<p>A Real-World Study Comparing Various Antimicrobial Regimens for Bloodstream Infections Caused by Carbapenem-Resistant Gram-Negative Bacilli in a Tertiary Hospital, Shanghai, China, from 2010 to 2017</p>

Abstract

Background We conducted a real-world analysis of the effectiveness of different antibiotic regimens for bloodstream infections (BSIs) caused by carbapenem-resistant gram-negative bacilli (CR-GNB) in a Chinese population. Methods A retrospective observational study was conducted between January 2010 and December 2017. Patients with BSIs caused by CR-GNB confirmed by in vitro susceptibility tests were enrolled, and patient medical record data on antimicrobial agents and microbiological and clinical outcomes were extracted. Results A total of 175 individuals were included; 127 individuals (72.6%) received combination therapy (two or more antibiotics), while 48 individuals (27.4%) received monotherapy (single antibiotic). The all-cause 28-day mortality was 20.0%. Treatment success or presumed success rates were very similar between the monotherapy and combination therapy groups (58.3% versus 59.1%; P = 0.931). Combination therapy had a higher success rate trend than monotherapy in septic shock patients (40.7% versus 18.2%; P = 0.268). Improved therapeutic effects were observed in the active agent-containing group, although the differences were not significant. Conclusion Combination therapy likely has better therapeutic effects on critical BSIs caused by CR-GNB than monotherapy. Choosing a proper active agent in an antimicrobial regime is relatively crucial to the ultimate treatment outcome.

Antibiotic combination therapy versus monotherapy for the treatment of infections due to carbapenem-resistant Gram-negative bacteria： a systematic review and meta-analysis

“…The remainder included multiple species of Gram-negative bacilli [15, 17-20, 22, 24, 26, 27, 29, 30, 33, 39, 48, 50, 53, 54, 59, 60]. Among eight studies all the participants were admitted to ICU [22,23,46,48,51,52,59,62].…”

“…Several different antimicrobial classes were used in the included studies for treatment of Gram-negative bacteremia; however, the detail provided in each study regarding the speci c antimicrobial used varied greatly [64]. Mortality 50 studies reported all mortality, of which ten reported 14-day mortality[16, 19,22,34,42,47,50,58,63,64], eleven reported 28-day mortality [14, 22, 25, 33, 40, 46, 50-52, 56, 57], twenty reported 30-day mortality [13, 15, 18, 20, 26, 28, 31, 32, 36, 37, 39, 41-44, 49, 55, 59-61, 63, 64], one reported 90-day mortality [53], seven reported infection-related mortality [13,15,22,24,25,45,49], and ten reported inhospital mortality [13,19,23,27,30,35,45,47,48,64].…”

Clinical outcomes and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacterial infections: a real-world multicenter study

“…The international consensus guidelines for the optimal use of polymyxins recommend that patients intravenous PMB should receive a dose of 1.25–1.5 mg/kg (equivalent to 12,500–15,000 IU/kg) PMB every 12 h infused over 1 h [ 16 ]. In one study, clinicians found that combination therapy with at least two in vitro active agents was associated with higher efficacy in treating bloodstream infections caused by CR-GNB [ 6 , 19 ]. Carbapenem was the agent combined most commonly with PMB, followed by tigecycline, and cefoperazone–sulbactam [ 20 ].…”

Clinical Outcomes and Safety of Polymyxin B in the Treatment of Carbapenem-resistant Gram-negative Bacterial Infections: a Real-world Multicenter Study

“…Nephrotoxicity was observed in 7 patients (7%).Conclusions: Our results provide positive clinical and safety outcomes for PMB in the treatment of CR-GNB. Timely and appropriate use of PMB may be particularly useful in treating patients with sepsis in CR-GNB infections.caused by CR-GNB [6,18].Currently, there is a lack of data available on the e cacy, 28-day mortality, and adverse events for PMB in the treatment of CR-GNB infections. Here, we report on a multicenter, real-world study of patients receiving intravenous PMB to investigate the clinical outcomes of antimicrobial therapy in patients infected with CR-GNB.…”