Abstract
There is a lack of consensus regarding management of infections with carbapenem- resistant Gram-negative (CR-GN) pathogens. This study comprised a medical chart review to assess patient management in a high CR prevalence setting. Data was collated retrospectively from medical records of patients hospitalized between November 1st, 2015 and October 31st, 2016. Of 29 patients, 66% had respiratory tract infections. Median duration of hospitalization was 28 days and ~50% of patients were admitted to the intensive care unit, with 77% remaining for >2 weeks. Median time to obtain respiratory culture results was 5 days. Isolation of patients with diagnosed CR-GN infection took ≥5 days in >50% of patients. A majority (76%) of patients received ≥1 antibiotic before providing a specimen for culture; a total of 17 antibiotic treatments were used. Overall, 72% of patients, and 68% of those with respiratory infections, were discharged alive; 38% were discharged without further antibiotics. The difficulties in achieving effective management in patients with CR-GN infections are largely due to complex co-morbidities, a history of prior antibiotic treatment, and multiple referrals across health care facilities.
Highlights
Guido Granata,1 Davide Manissero,2,3 Maria Vittoria Oppia,4 Keiko Tone,2 Bin Cai,5 Christopher Longshaw,2 Carolina Venditti,6 Nicola Petrosillo7Antibiotic resistance is a critical public health concern, influencing survival of a range of bacterial pathogens.1,2 Carbapenemresistant Gram-negative (CR-GN) pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are consideredKey words: Antibiotic resistance, carbapenem resistance, multi-drug resistance, Gram-negative bacteria, clinical management
UK; 3University College of London, Institute for Global Health, London, ly UK; 4Shionogi Srl, Rome, Italy; n 5Shionogi Inc., Florham Park, NJ, USA; o 6Microbiology Unit, National Institute for Infectious Diseases Lazzaro e Spallanzani, IRCCS, Rome, Italy; s 7Clinical and Research Department, u National Institute for Infectious Diseases l Lazzaro Spallanzani, Scientific Institute for Treatment and Inpatient Care, ia Rome, Italy erc Abstract m There is a lack of consensus regarding m management of infections with carbapenem-resistant Gram-negative (CR-GN)
Median duration of hospitalization was 28 days and ~50% of patients were admitted to the intensive care unit, with 77% remaining for >2 weeks
Summary
Guido Granata,1 Davide Manissero,2,3 Maria Vittoria Oppia,4 Keiko Tone,2 Bin Cai,5 Christopher Longshaw,2 Carolina Venditti,6 Nicola Petrosillo7Antibiotic resistance is a critical public health concern, influencing survival of a range of bacterial pathogens.1,2 Carbapenemresistant Gram-negative (CR-GN) pathogens including Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are considered. UK; 3University College of London, Institute for Global Health, London, ly UK; 4Shionogi Srl, Rome, Italy; n 5Shionogi Inc., Florham Park, NJ, USA; o 6Microbiology Unit, National Institute for Infectious Diseases Lazzaro e Spallanzani, IRCCS, Rome, Italy; s 7Clinical and Research Department, u National Institute for Infectious Diseases l Lazzaro Spallanzani, Scientific Institute for Treatment and Inpatient Care, ia Rome, Italy erc Abstract m There is a lack of consensus regarding m management of infections with carbapenem-resistant Gram-negative (CR-GN)
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