Compassionate use of meropenem/vaborbactam for infections caused by KPC-producing Klebsiella pneumoniae : a multicentre study.

Autor:	Tumbarello M; Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy.; UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy., Raffaelli F; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Cascio A; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy., Falcone M; Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Signorini L; UOC Malattie Infettive, Spedali Civili di Brescia, Brescia, Italy., Mussini C; Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy., De Rosa FG; Department of Medical Sciences, University of Turin, Torino, Italy., Losito AR; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., De Pascale G; Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy.; Dipartimento di Scienze dell'emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Pascale R; Dipartimento scienze mediche e chirurgiche, Università di Bologna/IRCCS Policlinico Sant'Orsola, Bologna, Italy., Giacobbe DR; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Dipartimento di Scienze della Salute (DISSAL), Università di Genova, Genova, Italy., Oliva A; Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy., Farese A; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy., Morelli P; Infectious Diseases Unit, Hospital Health Direction, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy., Tiseo G; Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Meschiari M; Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy., Del Giacomo P; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Montagnani F; Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy.; UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy., Fabbiani M; UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy., Vargas J; Dipartimento di Scienze dell'emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Spanu T; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.; Dipartimento di Scienze dell'emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Bassetti M; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Dipartimento di Scienze della Salute (DISSAL), Università di Genova, Genova, Italy., Venditti M; Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy., Viale P; Dipartimento scienze mediche e chirurgiche, Università di Bologna/IRCCS Policlinico Sant'Orsola, Bologna, Italy.
Jazyk:	angličtina
Zdroj:	JAC-antimicrobial resistance [JAC Antimicrob Resist] 2022 Mar 07; Vol. 4 (1), pp. dlac022. Date of Electronic Publication: 2022 Mar 07 (Print Publication: 2022).
DOI:	10.1093/jacamr/dlac022
Abstrakt:	Objectives: To explore the real-life performance of meropenem/vaborbactam for treating serious KPC-producing Klebsiella pneumoniae infections, including those resistant to ceftazidime/avibactam. Methods: A retrospective observational cohort study was conducted in 12 Italian hospitals. Enrolled patients had K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC- Kp ) infections (59.5% of which were ceftazidime/avibactam resistant). Patients who received ≥72 h of meropenem/vaborbactam therapy (with or without other antimicrobials) in a compassionate-use setting were included. Results: The 37 infections (all hospital-acquired) were mainly bacteraemic (BSIs, n  = 23) or lower respiratory tract infections (LRTIs, n  = 10). Clinical cure was achieved in 28 (75.6%) cases and microbiologically confirmed in all 25 with follow-up cultures. Three (10.7%) of the 28 clinical cures (all BSIs, 2/3 microbiologically confirmed) were followed by in-hospital recurrences after meropenem/vaborbactam was discontinued (median interval: 18 days). All three recurrences were susceptible to meropenem/vaborbactam and successfully managed with meropenem/vaborbactam combined with colistin or fosfomycin. Nine patients (24.3%) (all with BSIs or LRTIs) died in hospital with persistent signs of infection. Most were aged over 60 years, with high comorbidity burdens and INCREMENT scores ≥8. Only one had received meropenem/vaborbactam monotherapy. Six began meropenem/vaborbactam therapy >48 h after infection onset. Outcomes were unrelated to the isolate's ceftazidime/avibactam susceptibility status. The single adverse event observed consisted of severe leukopenia with thrombocytopenia. Conclusions: With the well-known limitations of real-life retrospective studies, our results support previous findings indicating that meropenem/vaborbactam therapy will be a safe, effective tool for managing serious KPC- Kp infections, including the increasing proportion displaying resistance to ceftazidime/avibactam. (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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