Estimating the Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in the United States Using Antibiotic Prescription Data.
carbapenem-resistant Enterobacteriaceae
ceftazidime-avibactam
meropenem-vaborbactam
plazomicin
polymyxins
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
11
04
2019
accepted:
22
07
2019
entrez:
30
10
2019
pubmed:
30
10
2019
medline:
30
10
2019
Statut:
epublish
Résumé
Polymyxins (colistin, polymyxin B) have been first-line antibiotics against carbapenem-resistant Enterobacteriaceae (CRE) infections. New anti-CRE antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) improve outcomes in CRE-infected patients and reduce toxicity compared with polymyxins. It is unclear how widely polymyxins and newer agents are used to treat CRE infections. We conducted an online survey of US hospital-based pharmacists to determine antibiotic positioning against CRE infections. Numbers of all infections and CRE infections treated with different antibiotics in the United States were determined using IQVIA prescription data and Driving Re-investment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) estimates of CRE infections. Ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin were positioned as first-line agents against CRE pneumonia, bacteremia, intra-abdominal infections, and urinary tract infections at 87%, 90%, 83%, and 56% of surveyed US hospitals, respectively. From February 2018 to January 2019, an estimated 9437 and 7941 CRE infections were treated with an intravenous polymyxin or new agent, respectively; these figures represented ~28% (range, 19%-50%) and ~23% (range, 16%-42%) of CRE infections in the United States. Use of ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin exceeded that of intravenous polymyxins against CRE infections as of December 2018. Currently, the new drugs are estimated to treat 35% (23% to 62%) of CRE infections in which they were expected to be first-line agents. New anti-CRE agents recently surpassed intravenous polymyxins as treatment for CRE infections, but use is less than expected from their positioning at US hospitals. Research on behavioral and economic factors that impact use of new antibiotics is needed, as are financial "pull" incentives that promote an economically viable marketplace.
Sections du résumé
BACKGROUND
BACKGROUND
Polymyxins (colistin, polymyxin B) have been first-line antibiotics against carbapenem-resistant Enterobacteriaceae (CRE) infections. New anti-CRE antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) improve outcomes in CRE-infected patients and reduce toxicity compared with polymyxins. It is unclear how widely polymyxins and newer agents are used to treat CRE infections.
METHODS
METHODS
We conducted an online survey of US hospital-based pharmacists to determine antibiotic positioning against CRE infections. Numbers of all infections and CRE infections treated with different antibiotics in the United States were determined using IQVIA prescription data and Driving Re-investment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) estimates of CRE infections.
RESULTS
RESULTS
Ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin were positioned as first-line agents against CRE pneumonia, bacteremia, intra-abdominal infections, and urinary tract infections at 87%, 90%, 83%, and 56% of surveyed US hospitals, respectively. From February 2018 to January 2019, an estimated 9437 and 7941 CRE infections were treated with an intravenous polymyxin or new agent, respectively; these figures represented ~28% (range, 19%-50%) and ~23% (range, 16%-42%) of CRE infections in the United States. Use of ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin exceeded that of intravenous polymyxins against CRE infections as of December 2018. Currently, the new drugs are estimated to treat 35% (23% to 62%) of CRE infections in which they were expected to be first-line agents.
CONCLUSIONS
CONCLUSIONS
New anti-CRE agents recently surpassed intravenous polymyxins as treatment for CRE infections, but use is less than expected from their positioning at US hospitals. Research on behavioral and economic factors that impact use of new antibiotics is needed, as are financial "pull" incentives that promote an economically viable marketplace.
Identifiants
pubmed: 31660388
doi: 10.1093/ofid/ofz344
pii: ofz344
pmc: PMC6734139
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofz344Informations de copyright
Published by Oxford University Press on behalf of Infectious Diseases Society of America 2019.
Références
Clin Infect Dis. 2012 Oct;55(8):1031-46
pubmed: 22891041
Clin Infect Dis. 2019 Jan 18;68(3):519-524
pubmed: 30020449
J Clin Microbiol. 2018 Jan 24;56(2):
pubmed: 29167294
N Engl J Med. 2019 Feb 21;380(8):791-793
pubmed: 30786196
Antimicrob Agents Chemother. 2017 Jan 24;61(2):
pubmed: 27895014
Clin Infect Dis. 2019 Jan 18;68(3):355-364
pubmed: 29893802
Clin Infect Dis. 2016 Dec 15;63(12):1615-1618
pubmed: 27624958
Clin Infect Dis. 2017 Jul 1;65(1):141-146
pubmed: 29017263
Int J Antimicrob Agents. 2018 Apr;51(4):629-635
pubmed: 29408227
BMC Infect Dis. 2017 Apr 17;17(1):279
pubmed: 28415969
Clin Infect Dis. 2018 Jan 6;66(2):163-171
pubmed: 29020404
J Law Med Ethics. 2018 Jun;46(1_suppl):59-65
pubmed: 30146959
Clin Infect Dis. 2009 Jan 1;48(1):1-12
pubmed: 19035777
Clin Infect Dis. 2016 Dec 1;63(11):1470-1474
pubmed: 27578820
Lancet Infect Dis. 2018 Mar;18(3):318-327
pubmed: 29276051
Infect Drug Resist. 2018 Sep 12;11:1461-1472
pubmed: 30254477
Clin Infect Dis. 2017 Sep 1;65(5):860-863
pubmed: 28472253
Infect Dis Ther. 2018 Dec;7(4):439-455
pubmed: 30270406
Antimicrob Agents Chemother. 2017 Jul 25;61(8):
pubmed: 28559250
Antimicrob Agents Chemother. 2017 Apr 24;61(5):
pubmed: 28223379
Lancet Glob Health. 2018 Sep;6(9):e969-e979
pubmed: 30103998