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Ceftaroline fosamil monotherapy for methicillin-resistant Staphylococcus aureus bacteremia (MRSAB): A comparative clinical outcomes study.

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Ceftaroline fosamil monotherapy for methicillin-resistant Staphylococcus aureus bacteremia (MRSAB): A comparative clinical outcomes study.

Int J Infect Dis. 2017 Jan 25;:

Authors: Arshad S, Huang V, Hartman P, Perri MB, Moreno D, Zervos MJ

Abstract
OBJECTIVES: Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia; however, it has been scrutinized due to failure in severe infections. Ceftaroline fosamil (CPT-F) is approved for MRSA acute bacterial skin and skin structure infection (ABSSSI) but not in bloodstream infections. We evaluated clinical outcomes of treatment with CPT-F in patients with MRSA bacteremia (MRSAB).
METHODS: Patients diagnosed with MRSAB at Henry Ford Hospital in Detroit, MI due to isolates with vancomycin MIC≥1.0mg/L, and susceptible in vitro to CPT-F were systematically reviewed retrospectively. CPT-F-treated patients were matched with vancomycin- and daptomycin-treated patients based on age (≥65years), ICU status, and severity of illness. Outcomes evaluated included duration of hospitalization, duration of therapy, adverse events, relapse, hospital readmission, and death.
RESULTS: 30 consecutive cases of MRSAB treated with CPT-F were identified from May 2011 – June 2013, and matched to 56 vancomycin and 46 daptomycin MRSAB patients. Primary sources of CPT-F-treated MRSAB cohort were endocarditis (n=7, 23%), skin/wound (n=9, 30%), and bone/joint (n=8, 27%). Origin of CPT-F-treated MRSAB was 43% community-acquired, 43% healthcare-associated, and 13% hospital- acquired. Mean hospital length of stay for CPT-F pts was 22 days. Overall 30-day mortality rate was observed in 13% (n=4) of CPT-F cases versus 24% (n=11) of daptomycin pts and 11% (n=6) in the vancomycin cohort (p=0.188).
CONCLUSIONS: Ceftaroline fosamil demonstrated comparable clinical outcomes in MRSAB patients compared with the other agents, especially as salvage therapy.

PMID: 28131729 [PubMed – as supplied by publisher]

How should we respond to the emergence of plasmid-mediated colistin-resistance in humans and animals?

How should we respond to the emergence of plasmid-mediated colistin-resistance in humans and animals?

Int J Infect Dis. 2016 Nov 30;:

Authors: Al-Tawfiq JA, Laxminarayan R, Mendelson M

Abstract
OBJECTIVE: The widespread use of antibiotics in humans and animals contributes to growing rates of antibiotic resistance. Previously treatable bacterial infections now require the last line of antibiotics or are untreatable. For carbapenem-resistant, Gram-negative bacterial infections the antibiotic of last resort is now often colistin. In this review, we present the evidence for the shifting pattern of colistin resistance and discuss how the international community should respond.
METHODS: This is a literature review of colistin resistance.
RESULTS: The first documentation of plasmid-mediated colistin resistance encoded by mcr-1 in China during routine surveillance of food animals has been followed by similar reports across a wide geographic spectrum, in humans, animals and the environment. The mcr-1 gene has been reported among human isolates in 29 countries, environmental surfaces in 4 countries and from food animals and other animals in 28 countries and more recently, a second gene encoding resistance, mcr-2 was isolated from porcine and bovine Escherichia coli.
CONCLUSION: The emergence and horizontal transmission of colistin resistance highlights the need for heightened stewardship efforts across the One Health platform for this antibiotic of last resort, and indeed for all antibiotics used in animals and humans.

PMID: 27915108 [PubMed – as supplied by publisher]

Clostridium tertium in Neutropenic Patients: Case Series at a Cancer Institute.

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Clostridium tertium in Neutropenic Patients: Case Series at a Cancer Institute.

Int J Infect Dis. 2016 Aug 26;

Authors: Shah S, Hankenson J, Pabbathi S, Greene J, Nanjappa S

Abstract
OBJECTIVE: Clostridium tertium is considered an uncommon pathogen in humans, but is a cause of bacteremia in patients with underlying hematologic malignancy and neutropenia. We present a case series highlighting our 10 year experience at a NCI designated cancer center of C. tertium as a cause of bacteremia in this population.
METHODS: Institutional review board approval was obtained prior to the start of the study. We reviewed all cases of C. tertium bacteremia at H. Lee Moffitt Cancer Center and Research Institute from 2005 to 2015. The study population was identified by positive blood cultures obtained from the microbiology laboratory over the same period of time.
RESULTS: Seven patients were found to have C. tertium bacteremia, with a temperature of>101°F at the time of diagnosis and severe neutropenia. All patients had a history of hematologic malignancy, five having AML and two having MDS. All of the patient’s blood cultures cleared within ≤ 3 days of antibiotic therapy.
CONCLUSIONS: The unusual susceptibility pattern of C. tertium, with resistance to beta-lactams and clindamycin, likely explains its presence in immunosuppressed patients. Vancomycin remains the drug of choice. The pathogen continues to have a low virulence and a low mortality when treated appropriately.

PMID: 27575937 [PubMed – as supplied by publisher]

Antimicrobial activity against a global collection of skin and skin structure pathogens: Results from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.), 2010-2014.

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Antimicrobial activity against a global collection of skin and skin structure pathogens: Results from the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.), 2010-2014.

Int J Infect Dis. 2016 Jun 22;

Authors: Tärnberg M, Nilsson LE, Dowzicky MJ

Abstract
BACKGROUND: As part of the Tigecycline Evaluation and Surveillance Trial we report antimicrobial resistance among Gram-positive and Gram-negative isolates collected globally from integumentary sources between 2010 and 2014.
METHODS: Minimum inhibitory concentrations and antimicrobial resistance were determined according to Clinical and Laboratory Standards Institute guidelines (US Food and Drug Administration breakpoints against tigecycline). The Cochran Armitage Trend Test was used to identify statistically significant changes in resistance.
RESULTS: Global rates of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii were 38% and 43% respectively. No S. aureus isolates were resistant to linezolid or vancomycin; all isolates were susceptible to tigecycline. 2% of Enterococcus faecalis and 28% of Enterococcus faecium were vancomycin-resistant. Extended-spectrum β-lactamase (ESBL) producers accounted for 22% of Klebsiella pneumoniae and 16% of Escherichia coli. Resistance to minocycline among E. faecalis, E. faecium, K. pneumoniae and E. coli decreased significantly (p<0.0001). There were significant increases (p<0.0001) in A. baumannii resistance to cefepime, ceftazidime, ceftriaxone, levofloxacin, meropenem and piperacillin-tazobactam.
CONCLUSIONS: Among isolates from integumentary sources rates of MRSA and ESBL-producing Enterobacteriaceae are stabilizing. Carbapenems and tigecycline retained their in vitro activity against Gram-positive and Gram-negative organisms. Few agents were active against A. baumannii; its increasing resistance is cause for concern.

PMID: 27343986 [PubMed – as supplied by publisher]