Outcomes of Children With Enterobacteriaceae Bacteremia With Reduced Susceptibility to Ceftriaxone

Wu, Harold; Gerber, Jeffrey S.; Hsu, Alice J.; Tekle, Tsigereda; Carroll, Karen C.; Cosgrove, Sara E.

doi:10.1097/inf.0b013e31829043b3

Cited by 9 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies from 1991 and 2001 reported 19% emergence of Enterobacter spp resistance to third-generation cephalosporin during therapy [7,8]. Although the higher prevalence seen in our study suggests that resistance to third-generation cephalosporins may be increasing, the lowering of the CLSI breakpoint for third-generation cephalosporins against Enterobacteriaceae in 2010 may be a contributing factor [41].…”

Section: Discussioncontrasting

confidence: 46%

The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Tamma

Girdwood²,

Gopaul³

et al. 2013

Clinical Infectious Diseases

Self Cite

137

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 46%

The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Tamma

Girdwood²,

Gopaul³

et al. 2013

Clinical Infectious Diseases

Self Cite

137

View full text Add to dashboard Cite

show abstract

“…have similar clinical outcomes when prescribed ceftriaxone compared with broader spectrum 215 β-lactam regimens" (19). 216 We believed that the other prognostic factors observed in our study: older age and the 217 onset of renal failure reflect patients' underlying disease and clinical condition and have been 218 found to be predictors of mortality in other studies involving patients with infections caused by 219 multidrug resistant microorganisms (20).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 87%

Treatment of KPC-producing Enterobacteriaceae: suboptimal efficacy of polymyxins

Oliveira

Assis

Freire

et al. 2015

Clinical Microbiology and Infection

View full text Add to dashboard Cite

Treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) remains a challenge. Combined therapy has been proposed as the best choice, but there are no clear data showing which combination therapy is superior. Our aim was to evaluate the effectiveness of antimicrobial regimens for treating KPC-EI. This was a retrospective cohort study of KPC-EI nosocomial infections (based on CDC criteria) between October 2009 and June 2013 at three tertiary Brazilian hospitals. The primary outcomes were the 30-day mortality for all infections and the 30-day mortality for patients with bacteraemia. Risk factors for mortality were evaluated by comparing clinical variables of survivors and nonsurvivors. In this study, 118 patients were included, of whom 78 had bacteraemia. Catheter-related bloodstream infections were the most frequent (43%), followed by urinary tract infections (n = 27, 23%). Monotherapy was used in 57 patients and combined treatment in 61 patients. The most common therapeutic combination was polymyxin plus carbapenem 20 (33%). Multivariate analysis for all infections (n = 118) and for bacteremic infections (n = 78) revealed that renal failure at the end of treatment, use of polymyxin and older age were prognostic factors for mortality. In conclusion, polymyxins showed suboptimal efficacy and combination therapy was not superior to monotherapy.

show abstract

“…With lower thresholds, even though the sensitivity of detecting ESBLs would be relatively unchanged (i.e., the likelihood of detecting additional ESBL producers would be low), the specificity of detecting ESBLs would be compromised. A decreased specificity or "overcalling" organisms as potential ESBL producers could mean a subsequent increase in carbapenem use, leading to an additional strain on our already constrained antibiotic armamentarium (8,9). Identification of ESBL-producing organisms has important implications.…”

mentioning

confidence: 99%

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

2014

Self Cite

View full text Add to dashboard Cite

As routine testing of clinical isolates for extended-spectrum ␤-lactamase (ESBL) production (screen plus phenotypic confirmatory testing) is no longer required by the Clinical and Laboratory Standards Institute (CLSI), a number of clinical microbiology laboratories use ceftriaxone MICs as a proxy means of identifying bacteria as potential ESBL producers. Data from 1,386 clinical isolates suggest that a ceftriaxone MIC cutoff of 8 g/ml is an excellent predictor of ESBL production, with a positive predictive value and negative predictive value approaching 100% and 99.5%, respectively. In 2010, the Clinical and Laboratory Standards Institute (CLSI) lowered the ceftriaxone (and cefotaxime) breakpoint from 8 g/ml to 1 g/ml, and with that change, the recommendation for screening for extended-spectrum ␤-lactamase (ESBL) production became optional (1). This was in part due to the large workload imposed on clinical microbiology laboratories with phenotypic confirmatory ESBL testing (1). However, identification of organisms producing ESBLs still has important clinical implications. A portion of these organisms retain in vitro susceptibility to piperacillin-tazobactam and cefepime (2), even though these agents are generally considered inferior to carbapenem therapy for the treatment of invasive infections by ESBL-producing organisms (3-5).Without a method of alerting clinicians to the possibility that an agent may be an ESBL producer, potentially suboptimal therapy (e.g., cefepime or piperacillin-tazobactam) may be inadvertently prescribed. In addition, the absence of institutional epidemiological data on ESBLs can hamper efforts to control their spread within health care facilities (6). For these reasons, many clinical microbiology laboratories use ceftriaxone (or other thirdgeneration cephalosporin) MIC thresholds to indicate to clinicians that an organism is a possible ESBL producer or to trigger additional confirmatory phenotypic testing. If the ceftriaxone MIC threshold is lower than necessary, this practice has the potential to lead to the overuse of carbapenems or to needlessly increase the workload of microbiology laboratories (for institutions where confirmatory testing is still performed). If the ceftriaxone MIC threshold for ESBL identification is too high, appropriate infection control and treatment strategies may not be deployed. Our objective was to evaluate the sensitivities and specificities of various ceftriaxone MICs in determining the optimal threshold for identifying an organism as a potential ESBL producer.Microbiology methods. Blood isolates growing Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis obtained from January 2007 to December 2013 were included. These bacteria were selected because the CLSI-recommended method for initial screening and phenotypic confirmatory testing is limited to these organisms (7). Clinical samples were processed at the Johns Hopkins Hospital Microbiology Laboratory according to standard operating procedures. Antimicrobial susceptibility t...

show abstract

Outcomes of Children With Enterobacteriaceae Bacteremia With Reduced Susceptibility to Ceftriaxone

Cited by 9 publications

References 23 publications

The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

The Use of Cefepime for Treating AmpC β-Lactamase–Producing Enterobacteriaceae

Treatment of KPC-producing Enterobacteriaceae: suboptimal efficacy of polymyxins

Determining the Optimal Ceftriaxone MIC for Triggering Extended-Spectrum β-Lactamase Confirmatory Testing

Contact Info

Product

Resources

About