem and Imipenem. A study done by Kidwai S et al showed Escherichia coli with highest sensitivity to Imipenem followed by Amikacin.…”

Antimicrobial Resistance Profile of MDR & Non-MDR Meropenem-Resistant Pseudomonas aeruginosa Isolates of Patients in Intensive Care Unit of Tertiary Hospital

“…Administration of amikacin therapy resulted in a more than threefold reduction in the risk of resistance. 27 Overuse of fl uoroquinolones in the treatment of P. aeruginosa infections increased bacterial resistance to fluoroquinolones in recent years. Resistance to fl uoroquinolones is mainly due to: (1) point mutations in the DNA gyrase (gyrA and gyrB) and topoisomerase IV (parC and parE) genes, (2) the presence of transferable plasmid-mediated quinolone resistance (PMQR), and (3) mutations in genes that regulate efflux expression and decreased expression of outer membrane porins.…”