Monitoring Ceftazidime-Avibactam and Aztreonam Concentrations in the Treatment of a Bloodstream Infection Caused by a Multidrug-Resistant Enterobacter sp. Carrying Both Klebsiella pneumoniae Carbapenemase–4 and New Delhi Metallo-β-Lactamase–1

Yasmin, Mohamad; Fouts, Derrick E.; Jacobs, Michael; Haydar, Hanan; Marshall, Steven H.; White, Richard C.; D’Souza, Roshan; Lodise, Thomas P.; Rhoads, Daniel D.; Hujer, Andrea M.; Rojas, Laura; Hoyen, Claudia K.; Pérez, Federico; Edwards, Amy; Bonomo, Robert A.

doi:10.1093/cid/ciz1155

Cited by 63 publications

(45 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The susceptibility profile of strain Kp-P2 was identical to that of strain Kp-P1 ( Table 1 ). Checkerboards were set up with twofold dilutions of aztreonam (ATM; 0.03 to 128 mg/L) and ceftazidime-avibactam (CAZ-AVI; 1–0.25 to 64–16 mg/L) as previously described [ 4 ]: the combination resulted fully synergistic (fractional inhibitory concentration index, FICI = 0.03; Table 1 ) against strain Kp-P2. The patient was treated with intravenous CAZ-AVI 2.5 g every 8 hours plus ATM 2 g every 8 hours.…”

Section: Case Reportsmentioning

confidence: 99%

Extremely drug-resistant NDM-9-producing ST147 Klebsiella pneumoniae causing infections in Italy, May 2020

et al. 2020

View full text Add to dashboard Cite

A large outbreak of New Delhi metallo-beta-lactamase (NDM)-1-producing Klebsiella pneumoniae sequence type (ST) 147 occurred in Tuscany, Italy in 2018–2019. In 2020, ST147 NDM-9-producing K. pneumoniae were detected at the University Hospital of Pisa, Tuscany, in two critically ill patients; one developed bacteraemia. Genomic and phylogenetic analyses suggest relatedness of 2018–2019 and 2020 strains, with a change from NDM-1 to NDM-9 in the latter and evolution by colistin, tigecycline and fosfomycin resistance acquisition.

show abstract

Section: Case Reportsmentioning

confidence: 99%

Extremely drug-resistant NDM-9-producing ST147 Klebsiella pneumoniae causing infections in Italy, May 2020

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Prolonged or continuous infusion of ceftazidime/avibactam does not seem to improve PD target attainment compared to the standard 2 h infusion [ 182 ]. However, the optimal regimen for the combination of ceftazidime/avibactam with aztreonam for MBL-producing Enterobacterales remains unclear [ 13 , 83 ]. In the largest cohort, the regimen used was: ceftazidime/avibactam 2 + 0.5 g every 8 h (administered as a prolonged 8 h infusion in half of the patients and as a 2 h infusion in the rest) and aztreonam 2 g every 8 h (administered as a 2 h infusion) [ 83 ].…”

Section: Treatment Regimen For the Combination Of Ceftazidime/avibactmentioning

confidence: 99%

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

2020

View full text Add to dashboard Cite

The management of carbapenem-resistant infections is often based on polymyxins, tigecycline, aminoglycosides and their combinations. However, in a recent systematic review, we found that Gram-negative bacteria (GNB) co-resistant to carbapanems, aminoglycosides, polymyxins and tigecycline (CAPT-resistant) are increasingly being reported worldwide. Clinical data to guide the treatment of CAPT-resistant GNB are scarce and based exclusively on few case reports and small case series, but seem to indicate that appropriate (in vitro active) antimicrobial regimens, including newer antibiotics and synergistic combinations, may be associated with lower mortality. In this review, we consolidate the available literature to inform clinicians dealing with CAPT-resistant GNB about treatment options by considering the mechanisms of resistance to carbapenems. In combination with rapid diagnostic methods that allow fast detection of carbapenemase production, the approach proposed in this review may guide a timely and targeted treatment of patients with infections by CAPT-resistant GNB. Specifically, we focus on the three most problematic species, namely Klebsiella pneumoniae , Pseudomonas aeruginosa and Acinetobacter baumannii . Several treatment options are currently available for CAPT-resistant K. pneumonia . Newer β-lactam-β-lactamase combinations, including the combination of ceftazidime/avibactam with aztreonam against metallo-β-lactamase-producing isolates, appear to be more effective compared to combinations of older agents. Options for P. aeruginosa (especially metallo-β-lactamase-producing strains) and A. baumannii remain limited. Synergistic combination of older agents (e.g., polymyxin- or fosfomycin-based synergistic combinations) may represent a last resort option, but their use against CAPT-resistant GNB requires further study.

show abstract

“…63,64 The above clinical scenarios certainly merit consideration of β-lactam TDM. Other populations to consider may include pediatrics, 65 obesity, 66,67 transplant recipients, 68 central nervous system (CNS) infections (which can be directly sampled as opposed to using serum levels as a surrogate marker), 69 and patients with known multidrug resistant organisms with few other treatment regimens who require the administration of higher doses of β-lactams than FDA approved to reach clinically therapeutic exposures. 64 Select case reports utilizing TDM of β-lactams in complex patients are summarized in Table 2.…”

Section: S Pecifi C Patient P Opul Ati On S That May B Enefit Mos Tmentioning

confidence: 99%

A guide to therapeutic drug monitoring of β‐lactam antibiotics

2021

View full text Add to dashboard Cite

Pharmacists play an important role in assessing, managing, and monitoring the efficacy and safety of medications. A common avenue for accomplishing this responsibility is through therapeutic drug monitoring (TDM) of many drugs, a duty that has been successfully managed by pharmacists for over four decades. 1,2 Antimicrobials, including aminoglycosides, vancomycin, voriconazole, and historically, chloramphenicol and quinidine, have been frequent candidates for pharmacist-led TDM. Antimicrobial TDM has traditionally targeted drugs with narrow therapeutic indices, where prevention of toxicity was the

show abstract

Monitoring Ceftazidime-Avibactam and Aztreonam Concentrations in the Treatment of a Bloodstream Infection Caused by a Multidrug-Resistant Enterobacter sp. Carrying Both Klebsiella pneumoniae Carbapenemase–4 and New Delhi Metallo-β-Lactamase–1

Cited by 63 publications

References 10 publications

Extremely drug-resistant NDM-9-producing ST147 Klebsiella pneumoniae causing infections in Italy, May 2020

Extremely drug-resistant NDM-9-producing ST147 Klebsiella pneumoniae causing infections in Italy, May 2020

Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems

A guide to therapeutic drug monitoring of β‐lactam antibiotics

Contact Info

Product

Resources

About