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Surveillance of Clostridioides difficile on hospital admission and outpatient antibiotic use in Germany-a 9 year ecological analysis. 艰难梭菌对德国住院和门诊抗生素使用的监测-一项9年生态学分析。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae483
Selin Saydan, Frank Schwab, Jakob Holstiege, Jörg Bätzing, Michael Behnke, Sandra Schneider, Jörg Clausmeyer, Petra Gastmeier, Christine Geffers, Friederike Maechler

Background: Antibiotic consumption is considered an important risk factor for Clostridioides difficile infection (CDI). This ecological analysis investigates the influence of outpatient antibiotic prescriptions in statutory health insurance (SHI) on the admission prevalence of CDI in German hospitals participating in voluntary CDI surveillance through the hospital infection surveillance system (Krankenhaus-Infektions-Surveillance-System; KISS).

Methods: The annual CDI admission prevalence of a hospital at the federal state level was associated with the outpatient antibiotic consumption of the corresponding federal state. The quantification of outpatient antibiotic prescriptions was determined as the average DDD per 1000 insured persons per day. The risk factors for CDI on hospital admission included the annual consumption of the eight substance groups aminopenicillin combinations/staphylococcal penicillins, basic penicillins, cephalosporins, quinolones, lincosamides/macrolides, nitrofurantoin/fosfomycin/nitroxoline, sulphonamides/trimethoprim and tetracyclines, the type of care provided by the hospital, and the calendar year, and were examined using multivariable regression analyses (generalized estimating equations models).

Results: Between 2011 and 2019, the number of outpatient antibiotic prescriptions decreased from 13.9 to 10.4 DDD per 1000 insured persons per day (-25%), and the CDI admission prevalence decreased from 0.22 to 0.12 per 100 patients (-45%). Basic penicillins and cephalosporins were identified as risk factors for increased CDI admission prevalence, while nitrofurantoin/fosfomycin/nitroxoline and sulphonamides/trimethoprim were associated with decreased CDI admission prevalence.

Conclusions: A decrease in outpatient antibiotic prescriptions with known risk of developing CDI was associated with a decrease in hospital CDI admission prevalence. Our ecological analysis indicates that rational and restrained antibiotic use in the outpatient setting may reduce the incidence of CDI in the population requiring inpatient treatment.

背景:抗生素的使用被认为是艰难梭菌感染(CDI)的重要危险因素。通过医院感染监测系统(krankenhaus - infections - surveillance - system;吻)。方法:联邦州一级医院的年度CDI住院率与相应联邦州的门诊抗生素消费量相关。门诊抗生素处方定量确定为每1000名参保人每天平均DDD。入院时CDI的危险因素包括八种物质组的年用量:氨霉素/葡萄球菌青霉素、碱性青霉素、头孢菌素、喹诺酮类、林科胺类/大环内酯类、呋喃妥因/磷霉素/硝基喹啉、磺胺类/甲氧苄啶和四环素、医院提供的护理类型和日历年,并使用多变量回归分析(广义估计方程模型)进行检验。结果:2011年至2019年,门诊抗生素处方数量从13.9 DDD / 1000人减少到10.4 DDD / 1000人(-25%),CDI入院患病率从0.22 DDD / 100人减少到0.12 DDD / 100人(-45%)。基础青霉素和头孢菌素被确定为CDI入院率增加的危险因素,而呋喃妥英/磷霉素/硝基喹啉和磺胺类药物/甲氧苄啶与CDI入院率降低相关。结论:已知发生CDI风险的门诊抗生素处方的减少与医院CDI入院率的降低有关。我们的生态学分析表明,在门诊环境中合理和克制地使用抗生素可以减少需要住院治疗的人群中CDI的发生率。
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引用次数: 0
No virological failure in patients living with HIV with past NNRTI resistance-associated mutations switched to doravirine-containing regimens. 在过去有NNRTI耐药相关突变的HIV患者中,没有病毒学失败,转而使用含多拉韦林的方案。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae481
B Abdi, S Saliba, M Wirden, A Faycal, T Cocherie, R Palich, L Schneider, S Seang, M A Valantin, V Pourcher, V Calvez, A Marcelin, C Katlama

Background: Doravirine is licensed in patients living with HIV (PWH) harbouring no prior resistance to any NNRTIs. We aimed to evaluate in real life the efficacy of doravirine with prior NNRTI virological failure and NNRTI resistance-associated mutations (RAMs).

Methods: This observational study included PWH switched to a doravirine-containing regimen between 30 September 2019 and 1 May 2022, with an HIV-1 RNA of ≤50 copies/mL and past NNRTI-RAMs. The main outcome was the proportion of participants with virological failure at Week 48 and Week 96. Secondary outcomes evaluated the rate of viral suppression and transient virological blip, RAMs in the case of virological failure and side effects.

Results: A total of 102 patients were analysed, mostly men (63%), with a median age of 59 years (IQR 51-63). The median time since HIV-1 diagnosis was 26 years (IQR 16-31), on ART for 22 years (IQR 14-26) and virally suppressed for 7 years (IQR 1-11).Of the patients analysed, 25/102 (25%) had documented historical RAMs to doravirine, 9/25 (36%) showing possible resistance and 16/25 (64%) showing major resistance. The resistance profile primarily (21/23) consisted of the K103N, Y181C and/or G190A/E reverse transcriptase substitutions. Median time since the last detection of NNRTI-RAMs was 12 years (5-17). Over 2 years follow-up, no virological failure occurred, neither at Week 48 (0/87; 0%) nor Week 96 (0/86; 0%).

Conclusions: This is the first real-world study to provide new insight about the use of doravirine-containing regimens as a treatment in long-term suppressed patients whose viruses harboured specific NNRTI-RAMs in their history.

背景:多拉韦林被许可用于HIV (PWH)患者,这些患者之前对任何NNRTIs都没有耐药性。我们的目的是在现实生活中评估具有NNRTI病毒学失败和NNRTI耐药相关突变(RAMs)的doravirine的疗效。方法:该观察性研究包括在2019年9月30日至2022年5月1日期间切换到含多拉韦林方案的PWH,其HIV-1 RNA≤50拷贝/mL,并且过去的NNRTI-RAMs。主要结果是48周和96周病毒学失败的参与者比例。次要结果评估病毒抑制率和短暂病毒学突变,病毒学失败情况下的RAMs和副作用。结果:共分析102例患者,多数为男性(63%),中位年龄59岁(IQR 51-63)。自HIV-1诊断以来的中位时间为26年(IQR 16-31),抗逆转录病毒治疗为22年(IQR 14-26),病毒抑制为7年(IQR 1-11)。在分析的患者中,25/102(25%)有文献记载的对多拉韦林的既往RAMs, 9/25(36%)显示可能耐药,16/25(64%)显示主要耐药。耐药谱主要由K103N、Y181C和/或G190A/E逆转录酶替代组成(21/23)。最后一次检测到NNRTI-RAMs的中位时间为12年(5-17)。在2年的随访中,没有发生病毒学失败,在第48周(0/87;0%)和第96周(0/86;0%)。结论:这是第一个真实世界的研究,为使用含多拉韦林的方案作为长期抑制患者的治疗提供了新的见解,这些患者的病毒在他们的历史中含有特异性的NNRTI-RAMs。
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引用次数: 0
Relationship between posaconazole concentrations and clinical outcomes in paediatric cancer and haematopoietic stem cell transplant recipients.
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae473
Heather Weerdenburg, Hannah Walker, Gabrielle M Haeusler, Theresa Cole, Nigel Curtis, Stephen Duffull, Amanda Gwee

Background: Posaconazole is used to prevent and treat invasive fungal infections (IFIs) in immunocompromised children, including those undergoing cancer treatment or HSCT. Despite differences in pharmacokinetics and IFI epidemiology between children and adults, therapeutic targets established in adult studies are often applied to children.

Objectives: This systematic review evaluated the correlation between serum posaconazole concentrations and clinical outcomes of IFI prophylaxis and treatment in children with malignancies or HSCT recipients.

Methods: Four databases (Cochrane, Embase, MEDLINE and PubMed) were searched for studies involving children (≤18 years old) receiving cancer treatment or HSCT that reported posaconazole serum concentrations and treatment outcomes. Animal studies, those primarily in adult (>18 years old) populations, non-malignant conditions (excluding HSCT), case reports, letters, editorials, conference abstracts and narrative reviews were excluded. Bias was assessed using the Newcastle-Ottawa scale.

Results: Nineteen studies were included: 12 reported outcomes of posaconazole prophylaxis; two of treatment; and five of both. For prophylaxis, breakthrough IFIs occurred in 1%-12% of children. All but one occurred with serum concentrations of ≤0.7 mg/L. For treatment, no clear association was observed between a trough concentration of >1.0 mg/L and treatment efficacy, with poor outcomes reported for serum concentrations ranging between 0.2 and 4.8 mg/L. Overall, quality of evidence was poor (medium to high risk of bias for 18 papers, low risk for 1 paper) and there was variation in IFI definitions across studies.

Conclusions: This review supports current recommendations for posaconazole prophylaxis in paediatric oncology and HSCT recipients. The absence of a clear correlation found between serum trough concentrations and treatment efficacy highlights the need for further studies to determine optimal therapeutic targets for treatment.

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引用次数: 0
Genomic analysis of early ST32 Acinetobacter baumannii strains recovered in US military treatment facilities reveals distinct lineages and links to the origins of the Tn6168 ampC transposon. 对在美国军事治疗设施中发现的早期 ST32 鲍曼不动杆菌菌株进行基因组分析,发现了不同的菌系以及与 Tn6168 ampC 转座子起源的联系。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae454
Liam A Tobin, Eradah Abu Sabah, Francois Lebreton, Garry S A Myers, Patrick T McGann, Mehrad Hamidian

Objectives: To study the population structure and genomic characteristics, including antimicrobial resistance genes, plasmid types and surface polysaccharide type, of the globally distributed Acinetobacter baumannii belonging to ST32 (Institut Pasteur scheme).

Methods: Antibiotic resistance phenotype for 19 antibiotics was determined using Vitek 2. Whole-genome sequencing was performed using the Illumina MiSeq platform. Genomes were assembled using Newbler. Phylogenetic analysis was done by determining the core-genome alignments using Panaroo v1.3, analysed in IQ-Tree2 v2.2.0.3 to construct Maximum Likelihood trees using the RaxML software. Resistance genes and IS were identified using the Abricate programme, and ISFinder databases.

Results: One hundred and thirty-three (n = 133) ST32 A. baumannii isolates were analysed in this study. These genomes originated mainly from US military treatment facilities (n = 113), but also included additional publicly available genomes in GenBank (n = 20) recovered from a broad geographic distribution extending to Asia and South America. Phylogenetic analysis of all 133 genomes revealed at least four clades, with over 80 genomes forming a tightly clustered branch, suggesting they are likely to represent outbreak strains. Analysis of the ampC region showed that ST32 strains played a significant role in the formation of the widely distributed ampC transposon, Tn6168, and supplying DNA segments containing an ISAba1-ampC from ST32s via homologous recombination.

Conclusions: ST32 strains played a significant role in the evolution of antibiotic resistance in several widely distributed sequence types including ST1 (global clone 1) and ST3.

研究目的研究全球分布的属于 ST32(巴斯德研究所计划)的鲍曼不动杆菌的种群结构和基因组特征,包括抗菌药耐药基因、质粒类型和表面多糖类型:方法:使用 Vitek 2 测定了 19 种抗生素的耐药性表型。使用 Illumina MiSeq 平台进行全基因组测序。使用 Newbler 对基因组进行组装。使用 Panaroo v1.3 确定核心基因组排列,并在 IQ-Tree2 v2.2.0.3 中进行分析,使用 RaxML 软件构建最大似然树,从而进行系统发生分析。使用 Abricate 程序和 ISFinder 数据库鉴定抗性基因和 IS:本研究分析了 133 个(n = 133)ST32 型鲍曼不动杆菌分离株。这些基因组主要来自美国军方治疗机构(n = 113),但也包括 GenBank 中其他公开的基因组(n = 20),这些基因组从亚洲和南美洲的广泛地理分布中回收。对所有133个基因组的系统发育分析显示至少有四个支系,其中80多个基因组形成了紧密聚类的分支,这表明它们很可能代表了爆发菌株。对ampC区域的分析表明,ST32菌株在广泛分布的ampC转座子Tn6168的形成过程中发挥了重要作用,并通过同源重组从ST32中提供了含有ISAba1-ampC的DNA片段:结论:ST32 菌株在包括 ST1(全球克隆 1)和 ST3 在内的几种广泛分布的序列类型的抗生素耐药性进化过程中发挥了重要作用。
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引用次数: 0
Synergistic effects of colistin-rifampin-based triple antimicrobial combination therapy against Carbapenem-resistant Pseudomonas aeruginosa: a time-kill assay. 以粘菌素-利福平为基础的三联抗微生物联合治疗对碳青霉烯耐药铜绿假单胞菌的协同作用:一项时间杀伤试验。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae466
Si-Ho Kim, Hye Mee Kim, Doo Ryeon Chung, Jae-Hoon Ko, Kyungmin Huh, Sun Young Cho, Cheol-In Kang, Kyong Ran Peck

Background: Our research aimed to investigate the potential of in vitro triple antimicrobial synergism against carbapenem-resistant Pseudomonas aeruginosa (CRPA) as a strategy to overcome antimicrobial resistance.

Methods: We used 12 CRPA blood isolates stocked in the Asian Bacterial Bank between 2016 and 2018. All isolates were tested by multi-locus sequencing and carbapenemase multiplex PCR. To assess the antimicrobial interactions, we performed time-kill assays using double or triple combination regimens. These regimens included CST and/or rifampin combined with IPM, MEM, or CZA. The assay was conducted at 1× and 0.5× MICs.

Results: Among the 12 CRPA isolates, nine produced metallo-beta-lactamases (6 IMP-6, 2 VIM-2 and 1 NDM-1). In the time-kill assay, the median viable bacterial count for CST-rifampin was the lowest among double combinations after 24 h incubation (2.25 log cfu/mL at 1× MIC and 3.71 log cfu/mL at 0.5× MIC). In contrast, all triple combinations achieved 0 log cfu/mL at both 1× MIC and 0.5× MIC. Compared with CST-rifampin (synergism: 25% at 1× MIC, 42% at 0.5× MIC; bactericidal: 50% at 1× MIC, 42% at 0.5× MIC), all triple combinations showed greater synergism and bactericidal activity at both 1× MIC (50%-75% for synergism, 75%-83% for bactericidal activity) and 0.5× MIC (58%-75% for both).

Conclusions: Our findings suggest that CST-rifampin-based triple antimicrobial combinations exhibit greater synergy and bactericidal activity in eradicating CRPA compared with double antimicrobial combinations.

背景:本研究旨在探讨抗碳青霉烯耐药铜绿假单胞菌(Pseudomonas aeruginosa, CRPA)体外三联抗微生物协同作用的潜力,作为一种克服耐药性的策略。方法:使用2016 - 2018年亚洲细菌库库存的12株CRPA血分离株。所有分离株均采用多位点测序和碳青霉烯酶多重PCR检测。为了评估抗菌药物的相互作用,我们使用双重或三重联合方案进行了时间杀伤试验。这些方案包括CST和/或利福平联合IPM、MEM或CZA。在1倍和0.5倍mic条件下进行测定。结果:12株CRPA分离株中,9株产生金属-内酰胺酶(IMP-6 6株、VIM-2 2株、NDM-1 1株)。在时间杀伤试验中,cst -利福平的中位活菌数在孵育24 h后最低(1倍MIC时为2.25 log cfu/mL, 0.5倍MIC时为3.71 log cfu/mL)。相比之下,所有三组组合在1× MIC和0.5× MIC下均达到0 log cfu/mL。与cst -利福平相比(增效作用:1倍MIC时增效25%,0.5倍MIC时增效42%;1倍MIC为50%,0.5倍MIC为42%),3种组合在1倍MIC(50% ~ 75%, 75% ~ 83%)和0.5倍MIC(58% ~ 75%)均表现出更强的增效作用和杀菌活性。结论:我们的研究结果表明,与双重抗菌组合相比,cst -利福平三联抗菌组合在根除CRPA方面表现出更大的协同作用和杀菌活性。
{"title":"Synergistic effects of colistin-rifampin-based triple antimicrobial combination therapy against Carbapenem-resistant Pseudomonas aeruginosa: a time-kill assay.","authors":"Si-Ho Kim, Hye Mee Kim, Doo Ryeon Chung, Jae-Hoon Ko, Kyungmin Huh, Sun Young Cho, Cheol-In Kang, Kyong Ran Peck","doi":"10.1093/jac/dkae466","DOIUrl":"10.1093/jac/dkae466","url":null,"abstract":"<p><strong>Background: </strong>Our research aimed to investigate the potential of in vitro triple antimicrobial synergism against carbapenem-resistant Pseudomonas aeruginosa (CRPA) as a strategy to overcome antimicrobial resistance.</p><p><strong>Methods: </strong>We used 12 CRPA blood isolates stocked in the Asian Bacterial Bank between 2016 and 2018. All isolates were tested by multi-locus sequencing and carbapenemase multiplex PCR. To assess the antimicrobial interactions, we performed time-kill assays using double or triple combination regimens. These regimens included CST and/or rifampin combined with IPM, MEM, or CZA. The assay was conducted at 1× and 0.5× MICs.</p><p><strong>Results: </strong>Among the 12 CRPA isolates, nine produced metallo-beta-lactamases (6 IMP-6, 2 VIM-2 and 1 NDM-1). In the time-kill assay, the median viable bacterial count for CST-rifampin was the lowest among double combinations after 24 h incubation (2.25 log cfu/mL at 1× MIC and 3.71 log cfu/mL at 0.5× MIC). In contrast, all triple combinations achieved 0 log cfu/mL at both 1× MIC and 0.5× MIC. Compared with CST-rifampin (synergism: 25% at 1× MIC, 42% at 0.5× MIC; bactericidal: 50% at 1× MIC, 42% at 0.5× MIC), all triple combinations showed greater synergism and bactericidal activity at both 1× MIC (50%-75% for synergism, 75%-83% for bactericidal activity) and 0.5× MIC (58%-75% for both).</p><p><strong>Conclusions: </strong>Our findings suggest that CST-rifampin-based triple antimicrobial combinations exhibit greater synergy and bactericidal activity in eradicating CRPA compared with double antimicrobial combinations.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"738-745"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quantification of maternal and fetal valaciclovir exposure in a pharmacokinetic study of cytomegalovirus-infected pregnant women treated to prevent vertical transmission. 在巨细胞病毒感染孕妇治疗以防止垂直传播的药代动力学研究中,定量测定母体和胎儿的伐昔洛韦暴露。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae470
Valentine Faure-Bardon, Naïm Bouazza, Sihem Benaboud, Frantz Foissac, Steeve Rouillon, Léo Froelicher-Bournaud, Marianne Leruez-Ville, Tiffany Guilleminot, Gabrielle Lui, Jean-Marc Tréluyer, Yves Ville

Background: In cases of maternal primary infection with cytomegalovirus (CMV-MPI) maternal treatment with oral valaciclovir 8 g/day has been shown to reduce the risk of fetal infection. The pharmacological profile of this high dosage during pregnancy is not yet known.

Objectives: To quantify maternal-fetal exposure to valaciclovir 8 g/day in a population pharmacokinetic (popPK) study.

Methods: Between October 2019 and April 2023, pregnant women referred for CMV-MPI were offered to participate following: (i) CMV-MPI <14 weeks of gestation; (ii) acceptance of valaciclovir 8 g/day; and (iii) consent for amniocentesis. Amniotic fluid was tested for (i) CMV PCR for prenatal diagnosis; and (ii) dosage of aciclovir concentration (the active form of valaciclovir). Maternal serum levels of aciclovir were also measured. Aciclovir assays in both compartments were used for popPK analysis. Pharmacokinetics were described using non-linear mixed-effect modelling.

Results: We prospectively included 119 women with their 122 fetuses. CMV-MPI occurred at a median of 3.0 (range: -12; + 14) weeks of gestation. CMV-infected pregnant women were treated at a median of 12.3 (range: 4.6-21.4) weeks of gestation for a median duration of 35 days (range: 7-90 days). Median pharmacokinetic parameters (Cmin, Cmax and AUC0-24) were all successfully defined in both maternal blood and amniotic fluid compartments. No differences in aciclovir exposure were observed between infected (n = 12, 9.8%) and non-infected fetuses. Simulations showed that after a last maternal dose, aciclovir concentration would be undetectable in the amniotic fluid after 43-47 h.

Conclusions: In this popPK study, maternal and fetal pharmacokinetics were established using in vivo data. The results provide a better understanding of how this fetal therapy works.

背景:在母体原发性巨细胞病毒感染(CMV-MPI)的病例中,母体口服8g /天的伐昔洛韦治疗已被证明可以降低胎儿感染的风险。这种高剂量在怀孕期间的药理学特征尚不清楚。目的:在人群药代动力学(popPK)研究中量化母体-胎儿暴露于8 g/天的伐昔洛韦。方法:在2019年10月至2023年4月期间,推荐接受CMV-MPI的孕妇参加以下活动:(i) CMV-MPI结果:我们前瞻性纳入119名妇女及其122名胎儿。CMV-MPI的中位数为3.0(范围:-12;妊娠+ 14周。cmv感染的孕妇接受治疗的中位时间为妊娠12.3周(范围:4.6-21.4),中位持续时间为35天(范围:7-90天)。中位药代动力学参数(Cmin, Cmax和AUC0-24)均在母体血液和羊水腔室中成功确定。感染胎儿(n = 12, 9.8%)和未感染胎儿的阿昔洛韦暴露量无差异。模拟结果显示,母体最后一次给药后,羊水中阿昔洛韦的浓度在43-47 h后将无法检测到。结论:在本popPK研究中,利用体内数据建立了母体和胎儿的药代动力学。结果提供了更好的理解这种胎儿治疗是如何工作的。
{"title":"Quantification of maternal and fetal valaciclovir exposure in a pharmacokinetic study of cytomegalovirus-infected pregnant women treated to prevent vertical transmission.","authors":"Valentine Faure-Bardon, Naïm Bouazza, Sihem Benaboud, Frantz Foissac, Steeve Rouillon, Léo Froelicher-Bournaud, Marianne Leruez-Ville, Tiffany Guilleminot, Gabrielle Lui, Jean-Marc Tréluyer, Yves Ville","doi":"10.1093/jac/dkae470","DOIUrl":"10.1093/jac/dkae470","url":null,"abstract":"<p><strong>Background: </strong>In cases of maternal primary infection with cytomegalovirus (CMV-MPI) maternal treatment with oral valaciclovir 8 g/day has been shown to reduce the risk of fetal infection. The pharmacological profile of this high dosage during pregnancy is not yet known.</p><p><strong>Objectives: </strong>To quantify maternal-fetal exposure to valaciclovir 8 g/day in a population pharmacokinetic (popPK) study.</p><p><strong>Methods: </strong>Between October 2019 and April 2023, pregnant women referred for CMV-MPI were offered to participate following: (i) CMV-MPI <14 weeks of gestation; (ii) acceptance of valaciclovir 8 g/day; and (iii) consent for amniocentesis. Amniotic fluid was tested for (i) CMV PCR for prenatal diagnosis; and (ii) dosage of aciclovir concentration (the active form of valaciclovir). Maternal serum levels of aciclovir were also measured. Aciclovir assays in both compartments were used for popPK analysis. Pharmacokinetics were described using non-linear mixed-effect modelling.</p><p><strong>Results: </strong>We prospectively included 119 women with their 122 fetuses. CMV-MPI occurred at a median of 3.0 (range: -12; + 14) weeks of gestation. CMV-infected pregnant women were treated at a median of 12.3 (range: 4.6-21.4) weeks of gestation for a median duration of 35 days (range: 7-90 days). Median pharmacokinetic parameters (Cmin, Cmax and AUC0-24) were all successfully defined in both maternal blood and amniotic fluid compartments. No differences in aciclovir exposure were observed between infected (n = 12, 9.8%) and non-infected fetuses. Simulations showed that after a last maternal dose, aciclovir concentration would be undetectable in the amniotic fluid after 43-47 h.</p><p><strong>Conclusions: </strong>In this popPK study, maternal and fetal pharmacokinetics were established using in vivo data. The results provide a better understanding of how this fetal therapy works.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"760-766"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapeutic drug monitoring versus Bayesian AUC-based dosing for vancomycin in routine practice: a cost-benefit analysis.
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkaf011
Barbara O M Claus, Delphine De Smedt, Pieter A De Cock

Background: AUC-based dosing with validated Bayesian software is recommended as a good approach to guide bedside vancomycin dosing.

Objectives: To compare treatment and vancomycin-associated acute kidney injury (AKI) costs between Bayesian AUC-based dosing and conventional therapeutic drug monitoring (TDM) using steady-state plasma concentrations of vancomycin administered as continuous infusion in hospitalized non-critically ill patients with severe Gram-positive infection.

Methods: A cost-benefit analysis presented as a return on investment (ROI) analysis from a hospital perspective was conducted using a decision tree model (TDM versus AUC-based dosing) to simulate treatment cost (personnel, serum sampling and drug cost), vancomycin-associated AKI risk and cost up to 14 days. ROI was calculated against AUC-based software cost. One-way and probabilistic sensitivity analyses (respectively OWSA and PSA) were performed to check for robustness.

Results: In base case, an overall cost per patient of €621.0 with TDM and €543.6 with AUC-based dosing resulted in a treatment saving of €77.4 per patient when applying AUC-based dosing. This saving against the software cost (€26.9/patient) generated an ROI per patient of €1.9 per invested € in software [€1.9 (95% CI 1.6-2.2) in PSA]. Enrolling 900 AUC-based dosed patients annually translated to a net saving of €45 469. Software break-even was reached after 313 patients. In OWSA, a higher AKI risk with TDM strongly contributed to a positive ROI.

Conclusions: AUC-based dosing appeared a cost-saving strategy compared with conventional TDM when applying base-case settings of vancomycin-associated AKI risk, treatment and AKI costs.

{"title":"Therapeutic drug monitoring versus Bayesian AUC-based dosing for vancomycin in routine practice: a cost-benefit analysis.","authors":"Barbara O M Claus, Delphine De Smedt, Pieter A De Cock","doi":"10.1093/jac/dkaf011","DOIUrl":"10.1093/jac/dkaf011","url":null,"abstract":"<p><strong>Background: </strong>AUC-based dosing with validated Bayesian software is recommended as a good approach to guide bedside vancomycin dosing.</p><p><strong>Objectives: </strong>To compare treatment and vancomycin-associated acute kidney injury (AKI) costs between Bayesian AUC-based dosing and conventional therapeutic drug monitoring (TDM) using steady-state plasma concentrations of vancomycin administered as continuous infusion in hospitalized non-critically ill patients with severe Gram-positive infection.</p><p><strong>Methods: </strong>A cost-benefit analysis presented as a return on investment (ROI) analysis from a hospital perspective was conducted using a decision tree model (TDM versus AUC-based dosing) to simulate treatment cost (personnel, serum sampling and drug cost), vancomycin-associated AKI risk and cost up to 14 days. ROI was calculated against AUC-based software cost. One-way and probabilistic sensitivity analyses (respectively OWSA and PSA) were performed to check for robustness.</p><p><strong>Results: </strong>In base case, an overall cost per patient of €621.0 with TDM and €543.6 with AUC-based dosing resulted in a treatment saving of €77.4 per patient when applying AUC-based dosing. This saving against the software cost (€26.9/patient) generated an ROI per patient of €1.9 per invested € in software [€1.9 (95% CI 1.6-2.2) in PSA]. Enrolling 900 AUC-based dosed patients annually translated to a net saving of €45 469. Software break-even was reached after 313 patients. In OWSA, a higher AKI risk with TDM strongly contributed to a positive ROI.</p><p><strong>Conclusions: </strong>AUC-based dosing appeared a cost-saving strategy compared with conventional TDM when applying base-case settings of vancomycin-associated AKI risk, treatment and AKI costs.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"857-867"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High prevalence of reverse transcriptase inhibitors associated resistance mutations among people living with HIV on dolutegravir-based antiretroviral therapy in Francistown, Botswana.
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae472
Ontlametse T Choga, Goitseone M Lemogang, Wonderful T Choga, Gaonyadiwe Muzanywa, Thembinkosi M Shadreck, Charity Ralegoreng, Dorcas Maruapula, Natasha O Moraka, Catherine K Koofhethile, Patrick T Mokgethi, Kedumetse Seru, Boitumelo J L Zuze, Patience Montshosi, Irene Gobe, Modisa S Motswaledi, Rosemary Musonda, Mpaphi B Mbulawa, Joseph Makhema, Roger Shapiro, Shahin Lockman, Tony Chebani, Judith Nawa, Lindani Bochena, Sikhulile Moyo, Simani Gaseitsiwe

Objectives: We assessed HIV-1 drug resistance profiles among people living with HIV (PLWH) with detectable viral load (VL) and on dolutegravir-based antiretroviral therapy (ART) in Botswana.

Methods: The study utilised available 100 residual HIV-1 VL samples from unique PLWH in Francistown who had viraemia at-least 6 months after initiating ART in Botswana's national ART program from November 2023 to January 2024. Viraemia was categorized as low-level viraemia (LLV) (VL: 200-999 copies/mL) or virologic failure (VF) (VL ≥1000 copies/mL). HIV-1 protease, reverse transcriptase and integrase genes were sequenced using an in-house next-generation sequencing Oxford nanopore technology. HIV-1 drug resistance mutations (DRMs) were identified using the HIVdb Program in the Stanford HIV drug resistance database and compared between VL groups.

Results: Among 100 participants, 83.0% were on dolutegravir-based, 10.0% were on non-dolutegravir-based ART and 7.0% had unknown/undocumented ART regimens. Thirty (30%) participants had LLV and 70 (70%) had VF. Among 58 successfully sequenced, 32.8% [95% Confidence Interval (CI): 21.8-46.0] had DRMs to any drug class, 33.3% (4/12) in the LLV group and 32.6% (15/46) in the VF group. Among individuals on dolutegravir-based ART, the overall HIV DRMs were 34.8% (95% CI: 22.7-49.2). By VL groups, 40.0% (95% CI: 16.8-68.7) and 33.3% (95% CI: 20.2-50.0) had DRMs at LLV and VF, respectively.

Conclusions: A high but similar prevalence of any DRMs was observed among individuals with LLV and those with VF on dolutegravir-based therapy. Monitoring DRMs in individuals with detectable VL is crucial for preserving dolutegravir-based ART.

{"title":"High prevalence of reverse transcriptase inhibitors associated resistance mutations among people living with HIV on dolutegravir-based antiretroviral therapy in Francistown, Botswana.","authors":"Ontlametse T Choga, Goitseone M Lemogang, Wonderful T Choga, Gaonyadiwe Muzanywa, Thembinkosi M Shadreck, Charity Ralegoreng, Dorcas Maruapula, Natasha O Moraka, Catherine K Koofhethile, Patrick T Mokgethi, Kedumetse Seru, Boitumelo J L Zuze, Patience Montshosi, Irene Gobe, Modisa S Motswaledi, Rosemary Musonda, Mpaphi B Mbulawa, Joseph Makhema, Roger Shapiro, Shahin Lockman, Tony Chebani, Judith Nawa, Lindani Bochena, Sikhulile Moyo, Simani Gaseitsiwe","doi":"10.1093/jac/dkae472","DOIUrl":"10.1093/jac/dkae472","url":null,"abstract":"<p><strong>Objectives: </strong>We assessed HIV-1 drug resistance profiles among people living with HIV (PLWH) with detectable viral load (VL) and on dolutegravir-based antiretroviral therapy (ART) in Botswana.</p><p><strong>Methods: </strong>The study utilised available 100 residual HIV-1 VL samples from unique PLWH in Francistown who had viraemia at-least 6 months after initiating ART in Botswana's national ART program from November 2023 to January 2024. Viraemia was categorized as low-level viraemia (LLV) (VL: 200-999 copies/mL) or virologic failure (VF) (VL ≥1000 copies/mL). HIV-1 protease, reverse transcriptase and integrase genes were sequenced using an in-house next-generation sequencing Oxford nanopore technology. HIV-1 drug resistance mutations (DRMs) were identified using the HIVdb Program in the Stanford HIV drug resistance database and compared between VL groups.</p><p><strong>Results: </strong>Among 100 participants, 83.0% were on dolutegravir-based, 10.0% were on non-dolutegravir-based ART and 7.0% had unknown/undocumented ART regimens. Thirty (30%) participants had LLV and 70 (70%) had VF. Among 58 successfully sequenced, 32.8% [95% Confidence Interval (CI): 21.8-46.0] had DRMs to any drug class, 33.3% (4/12) in the LLV group and 32.6% (15/46) in the VF group. Among individuals on dolutegravir-based ART, the overall HIV DRMs were 34.8% (95% CI: 22.7-49.2). By VL groups, 40.0% (95% CI: 16.8-68.7) and 33.3% (95% CI: 20.2-50.0) had DRMs at LLV and VF, respectively.</p><p><strong>Conclusions: </strong>A high but similar prevalence of any DRMs was observed among individuals with LLV and those with VF on dolutegravir-based therapy. Monitoring DRMs in individuals with detectable VL is crucial for preserving dolutegravir-based ART.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"767-776"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A scoring system to predict resistance to ceftolozane/tazobactam in respiratory isolates of Pseudomonas aeruginosa. 铜绿假单胞菌呼吸道分离株对头孢唑烷/他唑巴坦耐药的预测评分系统。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkae476
Eda Karadogan, Ahmet Sertcelik, Gulcin Telli Dizman, Hanife Uzar, Gulsen Hazirolan, Banu Cakir, Gokhan Metan

Objectives: To develop a scoring system to predict resistance to ceftolozane/tazobactam in Pseudomonas aeruginosa strains isolated from respiratory specimens.

Methods: A case-control study was conducted to evaluate the risk factors associated with resistance to ceftolozane/tazobactam. Patients with P. aeruginosa were defined as cases if they had ceftolozane/tazobactam-resistant strains, whereas those with ceftolozane/tazobactam-susceptible strains were defined as test-negative controls. A predictive scoring system based on binary logistic regression coefficients was formulated to predict resistance to ceftolozane/tazobactam. The score's performance was assessed using ROC curves and AUC. The sensitivity, specificity and predictive values of the score were determined on the basis of a cut-off point, using the Youden index.

Results: Ceftolozane/tazobactam resistance was detected in 18.4% of P. aeruginosa isolates from 473 patients. In multivariate analysis, a history of bronchoscopy [OR (95% CI) = 2.1 (1.1-4.3), P = 0.035], invasive mechanical ventilation [OR (95% CI) = 2.4 (1.2-4.5), P = 0.009], colistin/polymyxin B use [OR (95% CI) = 3.2 (1.8-5.7), P < 0.001] and fluoroquinolone use [OR (95% CI) = 2.3 (1.1-4.8), P = 0.024] in the preceding month prior to P. aeruginosa isolation were significantly associated with ceftolozane/tazobactam resistance. The AUC (95% CI) of the score was 0.734 (0.675-0.794), with a sensitivity of 69%, specificity of 71.8%, positive predictive value of 35.5% and negative predictive value of 91.1% at the cut-off point of 2, out of a range of 0-5.

Conclusions: In respiratory tract infections caused by P. aeruginosa, use of the proposed scoring system may reduce inappropriate use of ceftolozane/tazobactam in empirical treatment.

目的:建立一种预测呼吸标本中铜绿假单胞菌对头孢唑烷/他唑巴坦耐药的评分系统。方法:采用病例对照研究,评价头孢唑烷/他唑巴坦耐药的相关危险因素。铜绿假单胞菌患者如果有头孢唑烷/他唑巴坦耐药菌株被定义为病例,而头孢唑烷/他唑巴坦敏感菌株被定义为检测阴性对照。建立了基于二元logistic回归系数的预测评分系统来预测头孢唑烷/他唑巴坦的耐药性。采用ROC曲线和AUC评价评分的表现。采用约登指数(Youden index),根据分界点确定评分的敏感性、特异性和预测值。结果:473例铜绿假单胞菌中有18.4%对头孢唑烷/他唑巴坦耐药。在多因素分析中,支气管镜病史[OR (95% CI) = 2.1 (1.1-4.3), P = 0.035],有创机械通气[OR (95% CI) = 2.4 (1.2-4.5), P = 0.009],粘菌素/多粘菌素B使用[OR (95% CI) = 3.2 (1.8-5.7), P结论:在铜绿假单胞菌引起的呼吸道感染中,使用所提出的评分系统可减少经验治疗中不适当使用头孢唑烷/他唑巴坦。
{"title":"A scoring system to predict resistance to ceftolozane/tazobactam in respiratory isolates of Pseudomonas aeruginosa.","authors":"Eda Karadogan, Ahmet Sertcelik, Gulcin Telli Dizman, Hanife Uzar, Gulsen Hazirolan, Banu Cakir, Gokhan Metan","doi":"10.1093/jac/dkae476","DOIUrl":"10.1093/jac/dkae476","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a scoring system to predict resistance to ceftolozane/tazobactam in Pseudomonas aeruginosa strains isolated from respiratory specimens.</p><p><strong>Methods: </strong>A case-control study was conducted to evaluate the risk factors associated with resistance to ceftolozane/tazobactam. Patients with P. aeruginosa were defined as cases if they had ceftolozane/tazobactam-resistant strains, whereas those with ceftolozane/tazobactam-susceptible strains were defined as test-negative controls. A predictive scoring system based on binary logistic regression coefficients was formulated to predict resistance to ceftolozane/tazobactam. The score's performance was assessed using ROC curves and AUC. The sensitivity, specificity and predictive values of the score were determined on the basis of a cut-off point, using the Youden index.</p><p><strong>Results: </strong>Ceftolozane/tazobactam resistance was detected in 18.4% of P. aeruginosa isolates from 473 patients. In multivariate analysis, a history of bronchoscopy [OR (95% CI) = 2.1 (1.1-4.3), P = 0.035], invasive mechanical ventilation [OR (95% CI) = 2.4 (1.2-4.5), P = 0.009], colistin/polymyxin B use [OR (95% CI) = 3.2 (1.8-5.7), P < 0.001] and fluoroquinolone use [OR (95% CI) = 2.3 (1.1-4.8), P = 0.024] in the preceding month prior to P. aeruginosa isolation were significantly associated with ceftolozane/tazobactam resistance. The AUC (95% CI) of the score was 0.734 (0.675-0.794), with a sensitivity of 69%, specificity of 71.8%, positive predictive value of 35.5% and negative predictive value of 91.1% at the cut-off point of 2, out of a range of 0-5.</p><p><strong>Conclusions: </strong>In respiratory tract infections caused by P. aeruginosa, use of the proposed scoring system may reduce inappropriate use of ceftolozane/tazobactam in empirical treatment.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"788-796"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ceftaroline versus vancomycin for methicillin-resistant Staphylococcus aureus bacteraemia, a matched cohort study.
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2025-03-03 DOI: 10.1093/jac/dkaf009
Roni Bitterman, Aya Awwad, Basel Darawsha, Hajar Dallashi, Yael Dishon-Benattar, Dina Pollack, Mical Paul

Background: Vancomycin remains the treatment-of-choice in MRSA bacteraemia (MRSAB) despite significant limitations.

Objective: To compare the effectiveness of ceftaroline and vancomycin monotherapy as the initial targeted therapy for MRSAB.

Methods: We conducted a retrospective matched cohort study. Consecutive adult patients treated with ceftaroline in the years 2019-2021 were matched in a 1:2 ratio with patients who received vancomycin. Controls were matched for performance of trans-oesophageal echocardiography, Charlson comorbidity index and age. The primary outcome was a composite of treatment failure, defined as 90-day mortality or microbiological failure. Descriptive statistics were used to compare the ceftaroline and vancomycin-treated groups. Univariate and multivariable binary logistic regression models were created using ceftaroline treatment as the exposure variable.

Results: Forty-five patients treated with ceftaroline for MRSAB were matched with 83 patients who received vancomycin. The groups were well balanced with regards to demographics and clinical characteristics. The primary outcome of treatment failure occurred at a similar rate in patients treated with ceftaroline or vancomycin (51.1%, 23/45% versus 57.8%, 48/83, respectively, P = 0.47). In the multivariable analysis, only age (aOR 1.06, 95% CI 1.01-1.1, P = 0.02) was associated with treatment failure. Acute kidney injury was more common among patients treated with ceftaroline (51.1%, 23/45% versus 18.1%, 15/83, P < 0.001).

Conclusions: Ceftaroline was not associated with improved outcomes compared to vancomycin when given as initial treatment for MRSAB, however, it appears to be a viable alternative to vancomycin. Larger studies are needed to provide definitive results and to elucidate the risk of nephrotoxicity.

背景:万古霉素是治疗MRSA菌血症(MRSAB)的首选药物,尽管存在很大局限:万古霉素仍然是治疗MRSA菌血症(MRSAB)的首选药物,尽管它有很大的局限性:比较头孢他啶和万古霉素单一疗法作为 MRSAB 初始靶向疗法的有效性:我们进行了一项回顾性匹配队列研究。将 2019-2021 年期间接受头孢他啶治疗的连续成年患者与接受万古霉素治疗的患者按 1:2 的比例进行配对。对照组与经食道超声心动图检查结果、夏尔森合并症指数和年龄相匹配。主要结果是治疗失败的复合结果,即 90 天死亡率或微生物学失败。描述性统计用于比较头孢他啶治疗组和万古霉素治疗组。以头孢他啶治疗作为暴露变量,建立了单变量和多变量二元逻辑回归模型:45 名接受头孢他啶治疗的 MRSAB 患者与 83 名接受万古霉素治疗的患者进行了配对。两组在人口统计学和临床特征方面非常均衡。头孢他啶或万古霉素治疗患者治疗失败的主要结果发生率相似(分别为 51.1%,23/45% 对 57.8%,48/83,P = 0.47)。在多变量分析中,只有年龄(aOR 1.06,95% CI 1.01-1.1,P = 0.02)与治疗失败有关。急性肾损伤在接受头孢他啶治疗的患者中更为常见(51.1%,23/45% 对 18.1%,15/83,P 结论:头孢他啶与急性肾损伤无关:与万古霉素相比,头孢他啶在MRSAB的初始治疗中并不能改善疗效,但它似乎是万古霉素的一种可行替代药物。需要进行更大规模的研究来提供明确的结果,并阐明肾毒性的风险。
{"title":"Ceftaroline versus vancomycin for methicillin-resistant Staphylococcus aureus bacteraemia, a matched cohort study.","authors":"Roni Bitterman, Aya Awwad, Basel Darawsha, Hajar Dallashi, Yael Dishon-Benattar, Dina Pollack, Mical Paul","doi":"10.1093/jac/dkaf009","DOIUrl":"10.1093/jac/dkaf009","url":null,"abstract":"<p><strong>Background: </strong>Vancomycin remains the treatment-of-choice in MRSA bacteraemia (MRSAB) despite significant limitations.</p><p><strong>Objective: </strong>To compare the effectiveness of ceftaroline and vancomycin monotherapy as the initial targeted therapy for MRSAB.</p><p><strong>Methods: </strong>We conducted a retrospective matched cohort study. Consecutive adult patients treated with ceftaroline in the years 2019-2021 were matched in a 1:2 ratio with patients who received vancomycin. Controls were matched for performance of trans-oesophageal echocardiography, Charlson comorbidity index and age. The primary outcome was a composite of treatment failure, defined as 90-day mortality or microbiological failure. Descriptive statistics were used to compare the ceftaroline and vancomycin-treated groups. Univariate and multivariable binary logistic regression models were created using ceftaroline treatment as the exposure variable.</p><p><strong>Results: </strong>Forty-five patients treated with ceftaroline for MRSAB were matched with 83 patients who received vancomycin. The groups were well balanced with regards to demographics and clinical characteristics. The primary outcome of treatment failure occurred at a similar rate in patients treated with ceftaroline or vancomycin (51.1%, 23/45% versus 57.8%, 48/83, respectively, P = 0.47). In the multivariable analysis, only age (aOR 1.06, 95% CI 1.01-1.1, P = 0.02) was associated with treatment failure. Acute kidney injury was more common among patients treated with ceftaroline (51.1%, 23/45% versus 18.1%, 15/83, P < 0.001).</p><p><strong>Conclusions: </strong>Ceftaroline was not associated with improved outcomes compared to vancomycin when given as initial treatment for MRSAB, however, it appears to be a viable alternative to vancomycin. Larger studies are needed to provide definitive results and to elucidate the risk of nephrotoxicity.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"848-856"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Antimicrobial Chemotherapy
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