Available Abx by Pathogen - UTI

 
Pathogen Available Antibiotocs Citation
Acinetobacter Baumannii Imipenem, Meropenem, Ampicillin/Sulbactam (note: sulbactam is the active component), Tigecycline "Falagas ME, Vardakas KZ, Roussos NS: Trimethoprim/sulfamethoxazole for Acinetobacter spp.: A review of current microbiological and clinical evidence. Int J Antimicrob Agents May 15,[PMID:26070662]
Comment: Although isolates not commonly susceptible to TMP/SMX, occasionally there is ability and this review gives the successful reports.
Durante-Mangoni E, Utili R, Zarrilli R: Combination therapy in severe Acinetobacter baumannii infections: an update on the evidence to date. Future Microbiol 9:773, 2014,[PMID:25046524]
Comment: Authors suggest that combination therapy should be considered in resistant, severe infection with A. baumanii and include a review of the literature. Small studies have suggested colistin + glycopeptide were more efficacious with lower mortality if given for at least 5d.,Queenan AM et al: Assessment of the combination of doripenem plus a fluoroquinolone against non-susceptible Acinetobacter baumannii isolates from nosocomial pneumonia patients. J Chemother 25:141, 2013,[PMID:23783138]
Comment: Conclusion showed doripenem/levofloxacin show possible clinical utility.
Rating: Important
Durante-Mangoni E et al: Colistin and Rifampicin Compared With Colistin Alone for the Treatment of Serious Infections Due to Extensively Drug-Resistant Acinetobacter baumannii: A Multicenter, Randomized Clinical Trial. Clin Infect Dis 57:349, 2013,[PMID:23616495]
Comment: The 30 day mortality was not different between the two groups.
Rating: Important
Lee NY et al: Carbapenem therapy for bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli or Klebsiella pneumoniae: implications of ertapenem susceptibility. Antimicrob Agents Chemother 56:2888, 2012,[PMID:22430969]
Comment: Preferred agents for ESBL producing Enterobacteraceae -- imipenem, meropenem or ertapenem.
Rating: Important
Esterly JS et al: Impact of carbapenem resistance and receipt of active antimicrobial therapy on clinical outcomes of Acinetobacter baumannii bloodstream infections. Antimicrob Agents Chemother 55:4844, 2011,[PMID:21825287]
Comment: Retrospective review of 79 patients with A. baumannii bacteremia including 37 with carapenem-resistant strains. Those with resistant strains did not have a higher mortality rate or longer time to becoming afebrile. Survival favored rceipt of an active drug (94% vs. 74%); survival was reduced with use of colistin.
Rating: Important
Davies TA et al: Longitudinal survey of carbapenem resistance and resistance mechanisms in Enterobacteriaceae and non-fermenters from the USA in 2007-09. J Antimicrob Chemother 66:2298, 2011,[PMID:21775338]
Comment: Findings are based on sensitivity tests of 994 strains of A. baumannii from US 2007-09. This showed doripenem sensitivity was 63%, significantly lower than imipenem and meropenem. The most common A. baumannii resistance mechanism was the OXA-23/24 carbapenemases. Metallo-beta-lactamases were found < 0.1%.
Rating: Important
Baldry S: Attack of the clones. Nat Rev Microbiol 8:, 2010,[PMID:20467444]
Comment: Whole gene sequencing was used to show geographic dissemination of A. baumannii from military casualties in Iraq.,Rating: Important
Bishburg E, Bishburg K: Minocycline--an old drug for a new century: emphasis on methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii. Int J Antimicrob Agents 34:395, 2009,[PMID:19665876]
Comment: Review of minocycline for Acinetobacter -- the drug is old, cheap, IV or po and the best in class for MRSA and A. baumannii.,Rating: Important
Luyt CE et al: Aerosolized antibiotics to treat ventilator-associated pneumonia. Curr Opin Infect Dis 22:154, 2009,[PMID:19276883]
Comment: Authorities in VAP provide guidance on use of aerosolized colistin.,Rating: Important
Gounden R et al: Safety and effectiveness of colistin compared with tobramycin for multi-drug resistant Acinetobacter baumannii infections. BMC Infect Dis 9:, 2009,[PMID:19272139]
Comment: A retrospective response showing favorable results with colistin in terms of safety and efficacy.,Rating: Important
Tsakris A et al: Clusters of imipenem-resistant Acinetobacter baumannii clones producing different carbapenemases in an intensive care unit. Clin Microbiol Infect 14:588, 2008,[PMID:18397334]
Comment: Report shows A. baumannii clusters with different carbapenemase genes causing severe infections.,Sebeny PJ, Riddle MS, Petersen K: Acinetobacter baumannii skin and soft-tissue infection associated with war trauma. Clin Infect Dis 47:444, 2008,[PMID:18611157]
Comment: Review of war wound infections in Iraq war veterans. Most had cellulitis with ""peau d'orange"" and overlying vesicles that progressed to bullae. Treatment was a carbapenem plus debridement.,Maragakis LL, Perl TM: Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 46:1254, 2008,[PMID:18444865]
Comment: Major ICU pathogen and cause of outbreaks of bacteremia, pneumonia, meningitis UTIs and wound infections. This pathogen survives long periods n a wide range of environmental conditions. Most active drugs are carbapenems, colistin, amikacin and cefepime.,Scheetz MH et al: In vitro activities of various antimicrobials alone and in combination with tigecycline against carbapenem-intermediate or -resistant Acinetobacter baumannii. Antimicrob Agents Chemother 51:1621, 2007,[PMID:17307973]
Comment: A. baumannii strains resistant to carbapenems (n=93) showed 95% were sensitive to tigecycline , and 88% were sensitive to minocycline.,Rating: Important
Grupper M et al: Attributable mortality of nosocomial Acinetobacter bacteremia. Infect Control Hosp Epidemiol 28:293, 2007,[PMID:17326019]
Comment: A case control study of 52 patients with A. baumannii bacteremia showed a mortality rate of 56% and an attributable mortality of 37%.,Falagas ME, Bliziotis IA: Pandrug-resistant Gram-negative bacteria: the dawn of the post-antibiotic era? Int J Antimicrob Agents 29:630, 2007,[PMID:17306965]
Comment: Three bacteria are identified as potentially resistant to all antibiotics including colistin: A. baumannii, P. aeruginosaand K. pneumoniae. Resistance to colistin is now rare.,Hawley JS et al: Susceptibility of acinetobacter strains isolated from deployed U.S. military personnel. Antimicrob Agents Chemother 51:376, 2007,[PMID:17043112]
Comment: Sensitivity tests in 95 strains of A. baumannii in soldiers returning from Iraq show the following rates of sensitivity: colistin 99%, minocycline 97%, imipenem 63%, amikacin 50%, ampicillin-sulbactam 16%, ceftazidime 9%.,Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System: Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 41:848, 2005,[PMID:16107985]
Comment: The NNIS data with 410,000 isolates showed Acinetobacter isolations in ICU pneumonia increased from 4% in 1986 to 7% in 2003.,Rating: Important
Kwa AL et al: Nebulized colistin in the treatment of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis 41:754, 2005,[PMID:16080101]
Comment: 21 patients with pneumonia were given nebulized colistin. Overall clinical and microbiological response rates were 57% and 86% respectively.,Rating: Important
Hiransuthikul N et al: Skin and soft-tissue infections among tsunami survivors in southern Thailand. Clin Infect Dis 41:e93, 2005,[PMID:16231248]
Comment: Review of 641 wound infections in 305 tsunami survivors showed A. calcoaceticus, A. baumannii accounted for 26 (4%). The most common causes were ascribed to Aeromonas (23%) and coliforms (51%).,Davis KA et al: Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg Infect Dis 11:1218, 2005,[PMID:16102310]
Comment: Review of 23 soldiers wounded in Iraq with subsequent wound cultures yielding Acinetobacter: 18 osteomyelitis, 2 burn infections & 3 deep wound infections. All recovered with antibiotic treatment.,Pachón-Ibáñez ME et al: Activity of tigecycline (GAR-936) against Acinetobacter baumannii strains, including those resistant to imipenem. Antimicrob Agents Chemother 48:4479, 2004,[PMID:15504889]
Comment: Of 49 Acinetobacter baumannii isolates, including those resistant to imipenem, 92% were sensitive to tigecycline. This in vitro study suggested that the drug had bacteriostatic rather than bacteriocidal activity.,Higgins PG et al: In vitro activities of the beta-lactamase inhibitors clavulanic acid, sulbactam, and tazobactam alone or in combination with beta-lactams against epidemiologically characterized multidrug-resistant Acinetobacter baumannii strains. Antimicrob Agents Chemother 48:1586, 2004,[PMID:15105109]
Comment: With these agents the enhanced activity is due to intrinsic antimicrobial activity of the beta-lactamase inhibitor and not due to enhanced activity of the beta-lactam. In vitro activity of sulbactam was superior to clavulanate or tazobactam.,Maragakis LL et al: An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA 292:3006, 2004,[PMID:15613669]
Comment: Outbreak included 11 patients who got Acinetobacter infections from a contaminated pulsatile wound debriding device.,Rhomberg PR et al: Antimicrobial resistance rates and clonality results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme: report of year five (2003). Diagn Microbiol Infect Dis 49:273, 2004,[PMID:15313533]
Comment: Results with 2,848 GNB isolates in 2003 shows meropenem/imipenem active vs 96%, cefepime 94%, tobramycin 92%, pip-tazo 90%, ceftazidime 90%. Clonally-based resistance to carbapenems was noted with Klebsiella and Acinetobacter baumannii.,Markou N et al: Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care 7:R78, 2003,[PMID:12974973]
Comment: This is an anecdotal experience with the 26 cases of bacteremia involving GNB resistant to all antibiotics but colistin- 20 P. aeruginosa and 6 A. baumannii. All cases received a second agent despite resistance--usually ceftazidime. The response rate was 73%. Three (14%) developed renal failure.,García-Garmendia JL et al: Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 33:939, 2001,[PMID:11528563]
Comment: Risk factors in 42 cases of A. baumannii bacteremia in ICU & RR: Immunosuppression 3.0, respiratory failure 2.9, prior ICU sepsis 4.4, prior abx 2.4, and invasive procedures 1.8. All are statistically significant.,Urban C et al: Polymyxin B-Resistant Acinetobacter baumannii Clinical Isolate Susceptible to Recombinant BPI and Cecropin P1. Antimicrob Agents Chemother 45:994, 2001,[PMID:16557680]
Comment: This is the first report of resistance by A. baumannii to polymyxin and colistin. The MIC to colistin was 48ug/ml. The other drugs in the title are experimental.,Fierobe L et al: An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 22:35, 2001,[PMID:11198020]
Comment: This report concerns an outbreak of 17 cases of infections involving A. baumannii in a SICU illustrating the potential importance of this organism as a nosocomial pathogen, and the potential problem it poses with antibiotic resistance.,Ling ML et al: A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol 22:48, 2001,[PMID:11198024]
Comment: The authors report an outbreak involving 103 patients in an 8 month period. It was controlled by closing the unit.,Jellison TK, Mckinnon PS, Rybak MJ: Epidemiology, resistance, and outcomes of Acinetobacter baumannii bacteremia treated with imipenem-cilastatin or ampicillin-sulbactam. Pharmacotherapy 21:142, 2001,[PMID:11213849]
Comment: The authors retrospectively review 48 cases of A. baumannii bacteremia at Wayne State seen from 1987 to 1999. Treatment with ampicillin-sulbactam was as effective as treatment with imipenem.,Siau H et al: Acinetobacter bacteremia in Hong Kong: prospective study and review. Clin Infect Dis 28:26, 1999,[PMID:10028065]
Comment: The authors review 18 cases of Acinetobacter bacteremia - 16/18 were A. lwoffi. An intravenous catheter led to infection in 39%.,Jawad A et al: Survival of Acinetobacter baumannii on dry surfaces: comparison of outbreak and sporadic isolates. J Clin Microbiol 36:1938, 1998,[PMID:9650940]
Comment: A. baumannii accounts for most nosocomial outbreaks of Acinetobacter infections. These organisms may survive on dry surfaces for 21-32 days. Outbreak strains tend to be multiply-resistant - resistant to ciprofloxacin, cefotaxime, ceftriaxone, cefepime, aminoglycosides.,Villers D et al: Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 129:182, 1998,[PMID:9696725]
Comment: This review showed the following sites of infection in 45 cases: urine 31%, lung 27%, wounds 18%, blood 11%, CSF 4%. A major risk factor was prior treatment with a fluoroquinolone. The authors conclude A. baumannii is: 1)an important nosocomial pathogen; 2)may cause serious disease primarily in compromised host; 3)may be epidemic or endemic, esp in ICUs; 4)there may be multiply-resistant clones; 5)prior abx, esp fluoroquinolones, may be important risk factor.,Corbella X et al: Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clin Infect Dis 23:329, 1996,[PMID:8842272]
Comment: Fecal flora analysis showed A. baumannii colonization in 77 (41%) of 189 consecutive admissions to an ICU in Barcelona. Of these 77 patients, 25% had clinical infections with this organism compared to 5% of those without fecal colonization. The authors concluded that the GI tract was a major epidemic reservoir.,Lortholary O et al: Nosocomial acquisition of multiresistant Acinetobacter baumannii: risk factors and prognosis. Clin Infect Dis 20:790, 1995,[PMID:7795075]
Comment: Report of 25 cases of meningitis due to Acinetobacter baumannii. Most were patients with indwelling ventriculostomy tubes or CSF fistulae who were receiving antibiotics. There were 3 deaths. The most active antibiotics (active vs >21/25 strains): imipenem, minocycline, ciprofloxacin and amikacin.,Siegman-Igra Y et al: Nosocomial acinetobacter meningitis secondary to invasive procedures: report of 25 cases and review. Clin Infect Dis 17:843, 1993,[PMID:8286623]
Comment: Report of 25 cases of meningitis due to Acinetobacter baumannii. Most were patients with indwelling ventriculostomy tubes or CSF fistulae who were receiving antibiotics. There were 3 deaths. The most active antibiotics (active vs >21/25 strains): imipenem, minocycline, ciprofloxacin and amikacin.,Gradon JD, Chapnick EK, Lutwick LI: Infective endocarditis of a native valve due to Acinetobacter: case report and review. Clin Infect Dis 14:1145, 1992,[PMID:1600019]
Comment: The authors present a case of Acinetobacterendocarditis and review the literature which showed 15 cases of native valve endocarditis and 6 with prosthetic valve infections. The native valve cases tended to be acute, were often associated with a maculopapular rash involving palms and soles and 5/15 (33%) were fatal.,Cefai C et al: An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect 15:177, 1990,[PMID:1969441]"
Citrobacter Freundii Meropenem, Imipenem, Doripenem, Cefepime, Ciprofloxacin, Aminoglycoside, Piperacillin/tazobactam Aztreonam,TMP/SMX Guh AY et al: Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012-2013. JAMA 314:1479, 2015,[PMID:26436831]
Comment: Citrobacter was not identified in this multicenter surveillance.
Harris PN, Ferguson JK: Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides? Int J Antimicrob Agents 40:297, 2012,[PMID:22824371]
Comment: Risk for clinical failure due to inducible AmpC beta-lactamse production appears to be less in species other than Enterobacter. Piperacillin/tazobactam may remain effective and may be less selective for AmpC derepressed mutants than cephalosporins. The potential roles for agents such as cefepime or trimethoprim/sulfamethoxazole are also discussed.,Rimrang B et al: Emergence of NDM-1- and IMP-14a-producing Enterobacteriaceae in Thailand. J Antimicrob Chemother 67:2626, 2012,[PMID:22796889]
Comment: One of a number of studies finding the highly resistant mechanism NDM-1 in Citrobacter, which no doubt may greatly expand over time.
Livermore DM et al: What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents 37:415, 2011,[PMID:21429716]
Comment: Among resistant GNB including citrobacter spp with highly resistant profiles, colistin had greatest sensitivity (92.6%), fosfomycin (60.5%), tigecycline (49%).,Poirel L et al: Extremely drug-resistant Citrobacter freundii isolate producing NDM-1 and other carbapenemases identified in a patient returning from India. Antimicrob Agents Chemother 55:447, 2011,[PMID:20974865]
Comment: Pt in India returned to France with this highly-resistant isolate. This early description is certainly by no means the last.,Lin SY et al: Abscess caused by Citrobacter koseri infection: three case reports and a literature review. Intern Med 50:1333, 2011,[PMID:21673472]
Comment: Small series and review of abscesses caused by C. koseri. All patients responded to drainage and antibiotic therapy.
Cohen Stuart J, Leverstein-Van Hall MA, Dutch Working Party on the Detection of Highly Resistant Microorganisms: Guideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae. Int J Antimicrob Agents 36:205, 2010,[PMID:20598859]
Comment: European guidelines regarding identification of KPCs. For all Enterobacteriaceae, the meropenem screening breakpoint to detect carbapenemases is set at ≥ 0.5mg/L or a zone diameter of ≤ 23 mm (10 microg disk loading). For Citrobacter spp., the imipenem screening breakpoint is set at ≥ 2mg/L or a zone diameter ≤ 21 mm. Ertapenem is not advised as an indicator carbapenem as it has a lower specificity compared with imipenem and meropenem. On the first isolate from a patient with a positive carbapenemase screen test, a polymerase chain reaction (PCR)-based test should be performed to detect carbapenemase genes. However, if genotypic confirmation is not immediately available, phenotypic confirmation tests should be performed to avoid delayed reporting of carbapenemase-producers to the clinic. Recommended phenotypic confirmation tests are the modified Hodge test as well as carbapenemase inhibition tests with boronic acid for Ambler class A carbapenemases and with ethylene diamine tetra-acetic acid (EDTA) or dipicolinic acid for metallo-carbapenemases.,Samonis G et al: Citrobacter infections in a general hospital: characteristics and outcomes. Eur J Clin Microbiol Infect Dis 28:61, 2009,[PMID:18682995]
Comment: Study from Greece between the years 1994-- 2006. Seventy-eight patients (70 adults) with Citrobacter spp. isolates found C. freundii most commonly (71.8%), followed by C. koseri (23.1%) and C. braakii (3.8%). Infectious syndromes seen: UTI (52.6%), intra-abdominal (14.1%), surgical site (7.7%), skin and soft tissue (6.4%), and respiratory tract infections (6.4%). Antibiograms of 38 consecutive Citrobacter spp. isolates (29 C. freundii) were available. Most active agents were colistin (100%), fosfomycin (100%), imipenem (97.4%), gentamicin (89.5%), nitrofurantoin (89.5%), ciprofloxacin (80.6%), and cefepime (73.7%). Most patients (82.1%) had at least one underlying illness. Combination antimicrobial therapy was administered in 28.2% of cases. One patient died during hospitalization. The length of hospital stay was longer in patients with polymicrobial compared to monomicrobial infections (23 versus 13 days, respectively, p = 0.02). The isolation of Citrobacter species, although rather infrequent, was clinically relevant in the great majority of cases.,Pillar CM et al: In vitro activity profile of ceftobiprole, an anti-MRSA cephalosporin, against recent gram-positive and gram-negative isolates of European origin. J Antimicrob Chemother 61:595, 2008,[PMID:18218646]
Comment: Ceftobiprole had generally lower MIC50's (similar to cefepime) against Citrobacter spp. compared to other cephalosporins such as ceftazidime, ceftriaxone, etc [MIC90s: ceftazidime-susceptible, 0.12 mg/L; non-susceptible, >32 mg/L),]. Overall, drug performed with slightly higher MIC90's compared to cefepime if being screened against non-derepressed AmpC isolates.
Enterobacter aerogenes Piperacillin/Tazobactam, Imipenem, Meropenem, Doripenem, Meropenem, Amikacin, Colistin, Tigecycline, Ceftazidime/Avibactam, Ciprofloxacin, Nitrofurantoin (Macrobid)Fosfomycin,Ertapenem http://www.eucast.org… of 1/1/17, accessed 1/27/17.
Comment: MIC breakpoints for Enterobacteriaceae for cefepime ≤ 1 mg/L; ceftaroline ≤ 0.5 mg/L; doripenem ≤ 1 mg/L; ertapenem ≤ 0.5 mg/L; imipenem ≤ 2 mg/L; and meropenem ≤ 2 mg/L. The EUCAST document details that the breakpoints are set to detect clinically important resistance regardless of resistance mechanism, i.e., carbapenemase production. Ceftaroline is FDA-approved for complicated skin and skin-structure infections and community-acquired pneumonia. For Enterobacteriaceae ‹ 0.5 mcg/mL (FDA) and ‹ 1 mcg/mL (manufacturer).
Centers for Disease Control. Facility Guidance for Control of Carbapenem-Resistant Enterobacteriaceae. November 2015 Update. https://www.cdc.gov…
Comment: CDC update includes modification of CRE surveillance definition: resistant to any carbapenem antimicrobial (i.e., MIC ≥4 mcg/ml for doripenem, meropenem, or imipenem OR ≥2 mcg/ml for ertapenem OR documentation of carbapenemase production. For bacteria that have intrinsic imipenem nonsusceptibility (i.e., Morganella morganii, Proteus spp., Providencia spp.), resistance to carbapenems other than imipenem is required. At present, acceptable tests for detecting carbapenemases include PCR, MHT, Carba NP, and metallo-β-lactamase testing (e.g., MBL tests or screens). Accessed 1/30/2017.
CLSI. Performance Standards for antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
Comment: 27th edition published by CLSI can be accessed at www.em100.edaptivedocs.info (accessed 1/31/17).
Enterobacter Cloacae Ciprofloxacin, Nitrofuranation, Fosfomycin, Ertapenem http://www.eucast.org… of 1/1/17, accessed 1/27/17.
Comment: MIC breakpoints for Enterobacteriaceae for cefepime ≤ 1 mg/L; ceftaroline ≤ 0.5 mg/L; doripenem ≤ 1 mg/L; ertapenem ≤ 0.5 mg/L; imipenem ≤ 2 mg/L; and meropenem ≤ 2 mg/L. The EUCAST document details that the breakpoints are set to detect clinically important resistance regardless of resistance mechanism, i.e., carbapenemase production. Ceftaroline is FDA-approved for complicated skin and skin-structure infections and community-acquired pneumonia. For Enterobacteriaceae ‹ 0.5 mcg/mL (FDA) and ‹ 1 mcg/mL (manufacturer).
Centers for Disease Control. Facility Guidance for Control of Carbapenem-Resistant Enterobacteriaceae. November 2015 Update. https://www.cdc.gov…
Comment: CDC update includes modification of CRE surveillance definition: resistant to any carbapenem antimicrobial (i.e., MIC ≥4 mcg/ml for doripenem, meropenem, or imipenem OR ≥2 mcg/ml for ertapenem OR documentation of carbapenemase production. For bacteria that have intrinsic imipenem nonsusceptibility (i.e., Morganella morganii, Proteus spp., Providencia spp.), resistance to carbapenems other than imipenem is required. At present, acceptable tests for detecting carbapenemases include PCR, MHT, Carba NP, and metallo-β-lactamase testing (e.g., MBL tests or screens). Accessed 1/30/2017.
CLSI. Performance Standards for antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
Comment: 27th edition published by CLSI can be accessed at www.em100.edaptivedocs.info (accessed 1/31/17).
Enterococcus Faecalis "Penicillin, Ampicillin, Vancomycin IV, Amoxicillin, Nitrofurantoin, Nitrofurantoin-macrocrystals, Telavancin" "Baddour LM et al: Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 132:1435, 2015,[PMID:26373316]
Comment: Updated AMA guidelines state that in enterococci strains resistant to vancomycin, aminoglycosides and penicillin, testing for susceptibility to daptomycin and linezolid should be obtained. Double-beta-lactam therapy, ampicillin+ ceftriaxone, is endorsed for E. faecalis IE caused by gentamicin-susceptible or high-level gentamicin-resistant strains (Tables 12 and 13).
For multi-drug resistant strains (E. faecium, 95%; and E. faecalis, 3%) with vancomycin MIC >4 µg/ml, data supporting the use of linezolid and daptomycin are reviewed.
Habib G et al: 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36:3075, 2015,[PMID:26320109]
Comment: European Society of Cardiology guidelines endorses ampicillin + ceftriaxone as combination of choice for high-level aminoglycoside resistant E. faecalis.
Specific recommendation listed in Table 18 include:
High-level resistance to gentamicin (MIC .500 mg/L): if susceptible to streptomycin, replace gentamicin with streptomycin 15 mg/kg/day in two equally divided doses.
Beta-lactam resistance: (i) if due to beta-lactamase production, replace ampicillin with ampicillin–sulbactam or amoxicillin with amoxicillin–clavulanate; (ii) if due to PBP5 alteration, use vancomycin-based regimens.
Multiresistance to aminoglycosides, beta-lactams and vancomycin: suggested alternatives are (i) daptomycin 10 mg/kg/day plus ampicillin 200 mg/kg/day in 4-6 doses; (ii) linezolid 600 mg twice daily for ≥ 8 weeks (monitor haematological toxicity); (iii) quinupristin–dalfopristin 7.5 mg/kg IV q8h for ≥8 weeks. Quinupristin– dalfopristin is not active against E. faecalis; (iv) for other combinations (daptomycin plus ertapenem or ceftaroline), consult infectious diseases specialists.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59:e10, 2014,[PMID:24973422]
Comment: Empiric treatment of moderate to severe purulent skin and soft-tissue infections includes incision and drainage and antibiotics. In cases of severe infection (failed I&D plus oral ABX) OR systemic signs of infection (temp > 38’C, HR > 90/min, RR > 24/min, or WBC < 400 or > 12,000 cells/µL, or immunocompromise) empiric ABX includes: vancomycin or daptomycin or linezolid or telavancin or ceftaroline. Accessed 1/9/2017.
Fernández-Hidalgo N et al: Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis 56:1261, 2013,[PMID:23392394]
Comment: Observational, non-randomized study of 291 consecutive adults with E. faecalis IE enrolled from 17 Spanish and 1 Italian hospitals and followed for 3 months from 2005-2011, compared ampicillin 2gm q12h plus gentamicin 3mg/kg/d in 1,2, or 3 divided doses (AG) versus ampicillin plus ceftriaxone (AC). AC-treated pts more often had chronic renal failure, cancer, transplantation, and hospital-acquired infection. No difference between AC and AG-treated pts in mortality on treatment or at 3-months. Of those treated with AG vs AC, 25% vs 1% (p< 0.001) required discontinuation of abx for adverse effects.
Hooton TM et al: Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625, 2010,[PMID:20175247]
Comment: IDSA guidelines for catheter-associated urinary tract infections in heterogenous group of adults requiring short-term (< 30d) and long-term (>=30d) catheterization, intermittant catheterization and condom catheterization.
Mermel LA et al: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49:1, 2009,[PMID:19489710]
Comment: 2009 updated guidelines for treatment of intravascular catheter-related infections. For details regarding E. faecalis and E. faecium, see Table 5. Update in progress, anticipated publication 2017. https://www.idsociety.org/Other_Guidelines/ Accessed 1/9/2017."
Enterococcus Faucium Penicillin, Ampicillin, Vancomycin IV, Amoxicillin, Nitrofurantoin, Nitrofurantoin-macrocrystals, Telavancin "Baddour LM et al: Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 132:1435, 2015,[PMID:26373316]
Comment: Updated AMA guidelines state that in enterococci strains resistant to vancomycin, aminoglycosides and penicillin, testing for susceptibility to daptomycin and linezolid should be obtained. Double-beta-lactam therapy, ampicillin+ ceftriaxone, is endorsed for E. faecalis IE caused by gentamicin-susceptible or high-level gentamicin-resistant strains (Tables 12 and 13).
For multi-drug resistant strains (E. faecium, 95%; and E. faecalis, 3%) with vancomycin MIC >4 µg/ml, data supporting the use of linezolid and daptomycin are reviewed.
Habib G et al: 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36:3075, 2015,[PMID:26320109]
Comment: European Society of Cardiology guidelines endorses ampicillin + ceftriaxone as combination of choice for high-level aminoglycoside resistant E. faecalis.
Specific recommendation listed in Table 18 include:
High-level resistance to gentamicin (MIC .500 mg/L): if susceptible to streptomycin, replace gentamicin with streptomycin 15 mg/kg/day in two equally divided doses.
Beta-lactam resistance: (i) if due to beta-lactamase production, replace ampicillin with ampicillin–sulbactam or amoxicillin with amoxicillin–clavulanate; (ii) if due to PBP5 alteration, use vancomycin-based regimens.
Multiresistance to aminoglycosides, beta-lactams and vancomycin: suggested alternatives are (i) daptomycin 10 mg/kg/day plus ampicillin 200 mg/kg/day in 4-6 doses; (ii) linezolid 600 mg twice daily for ≥ 8 weeks (monitor haematological toxicity); (iii) quinupristin–dalfopristin 7.5 mg/kg IV q8h for ≥8 weeks. Quinupristin– dalfopristin is not active against E. faecalis; (iv) for other combinations (daptomycin plus ertapenem or ceftaroline), consult infectious diseases specialists.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59:e10, 2014,[PMID:24973422]
Comment: Empiric treatment of moderate to severe purulent skin and soft-tissue infections includes incision and drainage and antibiotics. In cases of severe infection (failed I&D plus oral ABX) OR systemic signs of infection (temp > 38’C, HR > 90/min, RR > 24/min, or WBC < 400 or > 12,000 cells/µL, or immunocompromise) empiric ABX includes: vancomycin or daptomycin or linezolid or telavancin or ceftaroline. Accessed 1/9/2017.
Fernández-Hidalgo N et al: Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis 56:1261, 2013,[PMID:23392394]
Comment: Observational, non-randomized study of 291 consecutive adults with E. faecalis IE enrolled from 17 Spanish and 1 Italian hospitals and followed for 3 months from 2005-2011, compared ampicillin 2gm q12h plus gentamicin 3mg/kg/d in 1,2, or 3 divided doses (AG) versus ampicillin plus ceftriaxone (AC). AC-treated pts more often had chronic renal failure, cancer, transplantation, and hospital-acquired infection. No difference between AC and AG-treated pts in mortality on treatment or at 3-months. Of those treated with AG vs AC, 25% vs 1% (p< 0.001) required discontinuation of abx for adverse effects.
Hooton TM et al: Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625, 2010,[PMID:20175247]
Comment: IDSA guidelines for catheter-associated urinary tract infections in heterogenous group of adults requiring short-term (< 30d) and long-term (>=30d) catheterization, intermittant catheterization and condom catheterization.
Mermel LA et al: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49:1, 2009,[PMID:19489710]
Comment: 2009 updated guidelines for treatment of intravascular catheter-related infections. For details regarding E. faecalis and E. faecium, see Table 5. Update in progress, anticipated publication 2017. https://www.idsociety.org/Other_Guidelines/ Accessed 1/9/2017."
Vancomycin-Resistant Enterococci "Baddour LM et al: Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 132:1435, 2015,[PMID:26373316]
Comment: Updated AMA guidelines state that in enterococci strains resistant to vancomycin, aminoglycosides and penicillin, testing for susceptibility to daptomycin and linezolid should be obtained. Double-beta-lactam therapy, ampicillin+ ceftriaxone, is endorsed for E. faecalis IE caused by gentamicin-susceptible or high-level gentamicin-resistant strains (Tables 12 and 13).
For multi-drug resistant strains (E. faecium, 95%; and E. faecalis, 3%) with vancomycin MIC >4 µg/ml, data supporting the use of linezolid and daptomycin are reviewed.
Habib G et al: 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 36:3075, 2015,[PMID:26320109]
Comment: European Society of Cardiology guidelines endorses ampicillin + ceftriaxone as combination of choice for high-level aminoglycoside resistant E. faecalis.
Specific recommendation listed in Table 18 include:
High-level resistance to gentamicin (MIC .500 mg/L): if susceptible to streptomycin, replace gentamicin with streptomycin 15 mg/kg/day in two equally divided doses.
Beta-lactam resistance: (i) if due to beta-lactamase production, replace ampicillin with ampicillin–sulbactam or amoxicillin with amoxicillin–clavulanate; (ii) if due to PBP5 alteration, use vancomycin-based regimens.
Multiresistance to aminoglycosides, beta-lactams and vancomycin: suggested alternatives are (i) daptomycin 10 mg/kg/day plus ampicillin 200 mg/kg/day in 4-6 doses; (ii) linezolid 600 mg twice daily for ≥ 8 weeks (monitor haematological toxicity); (iii) quinupristin–dalfopristin 7.5 mg/kg IV q8h for ≥8 weeks. Quinupristin– dalfopristin is not active against E. faecalis; (iv) for other combinations (daptomycin plus ertapenem or ceftaroline), consult infectious diseases specialists.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59:e10, 2014,[PMID:24973422]
Comment: Empiric treatment of moderate to severe purulent skin and soft-tissue infections includes incision and drainage and antibiotics. In cases of severe infection (failed I&D plus oral ABX) OR systemic signs of infection (temp > 38’C, HR > 90/min, RR > 24/min, or WBC < 400 or > 12,000 cells/µL, or immunocompromise) empiric ABX includes: vancomycin or daptomycin or linezolid or telavancin or ceftaroline. Accessed 1/9/2017.
Fernández-Hidalgo N et al: Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis 56:1261, 2013,[PMID:23392394]
Comment: Observational, non-randomized study of 291 consecutive adults with E. faecalis IE enrolled from 17 Spanish and 1 Italian hospitals and followed for 3 months from 2005-2011, compared ampicillin 2gm q12h plus gentamicin 3mg/kg/d in 1,2, or 3 divided doses (AG) versus ampicillin plus ceftriaxone (AC). AC-treated pts more often had chronic renal failure, cancer, transplantation, and hospital-acquired infection. No difference between AC and AG-treated pts in mortality on treatment or at 3-months. Of those treated with AG vs AC, 25% vs 1% (p< 0.001) required discontinuation of abx for adverse effects.
Hooton TM et al: Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625, 2010,[PMID:20175247]
Comment: IDSA guidelines for catheter-associated urinary tract infections in heterogenous group of adults requiring short-term (< 30d) and long-term (>=30d) catheterization, intermittant catheterization and condom catheterization.
Mermel LA et al: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49:1, 2009,[PMID:19489710]
Comment: 2009 updated guidelines for treatment of intravascular catheter-related infections. For details regarding E. faecalis and E. faecium, see Table 5. Update in progress, anticipated publication 2017. https://www.idsociety.org/Other_Guidelines/ Accessed 1/9/2017."
E. Coli Nitrofurantoin, TMP/SMX, Fosfomycin trometamol, Pivmecillinam, Fluoroquinolone, Levofloxacin, β-lactams "Shane AL et al: 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 65:1963, 2017,[PMID:29194529]
Comment: Guideline addresses primarily STEC diarrhea in terms of E coli, but of course has general management principles including approach to acute diarrhea and other common pathogens causing infectious diarrhea, acute and chronic.
Gupta K 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. Clin Infect Dis 52:e103, 2011,[PMID:21292654]
Comment: Guidelines for the treatment of uncomplicated cystitis have a wide range of options including nitrofurantoin, TMP-SMX, fosfomycin or pivmecillinam (not available in US). If patients have an intolerance or allergies, then fluoroquinolones or beta-lactams can be used. Options for pyelonephritis are also included.
Hooton TM et al: Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 50:625, 2010,[PMID:20175247]
Comment: Criteria for diagnosis of CA-UTI, treatment as well as strategies that have NOT been found to prevent such infections."
MRSA Vancomycin, Trimethoprim/sulfamethoxazole, Linezolid "Baddour LM et al: Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 132:1435, 2015,[PMID:26373316]
Comment: Most recent guidelines addressing S aureus endocarditis.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 59:147, 2014,[PMID:24947530]
Comment: Latest set of guidelines from the Infectious Diseases Society of American, incorporating recommendations for MRSA infections.,Liu C et al: Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52:285, 2011,[PMID:21217178]
Comment: Guidelines looking at the MRSA compendium of diseases with recommendations that also include vancomycin dosing recommendations.
Rybak MJ et al: Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 49:325, 2009,[PMID:19569969]
Comment: New guidelines for vancomycin dosing and monitoring. "
Klebsiella Pneumoniae Fosfomycin, Nitrofurantoin, Levofloxacin, Ciprofloxacin "Kalil AC et al: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63:e61, 2016,[PMID:27418577]
Comment: Clinical guidelines encourage decreased unnecessary use of dual Gram-negative coverage and empiric MRSA treatment by incorporating hospital-based antibiograms, employment of short course treatment duration, and de-escalation of ABX regimens.
van Duin D, Bonomo RA: Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/β-Lactamase Inhibitor Combinations. Clin Infect Dis 63:234, 2016,[PMID:27098166]
Comment: Two new second-generation cephalosporin/beta-lactamase inhibitor combinations are FDA-approved for treatment of complicated intra-abdominal infections (cIAI) and complicated UTIs. For treatment of cIAI, metronidazole is added. Ceftazidime/avibactam has the advantage of inhibition of ESBLs, AmpC beta-lactamases, and class A carbapenemases of KPC family (KPC and OXA-48). Notably, porin loss increases in vitro MIC values of ceftazidime, but not ceftolozane. Both show potent in vitro activity against Pseudomonas spp. However, Acinetobacter and Stenotrophomonas spp. are generally resistant.
Chea N et al: Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae. Emerg Infect Dis 21:1611, 2015,[PMID:26290955]
Comment: Centers for Disease Control (CDC) Emerging Pathogens Program CRE surveillance system evaluated 312 isolates of Enterobacter spp., E. coli., and Klebsiella spp. to refine a phenotype-based CRE definition that differentiated carbapenemase-producing CRE from non-carbapenemase-producing CRE on the basis of antimicrobial susceptibility patterns. The pre-2015 CDC CRE surveillance definition was "nonsusceptibility to imipenem, meropenem, or doripenem, and resistance to all third-generation cephalosporins tested, as determined by using CLSI M100-S23 testing standards." Results identified "resistance to any carbapenem" as the most sensitive (% false negative, 0.7%; % false positive, 55%) and simplest. Recommendations included the addition of resistance-mechanism testing to those isolates identified as carbapenemase producers particularly in settings with low prevalence of CRE.
Sawyer RG et al: Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 372:1996, 2015,[PMID:25992746]
Comment: RTC of 518 patients treated for complicated intraabdominal infection with adequate source control and antibiotics found no difference between control group (N=260) those treated with ABX until 2 days after resolution (median, 8; IQR, 5-10d) versus experimental group (N=257) those treated with ABX for 4 +/- calendar days (median, 4;IQR, 4-5d). Surgical site infection, recurrent IAI or death occurred in 22% of both groups.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing.CLSI guideline M100S. 26th ed. Wayne, PA: CLSI, 2016.
Comment: CLSI breakpoints updated annually and available at: http://www.clsi.org/m100/. Accessed 7/18/2016."
Klebsiella Oxytoca Fosfomycin, Nitrofurantoin, Levofloxacin, Ciprofloxacin "Kalil AC et al: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 63:e61, 2016,[PMID:27418577]
Comment: Clinical guidelines encourage decreased unnecessary use of dual Gram-negative coverage and empiric MRSA treatment by incorporating hospital-based antibiograms, employment of short course treatment duration, and de-escalation of ABX regimens.
van Duin D, Bonomo RA: Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/β-Lactamase Inhibitor Combinations. Clin Infect Dis 63:234, 2016,[PMID:27098166]
Comment: Two new second-generation cephalosporin/beta-lactamase inhibitor combinations are FDA-approved for treatment of complicated intra-abdominal infections (cIAI) and complicated UTIs. For treatment of cIAI, metronidazole is added. Ceftazidime/avibactam has the advantage of inhibition of ESBLs, AmpC beta-lactamases, and class A carbapenemases of KPC family (KPC and OXA-48). Notably, porin loss increases in vitro MIC values of ceftazidime, but not ceftolozane. Both show potent in vitro activity against Pseudomonas spp. However, Acinetobacter and Stenotrophomonas spp. are generally resistant.
Chea N et al: Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae. Emerg Infect Dis 21:1611, 2015,[PMID:26290955]
Comment: Centers for Disease Control (CDC) Emerging Pathogens Program CRE surveillance system evaluated 312 isolates of Enterobacter spp., E. coli., and Klebsiella spp. to refine a phenotype-based CRE definition that differentiated carbapenemase-producing CRE from non-carbapenemase-producing CRE on the basis of antimicrobial susceptibility patterns. The pre-2015 CDC CRE surveillance definition was "nonsusceptibility to imipenem, meropenem, or doripenem, and resistance to all third-generation cephalosporins tested, as determined by using CLSI M100-S23 testing standards." Results identified "resistance to any carbapenem" as the most sensitive (% false negative, 0.7%; % false positive, 55%) and simplest. Recommendations included the addition of resistance-mechanism testing to those isolates identified as carbapenemase producers particularly in settings with low prevalence of CRE.
Sawyer RG et al: Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 372:1996, 2015,[PMID:25992746]
Comment: RTC of 518 patients treated for complicated intraabdominal infection with adequate source control and antibiotics found no difference between control group (N=260) those treated with ABX until 2 days after resolution (median, 8; IQR, 5-10d) versus experimental group (N=257) those treated with ABX for 4 +/- calendar days (median, 4;IQR, 4-5d). Surgical site infection, recurrent IAI or death occurred in 22% of both groups.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing.CLSI guideline M100S. 26th ed. Wayne, PA: CLSI, 2016.
Comment: CLSI breakpoints updated annually and available at: http://www.clsi.org/m100/. Accessed 7/18/2016."
Morganella Morganii Meropenem, Ertapenem, Cefepime, Ciprofloxacin, Piperacillin, Ticarcillin, Gentamicin or Tobramycin, Amikacin "Hoban DJ et al: In vitro susceptibility and distribution of beta-lactamases in Enterobacteriaceae causing intra-abdominal infections in North America 2010-2011. Diagn Microbiol Infect Dis 79:367, 2014,[PMID:24813688]
Comment: This report documents the in vitro activity of several recommended antimicrobials against 61 isolates of Morganella morganii among other GNB causing intraabdominal infections from several participating sites in North America in 2010–2011.
Jean SS et al: Carbapenem susceptibilities and non-susceptibility concordance to different carbapenems amongst clinically important Gram-negative bacteria isolated from intensive care units in Taiwan: results from the Surveillance of Multicentre Antimicrobial Resistance in Taiwan (SMART) in 2009. Int J Antimicrob Agents 41:457, 2013,[PMID:23507415]
Comment: This is amulticenter study from taiwan that reported susceptibility profile to various carbapenems amongst clinical GNB isolated from patiets in ICUs. M. morganii were susceptible to ertapenem however none of them were susceptible to imipenem."
Proteus Mirabilis Ampicillin, Cefuroxime, Ciprofloxacin, Levofloxacin "Gupta K 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. Clin Infect Dis 52:e103, 2011,[PMID:21292654]
Comment: Updated guideline regarding uUTI and acute pyelonephritis, acknowledging that E. coli would be the predominate cause, and Proteus spp. on a small minority."
Proteus Vulgaris "Gupta K 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. Clin Infect Dis 52:e103, 2011,[PMID:21292654]
Comment: Updated guideline regarding uUTI and acute pyelonephritis, acknowledging that E. coli would be the predominate cause, and Proteus spp. on a small minority."
Pseudomonas Aeruginosa Ceftazidime, Cefepime, Piperacillin/tazobactam, Imipenem, Meropenem "Mitsugui CS et al: In vitro activity of polymyxins in combination with β-lactams against clinical strains of Pseudomonas aeruginosa. Int J Antimicrob Agents 38:447, 2011,[PMID:21872449]
Comment: Study of in vitro antimicrobial activity of six combinations of polymixins (polymixin B and colistin) and beta-lactams (ceftazidime, cefepime and piperacillin) against 34 clinical isolates of Pseudomonas aeruginosa. Combination therapy reduced MICs to susceptibile in 8 MDR strains. Advantages to combinations include synergy, lower required doses with less toxicity, and reduced development of resistance.
Martínez JA et al: Influence of empiric therapy with a beta-lactam alone or combined with an aminoglycoside on prognosis of bacteremia due to gram-negative microorganisms. Antimicrob Agents Chemother 54:3590, 2010,[PMID:20585123]
Comment: Retrospective analysis of 4863 episodes of gram-negative bacteremia showed mortality was associated with age > 65yrs, hospital acquisition, fatal underlying disease, prior corticosteroids, shock on presentation, cirrhosis, pneumonia or inappropriate empiric therapy. If drug resistance suspected, combination beta-lactam and aminoglycoside therapy is prudent. "
Serratia Marcescens Ciprofloxacin, Levofloxacin "Samonis G et al: Serratia infections in a general hospital: characteristics and outcomes. Eur J Clin Microbiol Infect Dis 30:653, 2011,[PMID:21222011]
Comment: Helpful study from a country with high rates of antimicrobial resistance that reports on 77 patients with Serratia from Crete. About 85% were due to S. marcescens, the balance other species. Most frequently detected infections were respiratory (32.5%) and ocular (20.8%). Most patients were cured by employing anti-pseudomonal penicillins +/- beta-lactamase inhibitor combinations or carbapenems. In this study, ciprofloxacin susceptibility ranged 96.9-100% among the recovered species. This five year study is limited by small number, but suggests that ESBL production and other severe forms of resistance have not yet emerged significantly within Serratia, at least in this locale."
Staphylococcus Aureus Amoxicillin/clavulanate, Amoxicillin, Ciprofloxacin, Norfloxacin,TMP/SMX,TMP, Cephalexin "Baddour LM et al: Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 132:1435, 2015,[PMID:26373316]
Comment: Most recent guidelines addressing S aureus endocarditis.
Stevens DL et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 59:147, 2014,[PMID:24947530]
Comment: Latest set of guidelines from the Infectious Diseases Society of American, incorporating recommendations for MRSA infections.,Liu C et al: Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 52:285, 2011,[PMID:21217178]
Comment: Guidelines looking at the MRSA compendium of diseases with recommendations that also include vancomycin dosing recommendations.
Rybak MJ et al: Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 49:325, 2009,[PMID:19569969]
Comment: New guidelines for vancomycin dosing and monitoring. "