未经批准:耐碳青霉烯类肠杆菌(CRE)被认为是一种紧急威胁。头孢他啶-阿维巴坦和美罗培南-伐巴坦含有对包括产生肺炎克雷伯菌碳青霉烯酶(KPC)的CRE分离株具有活性的β-内酰胺酶抑制剂。
UNASSIGNED:2016年1月1日至2018年11月1日CRE分离株的回顾性图表回顾。收集的数据包括测量的MIC值的描述性概述,通过聚合酶链反应测试的抗性机制(XpertCarba-R,造父变星,桑尼维尔CA),以及临床结果。
未经评估:在审查的106个分离株中,来自85个个体受试者的86个分离株符合纳入标准。头孢他啶-阿维巴坦的断点:MIC比率总体为4,而美罗培南-伐巴坦的该比率为32(p<0.0001)。对于KPC分离株,2016年、2017年和2018年头孢他啶-阿维巴坦MIC50/MIC90为2/4mg/L(n=32),2/4mg/L(n=17),和2/8毫克/升(n=30),分别。2016年、2017年和2018年KPC分离株的美罗培南-伐巴坦MIC50/MIC90为0.06/0.125mg/L(n=32),0.06/0.1mg/L(n=17),和0.06/0.5mg/L(n=30),分别。头孢他啶-阿维巴坦受试者的微生物治愈率为75%(n=16),接受替代药物治疗的受试者为58.3%(n=12)(p=0.43)。与头孢他啶-阿维巴坦2/9(22.2%)比3/17(17.6%)(p=1.00)和4/9(44.4%)比4/17(28.6%)(p=0.38)相比,接受替代药物治疗的受试者的14天和30天死亡率在数字上较高。分别。对于头孢他啶-阿维巴坦,2016年,2017年和2018年的30天死亡率为0/5(0%),0/2(0%),和4/10(40%)。
UNASSIGNED:我们机构使用头孢他啶-阿维巴坦的选择性压力可能会降低其作为CRE感染一线药物的效用。美罗培南-伐巴坦保持较低的MIC值,可能是CRE的有希望的治疗选择。
Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat. Ceftazidime-avibactam and meropenem-vaborbactam contain β-lactamase inhibitors active against CRE isolates including those that produce Klebsiella pneumoniae carbapenemases (KPC).
Retrospective chart review of CRE isolates from 1 January 2016 to 1 November 2018. Collected data includes a descriptive overview of measured MIC values, resistance mechanism via a polymerase chain reaction test (Xpert Carba-R, Cepheid, Sunnyvale CA), as well as clinical outcomes.
Of 106 isolates reviewed, 86 isolates met the inclusion criteria from 85 individual subjects. The breakpoint:MIC ratio for ceftazidime-avibactam overall was 4, while for meropenem-vaborbactam this ratio was 32 (p < 0.0001). For KPC isolates, ceftazidime-avibactam MIC50/MIC90 in 2016, 2017, and 2018 were 2/4 mg/L (n = 32), 2/4 mg/L (n = 17), and 2/8 mg/L (n = 30), respectively. The meropenem-vaborbactam MIC50/MIC90, for KPC isolates in 2016, 2017, and 2018 were 0.06/0.125 mg/L (n = 32), 0.06/0.1 mg/L (n = 17), and 0.06/0.5 mg/L (n = 30), respectively. Microbiologic cure was 75% (n = 16) in ceftazidime-avibactam subjects and 58.3% (n = 12) in subjects treated with alternative agents (p = 0.43). The 14- and 30-day mortality was numerically higher in subjects treated with alternate agents when compared ceftazidime-avibactam 2/9 (22.2%) vs 3/17 (17.6%) (p = 1.00) and 4/9 (44.4%) vs 4/17 (28.6%) (p = 0.38), respectively. For ceftazidime-avibactam, 30-day mortality in 2016, 2017, and 2018 was 0/5 (0%), 0/2 (0%), and 4/10 (40%).
Selective pressure from the use of ceftazidime-avibactam at our institution may be decreasing its utility as a first-line agent for CRE infections. Meropenem-vaborbactam maintained low MIC values and may be a promising treatment option for CRE.