Scientific letter
First case of ceftazidime/avibactam administration in home care. ESBL producing Klebsiella pneumoniae bacteremia
Primer caso de administración de ceftazidima/avibactam en hospitalización a domicilio. Bacteriemia por Klebsiella pneumoniae BLEE multirresistente
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ESBL producing <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> bacteremia" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "322" "paginaFinal" => "323" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisa Torres-del-Pliego, Elena Delgado-Mejía, Leire Gil-Alonso, Leonor del Mar-Periáñez-Párraga" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elisa" "apellidos" => "Torres-del-Pliego" "email" => array:1 [ 0 => "elisatorresdelpliego@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elena" "apellidos" => "Delgado-Mejía" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Leire" "apellidos" => "Gil-Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Leonor" "apellidos" => "del Mar-Periáñez-Párraga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Hospitalización a Domicilio, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primer caso de administración de ceftazidima/avibactam en hospitalización a domicilio. Bacteriemia por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> BLEE multirresistente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The increase in nosocomial infections caused by multi-drug resistant Gram-negative bacilli has necessitated the development of new antibiotics. In recent months, the FDA approved 2 new antibiotics, ceftolozane/tazobactam and ceftazidime/avibactam, for the treatment of intra-abdominal infections (together with metronidazole) and urinary tract infections.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Since June 2016, ceftazidime/avibactam has been approved in Europe for the treatment of nosocomial pneumonia, including those cases associated with mechanical ventilation and infections caused by Gram-negative aerobic microorganisms, with limited treatment options.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> There is no documented evidence on the use of these drugs in the hospital at home (HAH) setting, a treatment modality that is not only less expensive, but also drastically reduces the possibility of intrahospital transmission of the bacteria.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the first case of ceftazidime/avibactam administration in a hospital at home programme. It discusses a 62-year-old patient with hypertension who had recently been diagnosed (February 2016) with acute myeloblastic leukaemia and was undergoing treatment with chemotherapy. He was admitted to haematology for a consolidation cycle, and had as a complication persistent bacteraemia caused by multi-drug resistant extended-spectrum beta-lactamase (ESBL) <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> secondary to sacral ulcer. Initially he received empirical treatment with imipenem/cilastatin and colistin. Given that his fever persisted and his blood cultures were positive again, the antibiogram was extended and showed sensitivity only to ceftazidime/avibactam and resistance even to ceftolozane/tazobactam (minimum inhibitory concentration of 8). Therefore, in view of the results, despite the fact that it was not among the approved indications at that time (it is now), it was decided to start treatment with ceftazidime/avibactam. Given his clinical stability, HAH services were contacted to complete treatment. They continued administering 2/0.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h of ceftazidime/avibactam, which required pump infusion and 2 home visits (the drug is stable diluted and unrefrigerated for 12<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a>). No outstanding incidents or related side effects occurred, and his monitoring rectal swab and blood cultures became negative.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hospital-acquired infections are the sixth leading cause of death both in the United States and in Europe.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Those caused by Gram-negative bacteria have a special capacity for acquiring new mechanisms of resistance to antibiotics, especially if they are under antibiotic pressure. Since few new antibiotics have been developed in recent years, few treatment options are available to fight these infections. Cases of nosocomial bacteraemia caused by Gram-negative bacteria account for 30% of these infections. The most common microorganisms include species of <span class="elsevierStyleItalic">Klebsiella</span>, as in our case. The increase in resistance to broad-spectrum cephalosporins and carbapenems is also a particularly significant problem.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Among cases of nosocomial bacteraemia caused by <span class="elsevierStyleItalic">K. pneumoniae</span>, in the United States, 27.1% were resistant to third-generation cephalosporins, and 10.8% were resistant to carbapenems, with even higher rates of resistance in Europe.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Therefore, in this regard it is essential to have new therapeutic weapons such as ceftazidime/avibactam, an antibiotic approved on 25 February 2015. This antibiotic is active against a broad group of Gram-negative bacteria, <span class="elsevierStyleItalic">Enterobacteriaceae</span> and even <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>. However, it is minimally active against <span class="elsevierStyleItalic">Acinectobacter</span>, anaerobes and Gram-positive bacteria.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> It is well tolerated (the most common side effects reported in the REPRISE study were gastrointestinal, in the same proportion in the 2 branches of the study–with and without ceftazidime/avibactam–with no other significant side effects).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In addition, it has demonstrated activity against <span class="elsevierStyleItalic">K. pneumoniae</span> carbapenemase, or KPC,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> class A carbapenemases, encoded by plasmid genes, which would explain its greater capacity for spreading. Moreover, it should be noted that the antibiotic treatment directly observed in HAH units in Spain has proven to be safe, effective and probably more economical (there are no clear data that confirm this).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> In addition, another advantage demonstrated in this case in particular–and to date not studied–is the potential for home administration of the antibiotic. This would significantly decrease the potential for transmission of the bacterium.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, administration of ceftazidime/avibactam in the HAH setting in selected cases would drastically decrease costs deriving from hospital admission, as well as complications related to hospital stay; would not undermine the treatment indicated for the patient; and would help control intrahospital transmission. Therefore, we believe that its home use should be considered under suitable circumstances.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they did not receive funding to complete this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torres-del-Pliego E, Delgado-Mejía E, Gil-Alonso L, del Mar-Periáñez-Párraga L. Primer caso de administración de ceftazidima/avibactam en hospitalización a domicilio. Bacteriemia por <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> BLEE multirresistente. Enferm Infecc Microbiol Clin. 2017;35:322–323.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Highlights of prescribing information for Avycaz (ceftazidime and avibactam). Available in: <a href="http://www.allergan.com/assets/pdf/avycaz_pi">http://www.allergan.com/assets/pdf/avycaz_pi</a> [accessed February 2015]" ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Medicines Agency (Internet). Committee for Medicinal Products for Human Use. 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Mujal-Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/fmb.15.141" "Revista" => array:6 [ "tituloSerie" => "Future Microbiol" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "375" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26974259" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000005/v1_201705111055/S2529993X17301028/v1_201705111055/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000005/v1_201705111055/S2529993X17301028/v1_201705111055/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17301028?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 29 | 8 | 37 |
| 2024 September | 26 | 7 | 33 |
| 2024 August | 28 | 8 | 36 |
| 2024 July | 29 | 10 | 39 |
| 2024 June | 17 | 5 | 22 |
| 2024 May | 7 | 3 | 10 |
| 2024 April | 22 | 2 | 24 |
| 2024 March | 14 | 8 | 22 |
| 2024 February | 12 | 3 | 15 |
| 2024 January | 19 | 4 | 23 |
| 2023 December | 10 | 9 | 19 |
| 2023 November | 11 | 14 | 25 |
| 2023 October | 21 | 2 | 23 |
| 2023 September | 11 | 5 | 16 |
| 2023 August | 16 | 3 | 19 |
| 2023 July | 7 | 2 | 9 |
| 2023 June | 15 | 5 | 20 |
| 2023 May | 44 | 3 | 47 |
| 2023 April | 32 | 4 | 36 |
| 2023 March | 35 | 10 | 45 |
| 2023 February | 22 | 8 | 30 |
| 2023 January | 30 | 6 | 36 |
| 2022 December | 16 | 8 | 24 |
| 2022 November | 27 | 8 | 35 |
| 2022 October | 26 | 10 | 36 |
| 2022 September | 33 | 10 | 43 |
| 2022 August | 26 | 10 | 36 |
| 2022 July | 38 | 8 | 46 |
| 2022 June | 26 | 9 | 35 |
| 2022 May | 29 | 11 | 40 |
| 2022 April | 26 | 17 | 43 |
| 2022 March | 43 | 17 | 60 |
| 2022 February | 47 | 3 | 50 |
| 2022 January | 71 | 16 | 87 |
| 2021 December | 45 | 15 | 60 |
| 2021 November | 51 | 15 | 66 |
| 2021 October | 52 | 15 | 67 |
| 2021 September | 41 | 12 | 53 |
| 2021 August | 42 | 18 | 60 |
| 2021 July | 26 | 11 | 37 |
| 2021 June | 60 | 17 | 77 |
| 2021 May | 69 | 30 | 99 |
| 2021 April | 150 | 24 | 174 |
| 2021 March | 95 | 58 | 153 |
| 2021 February | 65 | 11 | 76 |
| 2021 January | 61 | 15 | 76 |
| 2020 December | 60 | 21 | 81 |
| 2020 November | 55 | 11 | 66 |
| 2020 October | 37 | 7 | 44 |
| 2020 September | 61 | 39 | 100 |
| 2020 August | 62 | 33 | 95 |
| 2020 July | 35 | 15 | 50 |
| 2020 June | 38 | 16 | 54 |
| 2020 May | 52 | 16 | 68 |
| 2020 April | 33 | 17 | 50 |
| 2020 March | 65 | 13 | 78 |
| 2020 February | 49 | 30 | 79 |
| 2020 January | 42 | 11 | 53 |
| 2019 December | 40 | 13 | 53 |
| 2019 November | 26 | 13 | 39 |
| 2019 October | 43 | 13 | 56 |
| 2019 September | 39 | 7 | 46 |
| 2019 August | 27 | 9 | 36 |
| 2019 July | 41 | 21 | 62 |
| 2019 June | 51 | 26 | 77 |
| 2019 May | 212 | 36 | 248 |
| 2019 April | 76 | 10 | 86 |
| 2019 March | 29 | 8 | 37 |
| 2019 February | 22 | 9 | 31 |
| 2019 January | 20 | 6 | 26 |
| 2018 December | 19 | 4 | 23 |
| 2018 November | 19 | 6 | 25 |
| 2018 October | 34 | 9 | 43 |
| 2018 September | 11 | 12 | 23 |
| 2018 August | 16 | 1 | 17 |
| 2018 July | 18 | 2 | 20 |
| 2018 June | 12 | 1 | 13 |
| 2018 May | 16 | 4 | 20 |
| 2018 April | 12 | 5 | 17 |
| 2018 March | 15 | 0 | 15 |
| 2018 February | 14 | 1 | 15 |
| 2018 January | 24 | 0 | 24 |
| 2017 December | 13 | 1 | 14 |
| 2017 November | 28 | 3 | 31 |
| 2017 October | 3 | 0 | 3 |
| 2017 May | 9 | 0 | 9 |
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