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Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options.

Golan Y - BMC Infect. Dis. (2015)

Bottom Line: Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms.Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting.

View Article: PubMed Central - PubMed

Affiliation: Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Disease, 800 Washington St, Boston, MA, 02446, USA. ygolan@tuftsmedicalcenter.org.

ABSTRACT

Background: Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.

Methods: This systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa.

Results: Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.

Conclusions: Practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of literature search and study selection
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Fig1: Flow diagram of literature search and study selection

Mentions: Literature searches were performed on PubMed using generic drug names (and alternative names) as primary search terms (Table 1). Results were filtered to include only phase 2, 3, and 4 clinical trials. In most cases, results were limited to trials published from 2000 to present. Publications were manually selected to include only trials of empiric therapy in adult patients with hospital-acquired cIAI or cUTI. In addition, to capture recent studies in pre-publication, abstracts from 2014 Infectious Disease Week (IDWeek) and the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) were manually searched using the same criteria as above. Other studies known to the author were also included. Individual case study reports were not included (Fig. 1).Table 1


Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options.

Golan Y - BMC Infect. Dis. (2015)

Flow diagram of literature search and study selection
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526420&req=5

Fig1: Flow diagram of literature search and study selection
Mentions: Literature searches were performed on PubMed using generic drug names (and alternative names) as primary search terms (Table 1). Results were filtered to include only phase 2, 3, and 4 clinical trials. In most cases, results were limited to trials published from 2000 to present. Publications were manually selected to include only trials of empiric therapy in adult patients with hospital-acquired cIAI or cUTI. In addition, to capture recent studies in pre-publication, abstracts from 2014 Infectious Disease Week (IDWeek) and the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) were manually searched using the same criteria as above. Other studies known to the author were also included. Individual case study reports were not included (Fig. 1).Table 1

Bottom Line: Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms.Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting.

View Article: PubMed Central - PubMed

Affiliation: Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Disease, 800 Washington St, Boston, MA, 02446, USA. ygolan@tuftsmedicalcenter.org.

ABSTRACT

Background: Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.

Methods: This systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa.

Results: Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.

Conclusions: Practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

No MeSH data available.


Related in: MedlinePlus