Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study

Ghafur, Abdul; Devarajan, Vidya; Raja, T; Easow, Jose; Raja, MA; Sreenivas, Sankar; Balasubramaniam, R.; Raman, SG; Devaprasad, Dedeepiya; Venkatachalam, Balaji; Nimmagadda, Ramesh

doi:10.4103/0019-509x.204767

Cited by 6 publications

(7 citation statements)

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“…This suggests that patients with more comorbidities or with more severe clinical manifestations at admission (e.g., septic shock) are most frequently given triple therapy, and that these conditions are the ones that increase mortality. Similar findings were reported by Ghafur et al, who found no statistically significant differences between monotherapy and combination therapy [19].…”

Section: Discussionsupporting

confidence: 91%

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Gualtero

Valderrama

Valencia

et al. 2020

J Infect Dev Ctries

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Introduction: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. Methodology: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. Results: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06–10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. Conclusions: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.

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Section: Discussionsupporting

confidence: 91%

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Gualtero

Valderrama

Valencia

et al. 2020

J Infect Dev Ctries

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“…18 Our study population had 28-day mortality rates of 42.7% and 29.2% for VRE and CRGNB, respectively, which are similar to previous studies. 7,17 While all of the mentioned severity scores seemed to be related to 28-day mortality in the univariate analysis, no specific severity index was associated with 28-day mortality in the multivariate analysis. One possible explanation for these observations is that the 28-day mortality from patients with CRGNB or VRE bacteremia was a multifactorial event, and therefore, initial severity indexes alone were insufficient to predict 28-day mortality.…”

Section: Discussionmentioning

confidence: 92%

“…11 – 13 Studies of VRE bacteremia have documented variable mortality rates. 7 , 14 , 15 Moreover, 28-day mortality from CRGNB infection in China was 33.5% 11 , 16 , 17 and a multicenter study in the USA reported a 30-day mortality rate of 49% and 14-day mortality rate of 22%. 18 Our study population had 28-day mortality rates of 42.7% and 29.2% for VRE and CRGNB, respectively, which are similar to previous studies.…”

Section: Discussionmentioning

confidence: 99%

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<p>Predictors of Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli or Vancomycin-Resistant Enterococci Bacteremia</p>

Shi

Lee

Cho

et al. 2020

IDR

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The incidences of carbapenem-resistant gram-negative bacilli (CRGNB) and vancomycin-resistant Enterococci (VRE) have increased rapidly in South Korea since 2000. The mortality rate for CRGNB or VRE bacteremia cases is higher than that for nonresistant bacteremia cases. The factors associated with higher mortality are unclear. We investigated the factors associated with mortality from CRGNB or VRE bacteremia and compared the relative risk of these factors. Patients and Methods: We retrospectively collected data from adult patients with CRGNB or VRE bacteremia. Patients were grouped according to whether they survived or died. The data from both groups were compared. Results: During the study period, 171 cases of CRGNB or VRE bacteremia were identified, of which 100 were CRGNB bacteremia cases and 71 were VRE bacteremia cases. Multivariate analysis revealed significant associations with Pitt bacteremia score (PBS) (odds ratio [OR] 1.329, 95% confidence interval [CI] 1.049-1.684). In the multivariate analysis, negative conversion of follow-up blood culture (FUBC) was related with oneweek mortality from CRGNB or VRE bacteremia (OR 17.623, 95% CI 5.726-54.244). In the multivariate analysis of risk factors for 28-day mortality for CRGNB or VRE bacteremia, the significant risk factors were bacteremia of respiratory origin (OR 4.491, 95% CI 1.622-12.435) and positive FUBC (OR 4.082, 95% CI 1.626-10.204). Conclusion: Despite the high mortality rate in patients with CRGNB or VRE bacteremia, the related mortality could be predicted by independent risk factors of PBS, positive FUBC, and bacteremia of respiratory origin.

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“…Falagas et al, proposed a methodical review that combination therapy has offer a great correlative asset over single drug therapy clinically in survival of patients infected with carbapenem-resistant gram negative organisms [28]. An observational study done by Ghafur et al, from India, found that there was no remarkable distinction in mortality between single drug and two or three drug combinations in the patients infected with Acinetobacter and Pseudomonas bacteremia (n= 36) as well (P= 0.067), except in neutropenic patients, where combination therapy accomplished better outcome [29].…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of In-vitro Synergy Testing Methods in Carbapenem-Resistant Acinetobacter Species

Soni

Gupta²,

Gombar³

et al. 2019

Journal of Microbiology and Infectious Diseases

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Objective: There is an increasing incidence of Acinetobacter species causing serious hospital acquired infections such as blood stream infections (BSI), catheter associated urinary tract infections (CAUTI) and lower respiratory tract infections(LRTI) with high mortality rate of 30-75% in patients having long hospital stay especially in critical care units (CCUs). During the past decade, multi drug resistant Acinetobacter isolates have presented a real challenge to clinicians and are posing difficulties in treatment. Carbapenem-resistant Acinetobacter species particularly A. baumannii, represent a growing public health concern, since they often confer resistance to other critically important antimicrobials. Methodology: In the present study, various antibiotic combinations such as colistin + meropenem, imipenem + tigecycline, polymyxin B + azithromycin and doripenem + sulbactam are used for MDR Acinetobacter infections and tested for in-vitro combination test by Epsilometric test and Broth Micro dilution and confirmation done by time kill assay. Results: We found synergistic results with all three methods used in study with three combinations significantly (p<0.05) but with one combination i.e. doripenem+sulbactam, synergy found only with Etest not with MCB and time kill assay (p~0.069). Conclusions: We have also observed and compared outcome of the patients with respect to the treatment received during hospital stay, but we did not found significant difference between two groups, (two drug regimen & three drug regimen) regarding their mortality.

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Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study

Abstract: Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.

Cited by 6 publications

References 0 publications

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

<p>Predictors of Mortality in Patients with Carbapenem-Resistant Gram-Negative Bacilli or Vancomycin-Resistant Enterococci Bacteremia</p>

Comparative Evaluation of In-vitro Synergy Testing Methods in Carbapenem-Resistant Acinetobacter Species

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