PDF(Pubmed)
Abstract：
OBJECTIVE: Amongst all etiologic hospital-acquired infection factors, K. pneumoniae strains producing New Delhi metallo-β-lactamase (KP-NDM) belong to pathogens with the most effective antibiotic resistance mechanisms. Clinical guidelines recommend using ceftazidime/avibactam with aztreonam (CZA + AT) as the preferred option for NDM-producing Enterobacterales. However, the number of observations on such treatment regimen is limited. This retrospective study reports the clinical and microbiological outcomes of 23 patients with KP-NDM hospital-acquired infection treated with CZA + AT at a single center in Poland.
METHODS: The isolates were derived from the urine, lungs, blood, peritoneal cavity, wounds, and peritonsillar abscess. In microbiological analysis, mass spectrometry for pathogen identification, polymerase chain reaction, or an immunochromatographic assay for detection of carbapenemase, as well as VITEK-2 system, broth microdilution, and microdilution in agar method for antimicrobial susceptibility tests were used, depending of the pathogens\' nature. CZA was administered intravenously (IV) at 2.5 g every eight hours in patients with normal kidney function, and aztreonam was administered at 2 g every eight hours IV. Such dosage was modified when renal function was reduced.
RESULTS: KP-NDM was eradicated in all cases. Four patients (17.4%) died: three of them had a neoplastic disease, and one - a COVID-19 infection.
CONCLUSIONS: The combination of CZA + AT is a safe and effective therapy for infections caused by KP-NDM, both at the clinical and microbiological levels. The synergistic action of all compounds resulted in a good agreement between the clinical efficacy of CZA + AT and the results of in vitro susceptibility testing.
METHODS: The isolates were derived from the urine, lungs, blood, peritoneal cavity, wounds, and peritonsillar abscess. In microbiological analysis, mass spectrometry for pathogen identification, polymerase chain reaction, or an immunochromatographic assay for detection of carbapenemase, as well as VITEK-2 system, broth microdilution, and microdilution in agar method for antimicrobial susceptibility tests were used, depending of the pathogens\' nature. CZA was administered intravenously (IV) at 2.5 g every eight hours in patients with normal kidney function, and aztreonam was administered at 2 g every eight hours IV. Such dosage was modified when renal function was reduced.
RESULTS: KP-NDM was eradicated in all cases. Four patients (17.4%) died: three of them had a neoplastic disease, and one - a COVID-19 infection.
CONCLUSIONS: The combination of CZA + AT is a safe and effective therapy for infections caused by KP-NDM, both at the clinical and microbiological levels. The synergistic action of all compounds resulted in a good agreement between the clinical efficacy of CZA + AT and the results of in vitro susceptibility testing.
摘要：
目的：在所有病因性医院获得性感染因素中，产生新德里金属-β-内酰胺酶（KP-NDM）的肺炎克雷伯菌菌株属于具有最有效的抗生素耐药机制的病原体。临床指南建议使用头孢他啶/阿维巴坦联合氨曲南（CZAAT）作为产生NDM的肠杆菌的首选选择。然而,对此类治疗方案的观察数量有限.这项回顾性研究报告了在波兰的一个中心接受CZAAT治疗的23例KP-NDM医院获得性感染患者的临床和微生物学结果。
方法：分离株来自尿液，肺,血,腹膜腔,伤口,和扁桃体周围脓肿。在微生物分析中，用于病原体鉴定的质谱，聚合酶链反应，或用于检测碳青霉烯酶的免疫层析法，以及VITEK-2系统，肉汤微量稀释，采用琼脂微量稀释法进行抗菌药物敏感性试验，取决于病原体的性质。肾功能正常的患者每8小时静脉内（IV）给予CZA2.5g，氨曲南每8小时给药2g。当肾功能降低时，可以修改这种剂量。
结果：KP-NDM在所有病例中均被根除。四名患者（17.4％）死亡：其中三人患有肿瘤性疾病，和一个-COVID-19感染。
结论：CZA+AT联合治疗KP-NDM感染是一种安全有效的治疗方法，在临床和微生物学水平。所有化合物的协同作用导致CZA+AT的临床功效与体外敏感性测试的结果之间的良好一致性。
方法：分离株来自尿液，肺,血,腹膜腔,伤口,和扁桃体周围脓肿。在微生物分析中，用于病原体鉴定的质谱，聚合酶链反应，或用于检测碳青霉烯酶的免疫层析法，以及VITEK-2系统，肉汤微量稀释，采用琼脂微量稀释法进行抗菌药物敏感性试验，取决于病原体的性质。肾功能正常的患者每8小时静脉内（IV）给予CZA2.5g，氨曲南每8小时给药2g。当肾功能降低时，可以修改这种剂量。
结果：KP-NDM在所有病例中均被根除。四名患者（17.4％）死亡：其中三人患有肿瘤性疾病，和一个-COVID-19感染。
结论：CZA+AT联合治疗KP-NDM感染是一种安全有效的治疗方法，在临床和微生物学水平。所有化合物的协同作用导致CZA+AT的临床功效与体外敏感性测试的结果之间的良好一致性。
