Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis

Du, Xingran; Xu, Xinfeng; Yao, Jing; Deng, Kaili; Chen, Sixia; Shen, Ziyan; Yang, Lihua; Feng, Ganzhu

doi:10.1016/j.ajic.2019.03.003

Cited by 98 publications

(101 citation statements)

References 44 publications

(63 reference statements)

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“…SUL-DUR is being developed for patients with serious infections due to members of the ABC, including HABP/VABP. For infections caused by ABC isolates, high rates of multidrug resistance contribute to high morbidity, extended hospitalization, and excess mortality (4,6,27). Currently, colistin is the only antibiotic with consistent activity against ABC strains.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Tolerability of Intravenous Sulbactam-Durlobactam with Imipenem-Cilastatin in Hospitalized Adults with Complicated Urinary Tract Infections, Including Acute Pyelonephritis

Sagan

Yakubsevitch

Yanev³

et al. 2020

Antimicrob Agents Chemother

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Durlobactam (DUR; ETX2514) is a novel β-lactamase inhibitor with broad-spectrum activity against Ambler class A, C, and D β-lactamases. Durlobactam restores the in vitro activity of sulbactam (SUL) against members of the Acinetobacter baumannii-A. calcoaceticus complex (ABC). Sulbactam (SUL)-durlobactam (SUL-DUR) is under development for the treatment of ABC infections. Eighty patients with complicated urinary tract infection (cUTI), including acute pyelonephritis (AP), were randomized 2:1 to receive SUL-DUR at 1 g/1 g intravenously (i.v.) or placebo every 6 h (q6h) for 7 days and background therapy with imipenem-cilastatin (IMI) at 500 mg i.v. q6h to evaluate the tolerability of SUL-DUR in hospitalized patients. Patients with bacteremia could receive up to 14 days of therapy. SUL-DUR tolerability and the values of various pharmacokinetic (PK) parameters were determined. Efficacy was recorded at the test-of-cure (TOC) visit. SUL-DUR was well tolerated, with no serious adverse events (AEs) being reported. Headache (5.7%), nausea (3.8%), diarrhea (3.8%), and vascular pain (3.8%) were the most common drug-related AEs with SUL-DUR and were mostly of mild or moderate severity. The PK profile of DUR and SUL in hospitalized patients was consistent with observations in healthy volunteers. Overall success in the microbiological modified intent-to-treat (m-MITT) population was similar between the groups, as would be expected with IMI background therapy in all patients (overall success at the TOC visit, 76.6% [n = 36] with SUL-DUR and 81.0% [n = 17] with placebo). SUL-DUR in combination with IMI was well tolerated in patients with cUTIs. The pharmacokinetics of SUL-DUR observed in hospitalized patients was similar to that observed in healthy volunteers. (This study has been registered at ClinicalTrials.gov under identifier NCT03445195.)

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics and Tolerability of Intravenous Sulbactam-Durlobactam with Imipenem-Cilastatin in Hospitalized Adults with Complicated Urinary Tract Infections, Including Acute Pyelonephritis

Sagan

Yakubsevitch

Yanev³

et al. 2020

Antimicrob Agents Chemother

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“…CRAB infections carry high mortality that was reported up to 61.8% [21,22]. Bacteremic infections in particular have poor outcomes [22,23]. We found a high crude mortality with blood isolates but that needs to consider that those cases of CRAB represented only a small fraction (16.3%) of the studied cohort.…”

Section: Discussionmentioning

confidence: 72%

“…CRAB infections carry high mortality that was reported up to 61.8% [21,22]. Bacteremic infections in particular have poor outcomes [22,23].…”

Section: Discussionmentioning

confidence: 99%

Genetic Diversity of Imipenem-ResistantAcinetobacter baumanniiInfections at an Intensive Care Unit

Alnimr

Alamri

Alsultan

2020

Critical Care Research and Practice

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Introduction. Imipenem-resistant Acinetobacter baumannii (IRAB) represents a major clinical threat. Dissemination in critical care areas necessitates effective action measures including genotyping tools to study the clonality of these strains and trace their origin. e main aim of this study is to assess the genetic relatedness between IRAB isolates in our institution intensive care units (ICU) which are at a particular risk of outbreaks. Methods. Nonreplicate IRAB strains were serially collected over 3 years period (January 2016-December 2018) from patients admitted to the ICU. e isolates were phenotypically identified by a matrixassisted laser desorption/ionization time-of-flight-(MALDI-TOF-) based system (VITEK MS), and their susceptibility was tested by the phenotypic-based VITEK 2 system. Molecular fingerprinting was performed by enterobacterial repetitive intergenic consensus (ERIC-PCR) followed by hierarchal clustering. e patterns were analysed by the software of BioNumerics package version 7.6.3 (Applied Maths, Belgium). Results. A total of eighty IRAB were isolated from 31 colonization and 59 infection sites in patients admitted to the ICU. Sixty-two samples were respiratory in origin (77.5%). e generated dendrogram revealed distinct patterns for majority (95%) of the strains. Meropenem maintained activity against 43.8% of the imipenem-resistant A. baumannii. Conclusion. Meropenem can be a therapeutic option for imipenem-resistant A. baumannii. e banding patterns propose that multiple IRAB strains are circulating in the intensive care units of the institution. Drivers for this diversity need to be evaluated including antimicrobial consumption.

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“…In our research, PMB treatment of CRGNB infection patients with ICU-related mortality was 12%, hospital mortality was 15%, 28-day mortality was 40%. In infected carbapenem-resistant Acinetobacter baumannii patients without appropriate empirical antimicrobial therapy, the overall mortality rate was 86.1% [21]. The ICU mortality rate was 45.2% in critically ill patients infected with CRGNB who received tigecycline therapy [22], and the in-hospital mortality rate was 62.5% [23].…”

Section: Discussionmentioning

confidence: 99%

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

Zhang

Duan

et al. 2020

Preprint

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Background: High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CRGNB) was a challenge for clinicians has led to the resurgence of polymyxin B (PMB) use in the last decade. The goal of our multicenter, real-world study was to evaluate the efficacy and safety of PMB in the treatment of CRGNB.Methods: The real-world study included the patients with intravenous PMB at least 7 days during the period of October 2018 to June 2019. Data was collected from electronic patients register and follow-up. The primary outcome was 28-day mortality, the secondary outcomes included hospital mortality, occurrence of adverse events during PMB therapy. Associations between these variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. At the same time, therapeutic effects were observed. Results: The study included 100 patients. There were 39% presence of septic shock, 49% need mechanical ventilation at the beginning of therapy. The infection and condition improved after 7 days of PMB treatment. The major adverse reactions occurred in 16 cases (16%). The overall 28-day mortality was 40%. In terms of clinical characteristics, mean Sequential Organ Failure Assessment (6.77 versus 9.25，P = 0.004)，mean Acute Physiology and Chronic Health Evaluation II (APACHEII) scores (16.17 versus 19.78, P = 0.016) and the number of patient with mechanical ventilation (21 versus 30, P = 0.000) or septic shock (17 versus 32, P = 0.000) were lower in survivors group than nonsurvivors group. The mortality of 85 patients with identify pathogens was 38.82%, while the mortality of patients with negative pathogen culture results was 46.67% (P = 0.580). Multivariate analysis showed that mechanical ventilation (P = 0.023, OR = 3.5; CI: 1.194–10.739), septic shock (P = 0.002, OR = 5.960; CI: 1.923–18.473) were associated with 28-day mortality.Conclusion: Our research found that PMB may be as effective and safe as standard antibiotics for the treatment of CRGNB. Timely and appropriate use of PMB will have a positive impact on the clinical outcomes of patients with sepsis in CRGNB.

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Predictors of mortality in patients infected with carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis

Cited by 98 publications

References 44 publications

Pharmacokinetics and Tolerability of Intravenous Sulbactam-Durlobactam with Imipenem-Cilastatin in Hospitalized Adults with Complicated Urinary Tract Infections, Including Acute Pyelonephritis

Pharmacokinetics and Tolerability of Intravenous Sulbactam-Durlobactam with Imipenem-Cilastatin in Hospitalized Adults with Complicated Urinary Tract Infections, Including Acute Pyelonephritis

Genetic Diversity of Imipenem-ResistantAcinetobacter baumanniiInfections at an Intensive Care Unit

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

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