Treatment outcome of ceftriaxone resistant, Escherichia-coli and Klebsiella spp. bacteremia comparing carbapenem and Beta-lactam/ Beta-lactamase inhibiters in a tertiary care Hospital
DOI:
https://doi.org/10.61529/idjp.v34i2.359Abstract
Background: Carbapenem are recommended for the treatment of Ceftriaxone (CRO) resistant Enterobacterales, however, there are concerns of cost and resistance. Our aim is to compare the outcome of CRO resistant E-coli and Klebsiella bacteremia between Carbapenem and Beta-lactam/beta-lactamase inhibitors (BL/BLI).
Material and Methods: This was a prospective cohort study conducted at Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan from October 2021 to June 2022. All adult patients with E coli or Klebsiella spp. bacteremia, CRO resistant and sensitive to both BL/BLI and Carbapenem were included. The patients were divided into BL/BLI and Carbapenem groups. Demographics, clinical features, comorbidities, laboratory parameters and intensive care unit stay were compared. Outcomes were bacteriological clearance, clinical success and all-cause mortality at day 14 of bacteremia.
Results: A total of 156 patients, 93(59.6%) in BL/BLI and 63(40.0%) in Carbapenem group were included. There was no difference in co-morbidities, risk factors and severity of disease. The 14-day all-cause mortality was 14.1%. No statistically significant difference was found between BL/BLI and Carbapenem group regarding bacteriological clearance (p=0.27) and mortality (p=0.95). The Carbapenem group had less clinical success rate (69.8% vs 82.8%, p=0.057), however not statistically significant.
Conclusion: BL/BLIs were as effective as Carbapenem in microbiological clearance, clinical success and mortality in CRO resistant E-coli and Klebsiella bacteremia.
Keywords: Bacteremia, Ceftriaxone, Carbapenem, Mortality
References
Bhalodi AA, Magnano P, Humphries RM. Performance of ceftriaxone susceptibility testing on the Accelerate Pheno® system of ESBL-producing isolates. Diagn Microbiol Infect Dis. 2020; 98: 115171. DOI: https://doi.org/10.1016/j.diagmicrobio.2020.115171
Kang C-I, Kim S-H, Park WB, Lee K-D, Kim H-B, Kim E-C, et al. Bloodstream infections due to extended-spectrum β-lactamase-producing Escherichia coli and klebsiella pneumoniae: Risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother. 2004; 48: 4574–81.
DOI: https://doi.org/10.1128/AAC.48.12.4574-4581.2004
Rawat D, Nair D (2010) Extended-spectrum ß-lactamases in gram negative bacteria. J Global Infect Dis 2: 263.
Pitout JD, Laupland KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: An emerging public-health concern. Lancet Infect Dis. 2008; 8: 159–66. DOI: https://doi.org/10.1016/s1473-3099(08)70041-0
Vardakas KZ, Tansarli GS, Rafailidis PI, Falagas ME. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis. J Antimicrob Chemother. 2012; 67 (12): 2793-803. DOI: https://doi.org/10.1093/jac/dks301
Harris PNA, Tambyah PA, Lye DC, Mo Y, Lee TH, et al. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: A randomized clinical trial. JAMA. 2018; 320: 984-94. DOI: https://doi.org/10.1001/jama.2018.12163
McLaughlin M, Advincula MR, Malczynski M, Qi C, Bolon M, Scheetz MH. Correlations of antibiotic use and carbapenem resistance in Enterobacteriaceae. Antimicrob Agents Chemother. 2013; 57 (10): 5131–3.
DOI: https://doi.org/10.1128/aac.00607-13
Rodríguez-Baño J, Navarro MD, Retamar P, Picón E, Pascual Á; Extended-Spectrum Beta-Lactamases–Red Española de Investigación en Patología Infecciosa/Grupo de Estudio de Infección Hospitalaria Group. β-Lactam/β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts. Clin Infect Dis. 2012; 54(2): 167-74.
DOI: https://doi.org/10.1093/cid/cir790
Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrobial Resistance & Infection Control. 2018; 7: 1-1. DOI: https://doi.org/10.1186/s13756-018-0309-1
Pakistan Antimicrobial Resistance Network. 2024. Available: https://parn.org.pk/
Nasir N, Ahmed S, Razi S, Awan S, Mahmood SF. Risk factors for mortality of patients with ceftriaxone resistant E. coli bacteremia receiving carbapenem versus beta lactam/beta lactamase inhibitor therapy. BMC Res Notes. 2019; 12 (1): 611. DOI: https://doi.org/10.1186/s13104-019-4648-7
James S. Lewis II, PharmD, FIDSA (n.d.) Performance Standards for Antimicrobial Susceptibility Testing, 34th Edition. Available: CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 34th ed. CLSI supplement M100. Clinical and Laboratory Standards Institute; 2024. Available from: https://www.darvashco.com/wp-content/uploads/2024/07/CLSI-2024_compressed-1.pdf
Akhtar J, Saleem S, Shahzad N, Waheed A, Jameel I, Rasheed F, Jahan S. Prevalence of metallo-β-lactamase imp and vim producing gram negative bacteria in different hospitals of Lahore, Pakistan. 2018. Pak J Zoology; 50 (6): 2343-9. Available from: http://researcherslinks.com/current-issues/Prevalence-of-Metallo-Lactamase-IMP/20/1/1755/html.
Sfeir MM, Askin G, Christos P. Beta-lactam/beta-lactamase inhibitors versus carbapenem for bloodstream infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: systematic review and meta-analysis. Int J Antimicrob Agents. 2018; 52: 554–70. DOI: https://doi.org/10.1016/j.ijantimicag.2018.07.021
Rodríguez-Baño J, Gutiérrez-Gutiérrez B, Pascual A. CON: Carbapenems are NOT necessary for all infections caused by ceftriaxone-resistant Enterobacterales. JAC Antimicrob Resist. 2021; 3: dlaa112. DOI: https://doi.org/10.1093/jacamr/dlaa112
Zhang H, Xu J, Xiao Q, Wang Y, Wang J, Zhu M, Cai Y. Carbapenem-sparing beta-lactam/beta-lactamase inhibitors versus carbapenems for bloodstream infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: A systematic review and meta-analysis. Int J Infect Dis. 2023: 128; 194–204. DOI: https://doi.org/10.1016/j.ijid.2023.01.001
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Shaista Faiz, beena Rani, Sunil Kumar Dodani, Dr Zaheer Udin Babar, Maryam Mushtaq, sanjay badlani, asma nasim
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
