Emanuele Durante-Mangoni1, Lorenzo Bertolino1, Claudio Mastroianni2, Pierluigi Viale3, Matteo Bassetti4, Rita Citton5, David Gómez-Ulloa6, Montse Roset6, Eilish McCann7. 1. Department of Precision Medicine and Unit of Infectious and Transplant Medicine, Università della Campania 'L. Vanvitelli', Ospedale Monaldi, AORN Ospedali dei Colli, Naples, Italy. 2. Department of Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy. 3. Infectious Diseases Unit, Department of Medical and Surgical Sciences, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy. 4. Infectious Diseases Unit, Ospedale Policlinico San Martino IST-IRCCS, Genova, Italy. 5. Medical Affairs, MSD, Rome, Italy. 6. Real World Solutions, IQVIA, Barcelona, Spain. 7. Outcomes Research, Merck & Co., Inc., Kenilworth NJ, USA.
Abstract
INTRODUCTION: Efforts to curb a growing prevalence of carbapenem resistance are prominent worldwide and especially in countries where high levels of carbapenem resistance are reported, such as Italy. Complicated infections, including complicated urinary tract infections (cUTI), complicated intra-abdominal infections (cIAI), and hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP), are often caused by carbapenem-resistant Gram-negative (CRGN) bacteria and as such, these infection sites and their causative bacteria are important areas of focus for healthcare practitioners seeking to follow good antimicrobial stewardship practices. The aim of this study was to assess the clinical management and associated clinical and economic outcomes of patients with cUTI, cIAI, and HABP/VABP resulting from CRGN bacteria in Italy. METHODS: We first conducted a hospital survey focusing on Gram-negative infections and their antibacterial susceptibility profile in four participating Italian hospitals. The second part of the study involved a non-interventional, retrospective single cohort chart review of 100 patients with cUTI, cIAI, or HABP/VABP caused by CRGN bacteria, in which patient characteristics, index hospitalization characteristics, infection characteristics, patient outcomes, treatment pathways, and healthcare resource use were assessed. RESULTS: The hospital survey demonstrated carbapenem resistance in approximately 17% of complicated infections, mostly associated with Acinetobacter baumannii. The non-interventional, retrospective cohort component showed that complicated CRGN infections were hospital- or healthcare-acquired in 99.0% of cases and were most often caused by Klebsiella pneumoniae (66.0%). Despite the carbapenem-resistant nature of the included infections, carbapenems were used in 19.0% of patients as empirical therapy, in 43.0% as late empirical (i.e. immediately before receipt of susceptibility test results), and in 64.0% as targeted therapy (post-susceptibility test result receipt). Colistin was used in 61.0% of patients after susceptibility results were available. High clinical and economic burden was evident, with the average length of hospital stay being greater than 50 days, clinical cure achievement in only 43.0% of patients, and an overall mortality rate of 65.0% by the end of the follow-up period. CONCLUSION: Our results reflect the considerable burden associated with complicated CRGN infections in Italy and the limitations in current treatment strategies. Our study pinpoints potential areas for improvement. For example, regular and detailed local surveillance and state of the art microbial diagnostic capabilities might aid and hasten clinical decision-making and facilitate improved antimicrobial stewardship when treating complex CRGN infections. New therapeutic options which more appropriately address CRGN infections may assist in improving outcomes which are important to both patients and healthcare providers.
INTRODUCTION: Efforts to curb a growing prevalence of carbapenem resistance are prominent worldwide and especially in countries where high levels of carbapenem resistance are reported, such as Italy. Complicated infections, including complicated urinary tract infections (cUTI), complicated intra-abdominal infections (cIAI), and hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP), are often caused by carbapenem-resistant Gram-negative (CRGN) bacteria and as such, these infection sites and their causative bacteria are important areas of focus for healthcare practitioners seeking to follow good antimicrobial stewardship practices. The aim of this study was to assess the clinical management and associated clinical and economic outcomes of patients with cUTI, cIAI, and HABP/VABP resulting from CRGN bacteria in Italy. METHODS: We first conducted a hospital survey focusing on Gram-negative infections and their antibacterial susceptibility profile in four participating Italian hospitals. The second part of the study involved a non-interventional, retrospective single cohort chart review of 100 patients with cUTI, cIAI, or HABP/VABP caused by CRGN bacteria, in which patient characteristics, index hospitalization characteristics, infection characteristics, patient outcomes, treatment pathways, and healthcare resource use were assessed. RESULTS: The hospital survey demonstrated carbapenem resistance in approximately 17% of complicated infections, mostly associated with Acinetobacter baumannii. The non-interventional, retrospective cohort component showed that complicated CRGN infections were hospital- or healthcare-acquired in 99.0% of cases and were most often caused by Klebsiella pneumoniae (66.0%). Despite the carbapenem-resistant nature of the included infections, carbapenems were used in 19.0% of patients as empirical therapy, in 43.0% as late empirical (i.e. immediately before receipt of susceptibility test results), and in 64.0% as targeted therapy (post-susceptibility test result receipt). Colistin was used in 61.0% of patients after susceptibility results were available. High clinical and economic burden was evident, with the average length of hospital stay being greater than 50 days, clinical cure achievement in only 43.0% of patients, and an overall mortality rate of 65.0% by the end of the follow-up period. CONCLUSION: Our results reflect the considerable burden associated with complicated CRGN infections in Italy and the limitations in current treatment strategies. Our study pinpoints potential areas for improvement. For example, regular and detailed local surveillance and state of the art microbial diagnostic capabilities might aid and hasten clinical decision-making and facilitate improved antimicrobial stewardship when treating complex CRGN infections. New therapeutic options which more appropriately address CRGN infections may assist in improving outcomes which are important to both patients and healthcare providers.
Authors: Peter M Hawkey; Roderic E Warren; David M Livermore; Cliodna A M McNulty; David A Enoch; Jonathan A Otter; A Peter R Wilson Journal: J Antimicrob Chemother Date: 2018-03-01 Impact factor: 5.790
Authors: Jean-François Timsit; Matteo Bassetti; Olaf Cremer; George Daikos; Jan de Waele; Andre Kallil; Eric Kipnis; Marin Kollef; Kevin Laupland; Jose-Artur Paiva; Jesús Rodríguez-Baño; Étienne Ruppé; Jorge Salluh; Fabio Silvio Taccone; Emmanuel Weiss; François Barbier Journal: Intensive Care Med Date: 2019-01-18 Impact factor: 17.440
Authors: Lauren M Lim; Neang Ly; Dana Anderson; Jenny C Yang; Laurie Macander; Anthony Jarkowski; Alan Forrest; Jurgen B Bulitta; Brian T Tsuji Journal: Pharmacotherapy Date: 2010-12 Impact factor: 4.705
Authors: Akosua A Agyeman; Phillip J Bergen; Gauri G Rao; Roger L Nation; Cornelia B Landersdorfer Journal: Int J Antimicrob Agents Date: 2019-11-12 Impact factor: 5.283
Authors: Elena Carrara; Alessia Savoldi; Laura J V Piddock; Francois Franceschi; Sally Ellis; Mike Sharland; Adrian John Brink; Patrick N A Harris; Gabriel Levy-Hara; Anusha Rohit; Constantinos Tsioutis; Hiba Zayyad; Christian Giske; Margherita Chiamenti; Damiano Bragantini; Elda Righi; Anna Gorska; Evelina Tacconelli Journal: Clin Microbiol Infect Date: 2021-05-08 Impact factor: 8.067