Meropenem vs standard of care for treatment of neonatal late onset sepsis (NeoMero1): A randomised controlled trial

Lutsar, Irja; Chazallon, Corine; Trafojer, Ursula; Cabre, Vincent Meiffredy de; Auriti, Cinzia; Bertaina, Chiara; Carducci, Francesca Ippolita Calò; Canpolat, Fuat Emre; Esposito, Susanna; Fournier, Isabelle; Hallik, Maarja; Heath, Paul T; Ilmoja, Mari‐Liis; Iosifidis, Εlias; Kuznetsova, Jelena; Meyer, Laurence; Metsvaht, Tuuli; Mitsiakos, Georgıos; Pana, Zoi Dorothea; Mosca, Fabio; Pugni, Lorenza; Roilides, Emmanuel; Rossi, Paolo; Sarafidis, Kosmas; Sánchez, Laura; Usonis, Vytautas; Warris, Adilia; Aboulker, J; Giaquinto, Carlo

doi:10.1371/journal.pone.0229380

Cited by 39 publications

(31 citation statements)

References 31 publications

(49 reference statements)

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“…Overall, 87 infants from six European countries (the United Kingdom: 49, Estonia: 21, Greece: 7, Italy: 7, Lithuania: 2, Spain: 1) between 2010-2015 fulfilled our inclusion criteria and were included in the study. Forty patients were retrieved from the neonatal infection surveillance network (NeonIN) study [30], 38 from NeoMero [31], and 9 from the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) study [32]. Patients, pathogens and treatment characteristics of the included episodes are summarised in Table 2.…”

Section: Demographic and Clinical Datamentioning

confidence: 99%

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Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

et al. 2021

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Mortality in neonates with Gram-negative bloodstream infections has remained unacceptably high. Very few data are available on the impact of resistance profiles, virulence factors, appropriateness of empirical treatment and clinical characteristics on patients’ mortality. A survival analysis to investigate 28-day mortality probability and predictors was performed including (I) infants <90 days (II) with an available Enterobacterales blood isolate with (III) clinical, treatment and 28-day outcome data. Eighty-seven patients were included. Overall, 299 virulence genes were identified among all the pathogens. Escherichia coli had significantly more virulence genes identified compared with other species. A strong positive correlation between the number of resistance and virulence genes carried by each isolate was found. The cumulative probability of death obtained by the Kaplan-Meier survival analysis was 19.5%. In the descriptive analysis, early age at onset, gestational age at onset, culture positive for E. coli and number of classes of virulence genes carried by each isolate were significantly associated with mortality. By Cox multivariate regression, none of the investigated variables was significant. This pilot study has demonstrated the feasibility of investigating the association between neonatal sepsis mortality and the causative Enterobacterales isolates virulome. This relationship needs further exploration in larger studies, ideally including host immunopathological response, in order to develop a tailor-made therapeutic strategy.

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Section: Demographic and Clinical Datamentioning

confidence: 99%

“…A case series of neonates with clinical sepsis and microbiologically confirmed GN-BSIs was constructed from three separate studies: the NeonIN [30], the NeoMero clinical trial [31], and the CLAHRC [32]. The NeonIN is a multinational network which prospectively collect data on neonatal infections from neonatal units.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

et al. 2021

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“…Neonates with LOS were identified in 21 hospitals across Europe as previously described as part of the NeoMero studies. 1 21 The details of Neomero1 are presented elsewhere 22 . The recruitment centers were in 6 different countries (Italy, Greece, Estonia, Spain, Lithuania, and UK), and local ethics committees provided approval.…”

Section: Data Sourcementioning

confidence: 99%

Genetic study of late-onset neonatal sepsis reveals significant differences by sex

Ciesielski

Zhang

Tacconelli

et al. 2021

Preprint

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Late-Onset Neonatal Sepsis (LOS) is a rare, but life-threatening condition, involving widespread infection, immune disruption, organ dysfunction, and often death. Because exposure to pathogens is not 100% preventable, identifying susceptibility factors is critical to defining neonates at greater risk. Prior studies demonstrated that both genetics and infant sex influence susceptibility. We, therefore, performed a genome wide association study (GWAS) with 224 cases and 273 controls from six European countries to identify genetic risk factors. We tested for association with both autosomal and X-chromosome variants in the total sample and in the samples stratified by sex. In total 71 SNPs associated with neonatal sepsis at p<1x10-4 in at least one analysis. Most importantly, the sex stratified analyses revealed associations with multiple SNPs (28 SNPs in males and 16 in females), but none of 44 SNPs from single-sex analyses associated with sepsis in the other sex at p<0.05, and the vast majority showed significant SNPxsex interactions (17 of 28 from the male-only analyses and all 16 from the female-only study). Pathway analyses showed that NOTCH signaling is over-represented among loci identified by the analyses. Our results indicate that susceptibility to LOS is genetically sexually dimorphic, and suggest that NOTCH signaling is likely to play a role in it.

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“…In a very small study using an opportunistic sampling strategy with 9 cerebrospinal fluid (CSF) samples in 6 patients, CSF penetration of meropenem was estimated [24]. More recently, two large studies on meropenem use in neonates (NeoMero1 and NeoMero2) supported by the European Funded Program 7 reported on plasma and CSF PK of meropenem in neonates and young infants [27,28]. This much larger study collected 78 CSF samples in 56 patients and demonstrated that CSF penetration was low (8%).…”

Section: Meropenemmentioning

confidence: 99%

Approaches to Dose Finding in Neonates, Illustrating the Variability between Neonatal Drug Development Programs

et al. 2020

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Drug dosing in neonates should be based on integrated knowledge concerning the disease to be treated, the physiological characteristics of the neonate, and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. It is critically important that all sources of information be leveraged to optimize dose selection for neonates. Sources may include data from adult studies, pediatric studies, non-clinical (juvenile) animal models, in vitro studies, and in silico models. Depending on the drug development program, each of these modalities could be used to varying degrees and with varying levels of confidence to guide dosing. This paper aims to illustrate the variability between neonatal drug development programs for neonatal diseases that are similar to those seen in other populations (meropenem), neonatal diseases related but not similar to pediatric or adult populations (clopidogrel, thyroid hormone), and diseases unique to neonates (caffeine, surfactant). Extrapolation of efficacy from older children or adults to neonates is infrequently used. Even if a disease process is similar between neonates and children or adults, such as with anti-infectives, additional dosing and safety information will be necessary for labeling, recognizing that dosing in neonates is confounded by maturational PK in addition to body size.

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Meropenem vs standard of care for treatment of neonatal late onset sepsis (NeoMero1): A randomised controlled trial

Cited by 39 publications

References 31 publications

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

Genetic study of late-onset neonatal sepsis reveals significant differences by sex

Approaches to Dose Finding in Neonates, Illustrating the Variability between Neonatal Drug Development Programs

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