Role of Trimethoprim/Sulfamethoxazole in the Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae.
antimicrobial resistance; carbapenem-resistant enterobacteriaceae; Klebsiella pneumonia; trimethoprim-sulfamethoxazole; urinary tract infection
In the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), trimethoprim-sulfamethoxazole (TMP-SMX) had a limited role in the treatment of less severe carbapenem-resistant Enterobacteriaceae (CRE) infections, especially urinary tract infections. Of tested CRE, only 29% were susceptible to TMP-SMX. Development of resistance further limits the use of TMP-SMX in CRE infections. [ABSTRACT FROM AUTHOR]
Luterbach Courtney L; Boshe Ashley; Henderson Heather I; Cober Eric; Richter Sandra S; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Hujer Andrea M; Hujer Kristine M; Rudin Susan D; Domitrovic T Nicholas; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G; Bonomo Robert A; Duin David van
Open Forum Infectious Diseases
2019
2019-01
Journal Article
<a href="http://doi.org/10.1093/ofid/ofy351" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofy351</a>
508. Gentamicin Non-susceptibility is Associated with Persistence of Carbapenem-Resistant Klebsiella pneumoniae in the Urinary Tract.
NORTH Carolina; hospital admission; bacteriuria; urine; laboratory; antimicrobial susceptibility; Klebsiella pneumonia; bacteriuria; CENTERS for Disease Control & Prevention (U.S.); urinary tract infections; URINARY organs; urinary tract; health care systems; disclosure; CENTERS for Disease Control & Prevention (U.S.); amikacin; antibiotic overuse; carbapenem resistance; carbapenem-resistant enterobacteriaceae; GENTAMICIN; gentamicin sulfate (usp); gentamicins; health care safety; Klebsiella pneumonia; midwestern united states; persistence; persistence; rales; signs and symptoms; trimethoprim-sulfamethoxazole combination; urinary tract infections; urine culture
Background Urinary tract infection (UTI) is the most common clinical manifestation of carbapenem-resistant Klebsiella pneumoniae (CR Kp). Persistent CR Kp bacteriuria is associated with the spread of CR Kp and antibiotic overuse. Risk factors for persistent CR Kp bacteriuria are uncertain. Methods CRACKLE-1 was a multicenter, prospective study that included 960 patients with at least one carbapenem-resistant Enterobacteriaceae (CRE)-positive culture from December 2011 to June 2016 collected from 18 hospitals encompassing 8 healthcare systems in the Midwestern US and North Carolina. Patients with CR Kp bacteriuria who were discharged alive from index hospitalization were included in the current study, and sporadic (single positive CR Kp urine culture) and persistent (≥2 CR Kp urine cultures during independent hospital admissions occurring at least 2 days apart) cases were compared. Antibiotic susceptibility testing was performed by local laboratories. Amikacin, gentamicin (GENT), and trimethoprim/sulfamethoxazole were included in the analysis based on variance and frequency of testing. The CDC/National Healthcare Safety Network criteria for UTI were used. Results CR Kp was the most common CRE isolate (n = 869, prevalence 91%). In patients with CR Kp , 527 had CR Kp isolated from the urine (prevalence 61%, 95% CI 0.57, 0.64). Of these, 486 patients, of whom 129 (27%) were diagnosed with a UTI, were discharged alive. Notably, 135/486 (28%) patients with CR Kp bacteriuria were readmitted and yielded a second urine culture of CR Kp. Most patients with persistent bacteriuria, 99/135 (73%), were asymptomatic at initial admission. Of these patients, 20/99 (20%) were diagnosed with a UTI at second admission. In multivariable analysis, only GENT non-susceptibility was associated with an increased risk (adjusted OR 1.66, 95% CI 1.10–2.49) of persistent bacteriuria. Persistent bacteriuria was independent of GENT treatment during index hospitalization (GENT was used in 15% of patients). Conclusion Bacteriuria with GENT non-susceptible CR Kp strains was associated with persistent bacteriuria. As this was independent of GENT treatment, GENT resistance determinants may be co-transmitted along with traits that promote bacterial persistence in CR Kp. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]
Luterbach Courtney L; Henderson Heather I; Cober Eric; Richter Sandra S; Salata Robert A; Kaye Keith S; Doi Yohei; Watkins Richard R; Bonomo Robert A; Duin David van
Open Forum Infectious Diseases
2019
2019-10-02
Journal Article
<a href="http://doi.org/10.1093/ofid/ofz360.577" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofz360.577</a>
Ceftolozane/Tazobactam vs Polymyxin or Aminoglycoside-based Regimens for the Treatment of Drug-resistant Pseudomonas Aeruginosa
aminoglycoside; ceftolozane; multidrug resistant; polymyxin; Pseudomonas
October 2019 Update
BACKGROUND: Ceftolozane/tazobactam is a novel cephalosporin/beta-lactamase inhibitor combination that often retains activity against resistant Pseudomonas aeruginosa. The comparative safety and efficacy vs polymyxins or aminoglycosides in this setting remains unknown. METHODS: A retrospective, multicenter, observational cohort study was performed. Patients who received ceftolozane/tazobactam were compared with those treated with either polymyxin or aminoglycoside-based regimens for infections due to drug-resistant P. aeruginosa. Multivariate logistic regression was performed controlling for factors associated with treatment to assess the independent impact of ceftolozane/tazobactam on clinical cure, acute kidney injury (AKI), and in-hospital mortality. RESULTS: A total of 200 patients were included (100 in each treatment arm). The cohort represented an ill population with 69% in the intensive care unit, 63% mechanically ventilated, and 42% in severe sepsis or septic shock at infection onset. The most common infection type was ventilator-associated pneumonia (52%); 7% of patients were bacteremic. Combination therapy was more commonly used in polymyxin/aminoglycoside patients than those who received ceftolozane/tazobactam (72% vs 15%, P < .001). After adjusting for differences between groups, receipt of ceftolozane/tazobactam was independently associated with clinical cure (adjusted odds ratio [aOR], 2.63; 95% confidence interval [CI], 1.31-5.30) and protective against AKI (aOR, 0.08; 95% CI, 0.03-0.22). There was no difference in in-hospital mortality. The number needed to treat for a clinical cure with ceftolozane/tazobactam was 5, and the number needed to harm with AKI with a polymyxin/aminoglycoside was 4. CONCLUSIONS: These data support the preferential use of ceftolozane/tazobactam over polymyxins or aminoglycosides for drug-resistant P. aeruginosa infections.
Pogue Jason M; Kaye Keith S; Veve Michael P; Patel Twisha S; Gerlach Anthony T; Davis Susan L; Puzniak Laura A; File Tom M; Olson Shannon; Dhar Sorabh; Bonomo Robert A; Perez Federico
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
2019
2019-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/ciz816" target="_blank" rel="noreferrer noopener">10.1093/cid/ciz816</a>
The Pitt Bacteremia Score Predicts Mortality in Non-Bacteremic Infections.
Background: Predicting mortality risk in patients is important in research settings. The Pitt bacteremia score (PBS) is commonly used as a predictor of early mortality risk in patients with bloodstream infections (BSI). Here, we determined whether the PBS predicts 14-day inpatient mortality in non-bacteremia carbapenem-resistant Enterobacteriaceae (CRE) infections.; Methods: Patients were selected from the Consortium on resistance against carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-1), a prospective, multicenter, observational study. We estimated risk ratios to analyze the predictive ability of the PBS overall and each of its components individually. We analyzed each component of the PBS in the prediction of mortality, assessed the appropriate cutoff value for the dichotomized score, and compared the predictive ability of the qPitt score to that of the PBS.; Results: In a cohort of 475 patients with CRE infections, a PBS ≥ 4 was associated with mortality in patients with non-bacteremia infections (RR=21.9 [95% CI: 7.0, 68.8]) and with BSI (RR=6.0 [95% CI: 2.5, 14.4]). In multivariable analysis, the hypotension, mechanical ventilation, mental status, and cardiac arrest parameters of the PBS were independent risk factors for 14-day all-cause inpatient mortality. The temperature parameter as originally calculated for the PBS was not independently associated with mortality. However, a temperature < 36.0ᴼ C versus ≥ 36ᴼ C was independently associated with mortality. A qPitt score ≥ 2 had similar discrimination as a PBS ≥ 4 in non-bacteremia infections.; Conclusion: Here, we validated that the PBS and qPitt score can be used as reliable predictors of mortality in non-bacteremia CRE infections.; © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Henderson Heather; Luterbach Courtney L; Cober Eric; Richter Sandra S; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G; Bonomo Robert A; Harris Anthony; Napravnik Sonia; van Duin David
Clinical Infectious Diseases: An Official Publication Of The Infectious Diseases Society Of America
2019
2019-06
<a href="http://doi.org/10.1093/cid/ciz528" target="_blank" rel="noreferrer noopener">10.1093/cid/ciz528</a>
Increasing prevalence of carbapenem-resistant Enterobacteriaceae and strategies to avert a looming crisis.
Early Diagnosis; Drug Resistance; Microbial; Antibiotics – Therapeutic Use; Enterobacteriaceae Infections – Drug Therapy; Carbapenems – Therapeutic Use; Enterobacteriaceae – Drug Effects; Enterobacteriaceae – Physiology; Enterobacteriaceae Infections – Diagnosis; Enterobacteriaceae Infections – Microbiology
Watkins Richard R; Bonomo Robert A
Expert review of anti-infective therapy
2013
2013-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1586/eri.13.46" target="_blank" rel="noreferrer noopener">10.1586/eri.13.46</a>
Novel beta-lactamase inhibitors: a therapeutic hope against the scourge of multidrug resistance.
antibiotic resistance; beta-lactamase inhibitors
The increasing incidence and prevalence of multi-drug resistance (MDR) among contemporary Gram-negative bacteria represents a significant threat to human health. Since their discovery, beta-lactam antibiotics have been a major component of the armamentarium against these serious pathogens. Unfortunately, a wide range of beta-lactamase enzymes have emerged that are capable of inactivating these powerful drugs. In the past 30 years, a major advancement in the battle against microbes has been the development of beta-lactamase inhibitors, which restore the efficacy of beta-lactam antibiotics (e.g., ampicillin/sulbactam, amoxicillin/clavulanate, ticarcillin/clavulanate, and piperacillin/tazobactam). Unfortunately, many newly discovered beta-lactamases are not inactivated by currently available inhibitors. Is there hope? For the first time in many years, we can anticipate the development and introduction into clinical practice of novel inhibitors. Although these inhibitors may still not be effective for all beta-lactamases, their introduction is still welcome. This review focuses on the novel beta-lactamase inhibitors that are closest to being introduced in the clinic.
Watkins Richard R; Papp-Wallace Krisztina M; Drawz Sarah M; Bonomo Robert A
Frontiers in microbiology
2013
2013-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3389/fmicb.2013.00392" target="_blank" rel="noreferrer noopener">10.3389/fmicb.2013.00392</a>
The Role of Trimethoprim/Sulfamethoxazole in the Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae.
antimicrobial resistance; carbapenem-resistant Enterobacteriaceae; Klebsiella pneumonia; trimethoprim-sulfamethoxazole; urinary tract infection
In the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), trimethoprim-sulfamethoxazole (TMP-SMX) had a limited role in the treatment of less severe carbapenem-resistant Enterobacteriaceae (CRE) infections, especially urinary tract infections. Of tested CRE, only 29% were susceptible to TMP-SMX. Development of resistance further limits the use of TMP-SMX in CRE infections.
Luterbach Courtney L; Boshe Ashley; Henderson Heather I; Cober Eric; Richter Sandra S; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Hujer Andrea M; Hujer Kristine M; Rudin Susan D; Domitrovic T Nicholas; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G Jr; Bonomo Robert A; van Duin David
Open forum infectious diseases
2019
2019-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ofid/ofy351" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofy351</a>
Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.
carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae; mortality; renal failure; renal replacement therapy
Background: Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods: Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine \textless2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results: Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions: Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.
Eilertson Brandon; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G Jr; Bonomo Robert A; DeHovitz Jack; Kreiswirth Barry; van Duin David
Open forum infectious diseases
2017
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ofid/ofx216" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofx216</a>
A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae.
carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae; ST258; surgical site infections; wound infection
BACKGROUND: This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). METHODS: Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. RESULTS: One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from long-term care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93). CONCLUSIONS: Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.
Henig Oryan; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Marshall Steve; Rudin Susan D; Domitrovic T Nicholas; Hujer Andrea M; Hujer Kristine M; Doi Yohei; Evans Scott; Fowler Vance G Jr; Bonomo Robert A; van Duin David; Kaye Keith S
Open forum infectious diseases
2017
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ofid/ofx157" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofx157</a>
Colistin Versus Ceftazidime-Avibactam in the Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae.
benefit-risk; carbapenem-resistant Enterobacteriaceae; Carbapenems; Ceftazidime – Therapeutic Use; ceftazidime-avibactam; colistin; Colistin – Therapeutic Use; Comparative Studies; Drug Resistance; Enterobacteriaceae Infections – Drug Therapy; Human; In Vitro Studies; Klebsiella Infections; Klebsiella pneumoniae
Background: The efficacy of ceftazidime-avibactam-a cephalosporin-beta-lactamase inhibitor combination with in vitro activity against Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CRE)-compared with colistin remains unknown. Methods: Patients initially treated with either ceftazidime-avibactam or colistin for CRE infections were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), a prospective, multicenter, observational study. Efficacy, safety, and benefit-risk analyses were performed using intent-to-treat analyses with partial credit and the desirability of outcome ranking approaches. The ordinal efficacy outcome was based on disposition at day 30 after starting treatment (home vs not home but not observed to die in the hospital vs hospital death). All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW). Results: Thirty-eight patients were treated first with ceftazidime-avibactam and 99 with colistin. Most patients received additional anti-CRE agents as part of their treatment. Bloodstream (n = 63; 46%) and respiratory (n = 30; 22%) infections were most common. In patients treated with ceftazidime-avibactam versus colistin, IPTW-adjusted all-cause hospital mortality 30 days after starting treatment was 9% versus 32%, respectively (difference, 23%; 95% bootstrap confidence interval, 9%-35%; P = .001). In an analysis of disposition at 30 days, patients treated with ceftazidime-avibactam, compared with those treated within colistin, had an IPTW-adjusted probability of a better outcome of 64% (95% confidence interval, 57%-71%). Partial credit analyses indicated uniform superiority of ceftazidime-avibactam to colistin. Conclusions: Ceftazidime-avibactam may be a reasonable alternative to colistin in the treatment of K. pneumoniae carbapenemase-producing CRE infections. These findings require confirmation in a randomized controlled trial.
van Duin David; Lok Judith J; Earley Michelle; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Doi Yohei; Kaye Keith S; Fowler Vance G Jr; Paterson David L; Bonomo Robert A; Evans Scott
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2018
2018-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/cix783" target="_blank" rel="noreferrer noopener">10.1093/cid/cix783</a>
Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality.
*beta-Lactam Resistance; *carbapenem-resistant Enterobacteriaceae; *colistin; *Klebsiella pneumoniae; *mortality; *ST258; Aged; Anti-Bacterial Agents/pharmacology/*therapeutic use; beta-Lactamases/genetics; Carbapenems/pharmacology/therapeutic use; Colistin/pharmacology/*therapeutic use; Comorbidity; Female; Humans; Kaplan-Meier Estimate; Klebsiella Infections/diagnosis/*drug therapy/*microbiology/mortality; Klebsiella pneumoniae/classification/*drug effects/genetics; Male; Microbial Sensitivity Tests; Middle Aged; Phylogeny; Proportional Hazards Models
Background: Polymyxins including colistin are an important "last-line" treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide. Methods: A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling. Results: In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73-6.57; P \textless .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp. Conclusions: In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates.
Rojas Laura J; Salim Madiha; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Marshall Steve; Rudin Susan D; Domitrovic T Nicholas; Hujer Andrea M; Hujer Kristine M; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G Jr; Bonomo Robert A; van Duin David
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2017
2017-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/cid/ciw805" target="_blank" rel="noreferrer noopener">10.1093/cid/ciw805</a>
On the path to untreatable infections: colistin use in agriculture and the end of 'last resort' antibiotics.
*agriculture; *Agriculture; *antibiotic resistance; *Colistin; *Drug Resistance; Agriculture; Animal Husbandry; Anti-Bacterial Agents/*therapeutic use; Antibiotics – Therapeutic Use; Bacterial; Colistin – Analogs and Derivatives; Colistin – Therapeutic Use; Colistin/analogs & derivatives/*therapeutic use; Comparative Studies; Drug Resistance; Escherichia Coli; Escherichia Coli – Physiology; Escherichia coli Proteins/genetics; Escherichia coli/genetics/*physiology; European Union; Evaluation Research; Human; Humans; Microbial; Multicenter Studies; Multiple; Proteins; Validation Studies
Watkins Richard R; Smith Tara C; Bonomo Robert A
Expert review of anti-infective therapy
2016
2016-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/14787210.2016.1216314" target="_blank" rel="noreferrer noopener">10.1080/14787210.2016.1216314</a>
DISC: Describing Infections of the Spine treated with Ceftaroline.
Ceftaroline; Discitis; Epidural abscess; MRSA; Vertebral osteomyelitis
OBJECTIVES: Infections of the spine lead to considerable morbidity and a high cost to the global healthcare system. Currently, evidence for using ceftaroline, an advanced-generation cephalosporin active against methicillin-resistant Staphylococcus aureus (MRSA), in spine infections is limited. METHODS: Describing Infections of the Spine treated with Ceftaroline (DISC) is a multicentre, retrospective, cohort study that evaluated ceftaroline for treating spine infections. Patients were included if they were aged \textgreater/=18 years, diagnosed with a spine infection and treated with ceftaroline for \textgreater/=28 days. A control group was identified with the same inclusion criteria as the study population except they were treated with a comparator antibiotic for \textgreater/=28 days. RESULTS: Thirty-seven patients were included each in the ceftaroline and control groups. MRSA was the most commonly identified pathogen. With no differences between groups in age, sex, race or co-morbidities (with the exception of chronic kidney disease), treatment with ceftaroline led to similar clinical success compared with the control group. Multivariate regression analysis did not show a significant difference between the two groups in terms of clinical success after controlling for other covariates (adjusted odds ratio=1.49; P=0.711). More patients who received ceftaroline were discharged to an extended-care or rehabilitation facility than home compared with controls (81% vs. 54%, respectively; P=0.024). Side effects and toxicities were rare, including one case of eosinophilic pneumonia in the ceftaroline group. CONCLUSIONS: Ceftaroline appears to be a safe and effective therapy for infections of the spine, including from MRSA.
Watkins Richard R; Yendewa George; Burdette Steven D; Horattas Sophia; Haller Nairmeen Awad; Mangira Caroline; Salata Robert A; Bonomo Robert A
Journal of global antimicrobial resistance
2018
2018-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jgar.2018.01.001" target="_blank" rel="noreferrer noopener">10.1016/j.jgar.2018.01.001</a>
Overview: Global and Local Impact of Antibiotic Resistance.
*Agriculture; *Antibiotic resistance; *Bacterial Infections/drug therapy/microbiology/prevention & control; *Drug Resistance; *Global Health; *Infections; *Public health; *Public Health; Agriculture; Anti-Bacterial Agents/pharmacology/therapeutic use; Bacteria/drug effects; Bacterial; Humans; United States
The rapid and ongoing spread of antibiotic resistance poses a serious threat to global public health. The indiscriminant use of antibiotics in agriculture and human medicine along with increasingly connected societies has fueled the distribution of antibiotic-resistant bacteria. These factors together have led to rising numbers of infections caused by multidrug-resistant and pan-resistant bacteria, with increases in morbidity and mortality. This article summarizes the trends in antibiotic resistance, discusses the impact of antibiotic resistance on society, and reviews the use of antibiotics in agriculture. Feasible ways to tackle antibiotic resistance to avert a post-antibiotic era are suggested.
Watkins Richard R; Bonomo Robert A
Infectious disease clinics of North America
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.idc.2016.02.001" target="_blank" rel="noreferrer noopener">10.1016/j.idc.2016.02.001</a>