Shujuan Ji1, Fangfang Lv1, Xiaoxing Du1, Zeqing Wei2, Ying Fu1, Xinli Mu1, Yan Jiang1, Yunsong Yu3. 1. Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China. 2. Key Laboratory of Infectious Diseases of the Public Health Ministry, First Affiliated Hospital, School of Medicine, Zhejiang University, China. 3. Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, China; Key Laboratory of Infectious Diseases of the Public Health Ministry, First Affiliated Hospital, School of Medicine, Zhejiang University, China. Electronic address: yvys119@163.com.
Abstract
OBJECTIVE: Clinical treatment for blaKPC-positive Klebsiella pneumoniae isolates is challenging because the recommended antibiotic options are limited and are extraordinarily expensive. This study aimed to explore a new therapy for infection caused by KPC-producing K. pneumoniae. METHODS:Patients with blaKPC-positive K. pneumoniae infection, were prospectively screened and were categorised into two groups: patients in the study group received a combination-based therapy of cefepime and amoxicillin/clavulanic acid and the control group received tigecycline-based therapy. The pathogen clearance rate, 28-day mortality and cost of the antibiotic treatment were compared between the two groups. Moreover, the checkerboard microdilution method was performed to determine the synergy between cefepime and amoxicillin/clavulanic acid in vitro. RESULTS:Twenty-six and 25 cases were enrolled in the study and control groups. The mortality and the overall pathogen clearance rate showed no significant differences (P=0.311 and P=0.447). Both the total cost and the portion of the cost not covered by insurance were higher for the control group compared to the study group (both P<0.001). Consistently, synergy (65.4%) and partial synergy (26.9%) were the main effects. CONCLUSIONS: In contrast to the currently recommended tigecycline-based therapy, cefepime and amoxicillin/clavulanic acid combination was an effective and economical option to KPC-KP infection in China.
RCT Entities:
OBJECTIVE: Clinical treatment for blaKPC-positive Klebsiella pneumoniae isolates is challenging because the recommended antibiotic options are limited and are extraordinarily expensive. This study aimed to explore a new therapy for infection caused by KPC-producing K. pneumoniae. METHODS:Patients with blaKPC-positive K. pneumoniae infection, were prospectively screened and were categorised into two groups: patients in the study group received a combination-based therapy of cefepime and amoxicillin/clavulanic acid and the control group received tigecycline-based therapy. The pathogen clearance rate, 28-day mortality and cost of the antibiotic treatment were compared between the two groups. Moreover, the checkerboard microdilution method was performed to determine the synergy between cefepime and amoxicillin/clavulanic acid in vitro. RESULTS: Twenty-six and 25 cases were enrolled in the study and control groups. The mortality and the overall pathogen clearance rate showed no significant differences (P=0.311 and P=0.447). Both the total cost and the portion of the cost not covered by insurance were higher for the control group compared to the study group (both P<0.001). Consistently, synergy (65.4%) and partial synergy (26.9%) were the main effects. CONCLUSIONS: In contrast to the currently recommended tigecycline-based therapy, cefepime and amoxicillin/clavulanic acid combination was an effective and economical option to KPC-KP infection in China.
Authors: Melanie L Yarbrough; Meghan A Wallace; Robert F Potter; Alaric W D'Souza; Gautam Dantas; Carey-Ann D Burnham Journal: Eur J Clin Microbiol Infect Dis Date: 2019-11-02 Impact factor: 3.267
Authors: Adrian Schmid; Aline Wolfensberger; Johannes Nemeth; Peter W Schreiber; Hugo Sax; Stefan P Kuster Journal: Sci Rep Date: 2019-10-29 Impact factor: 4.379