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Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam
In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due...
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| Published in: | Brazilian journal of microbiology 2024-03, Vol.55 (1), p.333-341 |
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| container_title | Brazilian journal of microbiology |
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| creator | Neves, Camila Soares Moura, Líbia Cristina Rocha Vilela Da Costa Lima, Jailton Lobo Maciel, Maria Amélia Vieira |
| description | In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections.
Pseudomonas aeruginosa
was the prevailing agent in the sample evaluation (34.3%), followed by
Klebsiella pneumoniae
(30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally. |
| doi_str_mv | 10.1007/s42770-023-01193-x |
| format | article |
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Pseudomonas aeruginosa
was the prevailing agent in the sample evaluation (34.3%), followed by
Klebsiella pneumoniae
(30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.</description><identifier>ISSN: 1517-8382</identifier><identifier>ISSN: 1678-4405</identifier><identifier>EISSN: 1678-4405</identifier><identifier>DOI: 10.1007/s42770-023-01193-x</identifier><identifier>PMID: 38133795</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Anemia ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Azabicyclo Compounds ; Bacteria ; Biomedical and Life Sciences ; Carbapenems ; Ceftazidime ; Ceftazidime - pharmacology ; Ceftazidime - therapeutic use ; Cephalosporins - pharmacology ; Cephalosporins - therapeutic use ; Clinical Microbiology - Research Paper ; Comorbidity ; Drug Resistance, Multiple, Bacterial ; Drugs ; Food Microbiology ; Gram-Negative Bacteria ; Health services ; Hematology ; Hospitals ; Humans ; Intensive care ; Intensive Care Units ; Klebsiella ; Life Sciences ; Mechanical ventilation ; Medical Microbiology ; Microbial Ecology ; Microbial Genetics and Genomics ; Microbial Sensitivity Tests ; Microbiology ; Mortality ; Multidrug resistance ; Mycology ; Neurological diseases ; Nosocomial infection ; Nosocomial infections ; Patients ; Pseudomonas aeruginosa ; Tazobactam ; Tazobactam - pharmacology ; Tazobactam - therapeutic use ; Thrombocytopenia ; Thrombocytosis ; Urinary tract</subject><ispartof>Brazilian journal of microbiology, 2024-03, Vol.55 (1), p.333-341</ispartof><rights>The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-11eb12b344dc6b113ab05b43dfa5e134376fe9e1a0b6c6009c0ebac8a645e65a3</cites><orcidid>0000-0002-4161-8355 ; 0000-0002-5500-1129 ; 0000-0001-5477-4296 ; 0000-0002-4220-6889</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38133795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neves, Camila Soares</creatorcontrib><creatorcontrib>Moura, Líbia Cristina Rocha Vilela</creatorcontrib><creatorcontrib>Da Costa Lima, Jailton Lobo</creatorcontrib><creatorcontrib>Maciel, Maria Amélia Vieira</creatorcontrib><title>Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam</title><title>Brazilian journal of microbiology</title><addtitle>Braz J Microbiol</addtitle><addtitle>Braz J Microbiol</addtitle><description>In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections.
Pseudomonas aeruginosa
was the prevailing agent in the sample evaluation (34.3%), followed by
Klebsiella pneumoniae
(30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.</description><subject>Aged</subject><subject>Anemia</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Azabicyclo Compounds</subject><subject>Bacteria</subject><subject>Biomedical and Life Sciences</subject><subject>Carbapenems</subject><subject>Ceftazidime</subject><subject>Ceftazidime - pharmacology</subject><subject>Ceftazidime - therapeutic use</subject><subject>Cephalosporins - pharmacology</subject><subject>Cephalosporins - therapeutic use</subject><subject>Clinical Microbiology - Research Paper</subject><subject>Comorbidity</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Drugs</subject><subject>Food Microbiology</subject><subject>Gram-Negative Bacteria</subject><subject>Health services</subject><subject>Hematology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Klebsiella</subject><subject>Life Sciences</subject><subject>Mechanical ventilation</subject><subject>Medical Microbiology</subject><subject>Microbial Ecology</subject><subject>Microbial Genetics and Genomics</subject><subject>Microbial Sensitivity Tests</subject><subject>Microbiology</subject><subject>Mortality</subject><subject>Multidrug resistance</subject><subject>Mycology</subject><subject>Neurological diseases</subject><subject>Nosocomial infection</subject><subject>Nosocomial infections</subject><subject>Patients</subject><subject>Pseudomonas aeruginosa</subject><subject>Tazobactam</subject><subject>Tazobactam - pharmacology</subject><subject>Tazobactam - therapeutic use</subject><subject>Thrombocytopenia</subject><subject>Thrombocytosis</subject><subject>Urinary tract</subject><issn>1517-8382</issn><issn>1678-4405</issn><issn>1678-4405</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kctuFDEQRS1ERB7wAyyQJTbZmPGzH0s04iVFYkPWrWp39eCo2x5sd0jyRfnMeNIhSCxYVUn33FslXULeCv5BcF5vkpZ1zRmXinEhWsVuXpATUdUN05qbl2U3omaNauQxOU3pinNpuJavyLFqhFJ1a07I_XZy3lmYaFiyDTMmGkbqfEaf3DVSCxHp4l2me8gOfU5FHNFmHOhvl3_SeZmyG-KyYxGTSxl8prsIM_O4K44S0UOhowOaI8Kzz-KY4c4NbsYNXLsDBDMFPzwqYQp34HFTkLBKr8nRCFPCN0_zjFx-_vRj-5VdfP_ybfvxglklq8yEwF7IXmk92KoXQkHPTa_VMIJBobSqqxFbFMD7ylact5ZjOdBApQ1WBtQZOV9z9zH8WjDlbnbJ4jSVd8KSOtlyY-QhqaDv_0GvwhJ9-a5QWsoCmrpQcqVsDClFHLt9dDPE207w7tBjt_bYlR67xx67m2J69xS99DMOz5Y_xRVArUAqkt9h_Hv7P7EPl_WuFQ</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Neves, Camila Soares</creator><creator>Moura, Líbia Cristina Rocha Vilela</creator><creator>Da Costa Lima, Jailton Lobo</creator><creator>Maciel, Maria Amélia Vieira</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4161-8355</orcidid><orcidid>https://orcid.org/0000-0002-5500-1129</orcidid><orcidid>https://orcid.org/0000-0001-5477-4296</orcidid><orcidid>https://orcid.org/0000-0002-4220-6889</orcidid></search><sort><creationdate>20240301</creationdate><title>Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam</title><author>Neves, Camila Soares ; 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In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections.
Pseudomonas aeruginosa
was the prevailing agent in the sample evaluation (34.3%), followed by
Klebsiella pneumoniae
(30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38133795</pmid><doi>10.1007/s42770-023-01193-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4161-8355</orcidid><orcidid>https://orcid.org/0000-0002-5500-1129</orcidid><orcidid>https://orcid.org/0000-0001-5477-4296</orcidid><orcidid>https://orcid.org/0000-0002-4220-6889</orcidid></addata></record> |
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| identifier | ISSN: 1517-8382 |
| ispartof | Brazilian journal of microbiology, 2024-03, Vol.55 (1), p.333-341 |
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| subjects | Aged Anemia Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Azabicyclo Compounds Bacteria Biomedical and Life Sciences Carbapenems Ceftazidime Ceftazidime - pharmacology Ceftazidime - therapeutic use Cephalosporins - pharmacology Cephalosporins - therapeutic use Clinical Microbiology - Research Paper Comorbidity Drug Resistance, Multiple, Bacterial Drugs Food Microbiology Gram-Negative Bacteria Health services Hematology Hospitals Humans Intensive care Intensive Care Units Klebsiella Life Sciences Mechanical ventilation Medical Microbiology Microbial Ecology Microbial Genetics and Genomics Microbial Sensitivity Tests Microbiology Mortality Multidrug resistance Mycology Neurological diseases Nosocomial infection Nosocomial infections Patients Pseudomonas aeruginosa Tazobactam Tazobactam - pharmacology Tazobactam - therapeutic use Thrombocytopenia Thrombocytosis Urinary tract |
| title | Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam |
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