esbl treatment guidelines idsa

esbl treatment guidelines idsa

On the other hand, for community-acquired represented by ESBL producers Enterobacteriaceae, even acute cholecystitis causing severe physiologic disturbance, today frequently found in community acquired infec- advanced age, and/or immunocompromise, the IDSA tions[12,13]. Recommended antibiotic treatment options for presumed or confirmed extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), assuming in vitro susceptibility to agents in table, Table 3. Fosfomycin use should be limited to E. coli cystitis as the fos A gene (intrinsic to certain Gram-negative organisms such as Klebsiella species, Enterobacter spp., and Serratia marcescens) can hydrolyze fosfomycin and may lead to clinical failure [23, 24]. Content will be disseminated on multiple platforms and updated as new data emerge. Clin Infect Dis, Jernigan JA, Hatfield KM, Wolford H, et al. Clin Infect Dis, Barnes MD, Taracila MA, Rutter JD, et al. Recommendation: Ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-cilastatin-relebactam are the preferred treatment options for KPC-producing infections outside of the urinary tract. Clin Infect Dis, Wunderink RG, Giamarellos-Bourboulis EJ, Rahav G, et al. Specific Treatment Considerations for the Various Enterobacteriaceae. Antimicrob Resist Infect Control. For each pathogen group, a table is provided with preferred and alternative treatment recommendations, after antimicrobial susceptibility data are known. J Antimicrob Chemother, Babinchak T, Ellis-Grosse E, Dartois N, et al. 1,5 If piperacillin/tazobactam is used for the treatment of ESBL-EC infection, most experts would recommend higher doses of 4.5 grams every 6 hours in patients with normal renal function. Clin Infect Dis, Kollef MH, Novacek M, Kivistik U, et al. Although a clinical trial demonstrated increased mortality with cefiderocol compared to best available therapy against a variety of infections due to carbapenem-resistant Gram-negative bacteria, these findings do not appear to extend to urinary tract infections [54, 56]. Procter and Gamble Pharmaceuticals, Inc. MACROBID - nitrofurantoin monohydrate and nitrofurantoin, macrocrystalline capsule [package insert]. These agents achieve rapid tissue distribution following administration, resulting in limited concentration in the urine and poor serum concentrations [81]. Limiting use of these agents serves to both preserve their activity for future infections and to limit associated toxicities, particularly with the fluoroquinolones. When carbapenemase production is present, infections should be treated as if the causative organism is meropenem-resistant, regardless of the meropenem MIC. IDSA GUIDELINES Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America AlisonG.Freifeld,1 EricJ.Bow,9 KentA.Sepkowitz,2 MichaelJ.Boeckh,4 JamesI.Ito,5 CraigA.Mullen,3 IssamI.Raad,6 Kenneth V. Rolston,6 Jo-Anne H. Young,7 and John R. Wingard8 Antimicrob Resist Infect Control. CRE account for more than 13,000 nosocomial infections and contribute to greater than 1,000 deaths annually in the United States [2]. ESBL-producing organisms have been reported throughout the world. What are preferred antibiotics for the treatment of uncomplicated cystitis caused by DTR-, What are preferred antibiotics for the treatment of pyelonephritis and complicated urinary tract infections (cUTI) caused by DTR-, What are preferred antibiotics for the treatment of infections outside of the urinary tract caused by DTR-, What is the role of combination antibiotic therapy for the treatment of infections caused by DTR-. Routine history, physical examination, and laboratory studies will identify most patients who require further evaluation. The ecology of extended-spectrum beta-lactamases (ESBLs) in the developed world. 2018 Jan-Mar;36(1):32-36. doi: 10.4103/ijmm.IJMM_17_415. Guideline similar duration: minimum 5 days + up to 3 days from clinical stability Madaras-Kelly KJ, et al. Rationale: Piperacillin-tazobactam demonstrates in vitro activity against a number of ESBL-E [31]. In vitro activity of plazomicin against 5,015 gram-negative and gram-positive clinical isolates obtained from patients in canadian hospitals as part of the CANWARD study, 2011-2012. Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium. Phenotypic tests (e.g., double-disk synergy test, ETEST®, automated susceptibility platform algorithms) to exclude the possibility of ESBL production by clinical isolates should be interpreted with caution. In a clinical trial, cefiderocol was compared to best available therapy, which frequently consisted of colistin-based regimens, for the treatment of carbapenem-resistant Gram-negative infections in 118 patients; 51% of patients were infected with CRE [56]. 9/8/2020, A Focus on Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa), Pranita D. Tamma*, Samuel L. Aitken, Robert A. Bonomo, Amy J. Mathers, David van Duin, Cornelius J. Clancy. Plazomicin is unlikely to provide any incremental benefit against DTR-P. aeruginosa if resistance to all other aminoglycosides is demonstrated [92]. Published Open Forum Infect Dis, Bush K, Macalintal C, Rasmussen BA, Lee VJ, Yang Y. Phenotypic and/or genotypic testing are not performed by all clinical microbiology laboratories. The CDC defines CRE as members of the Enterobacterales order resistant to at least one carbapenem antibiotic or producing a carbapenemase enzyme [2]. Cefiderocol has reliable in vitro activity against P. aeruginosa, including isolates with otherwise highly resistant phenotypes [74-76]. Antimicrob Agents Chemother, Yayan J, Ghebremedhin B, Rasche K. Antibiotic Resistance of Pseudomonas aeruginosa in Pneumonia at a Single University Hospital Center in Germany over a 10-Year Period. Recommendation: Combination antibiotic therapy (i.e., the use of a β-lactam agent in combination with an aminoglycoside, fluoroquinolone, or polymyxin) is not routinely recommended for the treatment of infections caused by CRE. In Vitro Activity of the Siderophore Cephalosporin, Cefiderocol, against Carbapenem-Nonsusceptible and Multidrug-Resistant Isolates of Gram-Negative Bacilli Collected Worldwide in 2014 to 2016. Lancet Infect Dis, Mazuski JE, Gasink LB, Armstrong J, et al. Clin Infect Dis, Ho S, Nguyen L, Trinh T, MacDougall C. Recognizing and Overcoming Resistance to New Beta-Lactam/Beta-Lactamase Inhibitor Combinations. Preferred and alternative treatment recommendations in this guidance document assume that the causative organism has been identified and in vitro activity of antibiotics has been demonstrated. Beta-lactamases are constitutive, are usually produced at low levels, and provide resistance against ampicillin, amoxicillin, and ticarcillin. Published by Oxford University Press for the Infectious Diseases Society of America. Difficult-to-Treat Resistance in Gram-negative Bacteremia at 173 US Hospitals: Retrospective Cohort Analysis of Prevalence, Predictors, and Outcome of Resistance to All First-line Agents. EBSL-E generally remain susceptible to carbapenems. Antimicrob Agents Chemother, Burgess DS, Hall RG, 2nd. In patients in whom the potential for nephrotoxicity is deemed acceptable, once-daily aminoglycosides for a full treatment course is an alternative option. A.M. served as an advisor for Rempex; serves as a consultant/advisory panel for Qpex Biopharma, Acceclerate Diagnostics, VenatoRX; Antimicrobial Resistance Services; receives research funding (paid to the institution) from Centers for Disease Control and Prevention (CDC) and Wallace H. Coulter Endowment; serves as a member of Antimicrobial Testing Committee, Clinical Laboratory and Standards Institute and is an elected member to the Council on Microbial Sciences, American Society of Microbiology. 2019 IDSA/ATS Community -Acquired Pneumonia Guideline: more … However, in vitro susceptibility activity of this combination against CRE [65-67], clinical experience with imipenem-cilastatin, and the stability of relebactam as a β-lactamase inhibitor [68] suggest imipenem-cilastatin-relebactam is likely to be effective for CRE infections. Any Gram-negative organism has the potential to harbor ESBL genes; however, they are most prevalent in Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis [12, 13]. Recommendation: Ertapenem, meropenem, imipenem-cilastatin, ciprofloxacin, levofloxacin, or trimethoprim-sulfamethoxazole are preferred treatment options for pyelonephritis and cUTIs caused by ESBL-E. These agents are associated with improved clinical outcomes and reduced toxicity compared to other regimens commonly used to treat CRE infections, which are generally polymyxin-based [59-63]. Antimicrob Agents Chemother, Kulengowski B, Burgess DS. Rationale: A carbapenem is recommended as first-line treatment of infections outside of the urinary tract caused by ESBL-E, based largely on data from a multicenter randomized controlled trial [28]. It is defined by the presence of >250 polymorphonuclear cells (PMN)/mm3 in ascites in the absence of an intra-abdominal source of infection or malignancy. Key recommendations include the following: Nitrofurantoin and trimethoprim-sulfamethoxazole are preferred treatment options for uncomplicated cystitis caused by ESBL Enterobacterales. 2021 May 7;3(2):dlab019. Australian Guidelines for the Prevention and Control of Infection in Healthcare, 2010. Aminoglycosides are almost exclusively eliminated by the renal route in their active form. Table 3 outlines preferred and alternative treatment recommendations for CRE infections. Comparative effectiveness studies between the preferred agents are limited. Significantly less clinical information is available for imipenem-cilastatin-relebactam than for the other preferred treatment options for the treatment of CRE infections. Rationale: Nitrofurantoin and trimethoprim-sulfamethoxazole have been shown to be safe and effective options for cystitis [10, 19, 20]. Estimating the Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in the United States Using Antibiotic Prescription Data. Antimicrob Agents Chemother, Hackel MA, Tsuji M, Yamano Y, Echols R, Karlowsky JA, Sahm DF. Non-guideline … Clinical and Laboratory Standards Institute. Antimicrob Agents Chemother, Shaw E, Rombauts A, Tubau F, et al. 2021 Mar;10(1):621-630. doi: 10.1007/s40121-021-00412-y. Additionally, such guidance documents will not include a formal grading of the evidence, unlike IDSA guidelines, which utilize the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. World Health Organization. Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI). The cost of agents was not considered by the panel. Int J Antimicrob Agents, Rigatto MH, Oliveira MS, Perdigao-Neto LV, et al. These agents are preferably avoided in treatment of ESBL-E cystitis in order to preserve their activity for more invasive infections. Rationale: cUTIs are defined as a UTI occurring in association with a structural or functional abnormality of the genitourinary tract, or any UTI in a male patient. Cost Analysis of New Antibiotics to Treat Multidrug-Resistant Bacterial Infections: Mind the Gap. In patients with intra-abdominal infections, tigecycline and eravacycline are acceptable monotherapy options; high dose tigecycline may be more effective than standard dose tigecycline for complicated intra-abdominal infections, as listed in Table 1 [78-80]. This is because of the presence of the fosA gene intrinsic to P. aeruginosa which confers fosfomycin resistance and because oral fosfomycin does not achieve adequate concentrations in the renal parenchyma [23, 27]. Carbapenems, ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole are all preferred treatment options for patients with ESBL-E pyelonephritis and cUTIs based on clinical experience and the ability of these agents to achieve high concentrations in the urine. JAMA, Gupta K, Hooton TM, Roberts PL, Stamm WE. Meropenem should be avoided if carbapenemase testing is positive, even if susceptibility to meropenem is demonstrated. Rationale: cUTIs are defined as a UTI occurring in association with a structural or functional abnormality of the genitourinary tract, or any UTI in a male patient. Data are insufficient to favor one agent over the others. The Infectious Diseases Society of America's 10 x '20 Initiative (10 New Systemic Antibacterial Agents US Food and Drug Administration Approved by 2020): Is 20 x '20 a Possibility? Infect Drug Resist, Paterson DL, Henderson A, Harris PNA. Caroline Castillo, MD. Curr Infect Dis Rep, Kadri SS, Adjemian J, Lai YL, et al. There are still a few antibiotics that can be used to treat infections caused by ESBL-producing bacteria. Lancet Infect Dis, Satlin MJ. Additionally, important host factors related to immune status, ability to attain source control, and general response to therapy should be considered when determining treatment durations for antimicrobial resistant infections, as with the treatment of any bacterial infection. Lancet Infect Dis, Sims M, Mariyanovski V, McLeroth P, et al. Ceftazidime-avibactam is an alternative treatment for ertapenem-resistant, meropenem-susceptible CRE infections outside of the urinary tract. Deciphering the Evolution of Cephalosporin Resistance to Ceftolozane-Tazobactam in Pseudomonas aeruginosa. ESBLs do not inactivate non-β-lactam agents (e.g., ciprofloxacin, trimethoprim-sulfamethoxazole, gentamicin). Imipenem/relebactam activity compared to other antimicrobials against non-MBL-producing carbapenem-resistant Enterobacteriaceae from an academic medical center. However, for all other infections included here, if antibiotic susceptibility data indicate a potentially inactive agent was initiated empirically, a change to an active regimen for a full treatment course (dated from the start of active therapy) is recommended. The most common carbapenemases in the United States are Klebsiella pneumoniae carbapenemases (KPCs), which can be produced by any Enterobacterales. What is the role of combination antibiotic therapy for the treatment of infections caused by CRE? Clin Infect Dis. Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014-2016: Study for monitoring antimicrobial resistance trend report. Clinical outcomes data comparing these two treatment strategies are not available. They are encountered in US hospitals of all sizes and cause a wide range of serious infections that carry significant morbidity and mortality. Oral fosfomycin should be avoided for DTR-P. aeruginosa pyelonephritis and cUTI. Antimicrob Agents Chemother, Sader HS, Castanheira M, Shortridge D, Mendes RE, Flamm RK. Concerns about the clinical effectiveness of polymyxins and accuracy of in vitro polymyxin susceptibility testing led the Clinical and Laboratory Standards Institute to eliminate a susceptible category for colistin and polymyxin B [18]. Antimicrob Agents Chemother, Biagi M, Wu T, Lee M, Patel S, Butler D, Wenzler E. Searching for the Optimal Treatment for Metallo- and Serine-beta-Lactamase Producing Enterobacteriaceae: Aztreonam in Combination with Ceftazidime-avibactam or Meropenem-vaborbactam. Stein GE. J Clin Microbiol. Oral fosfomycin is an alternative agent exclusively for treatment of ESBL-producing E. coli cystitis as the fosA gene, intrinsic to K. pneumoniae and several other Gram-negative organisms, can hydrolyze the drug and may lead to clinical failure [23, 24]. Infect Dis Ther, Tumbarello M, Trecarichi EM, Corona A, et al. Polymyxin B should not be used as treatment for CRE cystitis, due to its predominantly nonrenal clearance. The Use of Noncarbapenem beta-Lactams for the Treatment of Extended-Spectrum beta-Lactamase Infections. Guidance documents will address specific clinical questions for difficult-to-manage infections that are not covered by present guidelines. People with these infections sometimes need to be hospitalized for treatment with IV antibiotics. Extra-intestinal pathogenic E. coli (ExPEC) infections. This may impact the duration of therapy. Infect Dis Ther. Clin Infect Dis, Gupta K, Hooton TM, Naber KG, et al. Antimicrob Agents Chemother, Pogue JM, Kaye KS, Veve MP, et al. CRE comprise a heterogenous group of pathogens with multiple potential mechanisms of resistance, broadly divided into those that are carbapenemase-producing and those that are not carbapenemase-producing. Languid Uptake of Ceftazidime-Avibactam for Carbapenem-Resistant Gram-Negative Infections and Continued Reliance on Polymyxins. Early experience with meropenem-vaborbactam for treatment of carbapenem-resistant Enterobacteriaceae infections. Significantly less clinical information is available for imipenem-cilastatin-relebactam than for the other preferred treatment options for the treatment of CRE infections. J Antimicrob Chemother, Hobson CA, Bonacorsi S, Fahd M, et al. Recommended antibiotic treatment options for difficult-to-treat (DTR) Pseudomonas aeruginosa, assuming in vitro susceptibility to agents in table. This site needs JavaScript to work properly. Antibacterial Susceptibility Test Interpretive Criteria. Antimicrob Agents Chemother, Castanheira M, Farrell SE, Krause KM, Jones RN, Sader HS. Published by IDSA, 9/8/2020 A Focus on Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa) Veeraraghavan B, Jesudason MR, Prakasah JAJ, Anandan S, Sahni RD, Pragasam AK, Bakthavatchalam YD, Selvakumar RJ, Dhole TN, Rodrigues C, Roy I, Joshi S, Chaudhuri BN, Chitnis DS. Epub 2021 Feb 13. This is likely because ceftolozane does not rely on an inhibitor to restore susceptibility to an otherwise inactive drug (i.e., ceftolozane has independent activity against DTR-P. aeruginosa). Bactericidal Properties of Rod-, Peanut-, and Star-Shaped Gold Nanoparticles Coated with Ceragenin CSA-131 against Multidrug-Resistant Bacterial Strains. Treatment of multidrug-resistant Gram-negative infections in children. Clin Infect Dis. M100 Performance Standards for Antimicrobial Susceptibility Testing. J Clin Microbiol, Guh AY, Bulens SN, Mu Y, et al. Although a clinical trial demonstrated increased mortality with cefiderocol compared to best available therapy against a variety of infections due to carbapenem-resistant Gram-negative bacteria, these findings do not appear to extend to urinary tract infections [54, 56]. Antimicrob Agents Chemother, Tuon FF, Rigatto MH, Lopes CK, Kamei LK, Rocha JL, Zavascki AP. C.C served on the advisory board for Merck, Qpex Biopharma, Shionogi; serves as an advisory Board member for Astellas, Cidara, Scynexis; Consultant for Needham & Associates; receives research funding paid to his institution from NIH, Veteran’s Administration, Astellas and Merck. Antimicrobial multidrug resistance in the era of COVID-19: a forgotten plight. September 25, 2020. Antibiotic Resistance Threats in the United States, 2019. Comparison of five commonly used automated susceptibility testing methods for accuracy in the China Antimicrobial Resistance Surveillance System (CARSS) hospitals. They reached consensus on the recommendations for each question based on extensive review of the published literature, coupled with clinical experience. Cefepime therapy for monomicrobial bacteremia caused by cefepime-susceptible extended-spectrum beta-lactamase-producing Enterobacteriaceae: MIC matters. by IDSA, This guidance document is current as of 17 September 2020. Antimicrob Agents Chemother, Robberts FJ, Kohner PC, Patel R. Unreliable extended-spectrum beta-lactamase detection in the presence of plasmid-mediated AmpC in Escherichia coli clinical isolates. For this guidance document, ESBL-E will refer to presumed or confirmed ESBL-producing E. coli, K. pneumoniae, K. oxytoca, or P. mirabilis. J Travel Med, Bush K, Bradford PA. A single dose of an aminoglycoside is also a preferred treatment option. Time-kill study showed that these antibiotics (flomoxef 8 mg/L and meropenem 4 mg/L) each acted actively against and inhibited the regrowth of the tested ESBL-KP for at least 24 h. Antimicrob Agents Chemother, Shields RK, Chen L, Cheng S, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Results: JAMA, Portsmouth S, van Veenhuyzen D, Echols R, et al. Randomized trial data comparing ceftolozane-tazobactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam as monotherapy and as a component of combination therapy are not available (e.g., ceftazidime-avibactam versus ceftazidime-avibactam and amikacin). IDSA – Guidance on the Treatment of ESBL Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and P aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). CTX-M enzymes, particularly CTX-M-15, are the most common ESBLs in the United States [13]. Clin Infect Dis, Chopra T, Marchaim D, Veltman J, et al. Recommendation: A carbapenem is preferred for the treatment of infections outside of the urinary tract caused by ESBL-E. Antimicrob Agents Chemother, Carvalhaes CG, Castanheira M, Sader HS, Flamm RK, Shortridge D. Antimicrobial activity of ceftolozane-tazobactam tested against gram-negative contemporary (2015-2017) isolates from hospitalized patients with pneumonia in US medical centers. Amoxicillin-clavulanate is an alternative rather than preferred agent since randomized controlled trial data have shown it is associated with a higher clinical failure rate than ciprofloxacin for cystitis, presumably due to persistent vaginal bacterial colonization [21]. Available at: U.S. Food and Drug Administration. An observational study including 131 patients with CRE infections found no difference in clinical outcomes between patients treated with ceftazidime-avibactam or meropenem-vaborbactam [64]. Meropenem-vaborbactam and imipenem-cilastatin-relebactam have limited to no activity against CRE producing OXA-48-like enzymes. Int J Antimicrob Agents, Tamma PD, Cosgrove SE, Maragakis LL. Assessing the Efficacy and Safety of Eravacycline vs Ertapenem in Complicated Intra-abdominal Infections in the Investigating Gram-Negative Infections Treated With Eravacycline (IGNITE 1) Trial: A Randomized Clinical Trial. Mortality or reinfection by the same ESBL-EB at 30 days was 8,6% in the short treatment group and 10% in the long treatment group, without significant differences (P = 0,8). To nitrofurantoin, macrocrystalline capsule [ package insert ] assume in vitro susceptibility to in... Hospitalized for treatment of acute kidney injury with intravenous colistimethate sodium compared with B. Ceftazidime-Avibactam and Identification of new Search results unable to load your delegates due to NDM-1-Producing Morganella morganii with and! As well as enable social media functionality, Marini RV, et al document will address clinical. Charurat ME, Karageorgopoulos de, Dimopoulos G. clinical significance of the fos a gene, can... 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