Bloodstream Infection Due to a VIM-Metallo-β-Lactamase-Producing Klebsiella pneumoniae Treated with Cefiderocol in a Preterm Newborn.
Antimicrobial stewardship program (ASP)
Cefiderocol
Infection prevention and control (IPC)
MDROs
Newborn
Journal
Infectious diseases and therapy
ISSN: 2193-8229
Titre abrégé: Infect Dis Ther
Pays: New Zealand
ID NLM: 101634499
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
21
09
2022
accepted:
21
11
2022
pubmed:
16
12
2022
medline:
16
12
2022
entrez:
15
12
2022
Statut:
ppublish
Résumé
The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns. We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae. We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative. Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.
Sections du résumé
BACKGROUND
BACKGROUND
The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns.
CASE REPORT
METHODS
We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae. We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative.
CONCLUSIONS
CONCLUSIONS
Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.
Identifiants
pubmed: 36522526
doi: 10.1007/s40121-022-00735-4
pii: 10.1007/s40121-022-00735-4
pmc: PMC9925637
doi:
Types de publication
Journal Article
Langues
eng
Pagination
727-734Informations de copyright
© 2022. The Author(s).
Références
WHO. Global action plan on antimicrobial resistance. 2016. https://www.who.int/publications/i/item/9789241509763 . Accessed 21 Sept 2022.
Romandini A, Pani A, Schenardi PA, et al. Antibiotics resistance in pediatric infections: global emerging threats predicting the near future. Antibiotic. 2021. https://doi.org/10.3390/antibiotics10040393 .
doi: 10.3390/antibiotics10040393
WHO Regional Office for Europe. Fact sheets on sustainable development goals: health targets. Antimicrobial resistance. 2017. https://www.euro.who.int/__data/assets/pdf_file/0005/348224/Fact-sheet-SDG-AMR-FINAL-07-09-2017.pdf . Accessed 21 Sept 2022.
Chung A, Perera R, Brueggemann AB et al. Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study. Br Med J. 2007. http://www.bmj.com/ .
Macera M, Calò F, Onorato L, et al. Inappropriateness of antibiotic prescribing in medical, surgical and intensive care units: results of a multicentre observational study. Life. 2021. https://doi.org/10.3390/life11060475 .
doi: 10.3390/life11060475
pubmed: 34073866
pmcid: 8225033
Calò F, Onorato L, Macera M, et al. Impact of an education-based antimicrobial stewardship program on the appropriateness of antibiotic prescribing: results of a multicenter observational study. Antibiotics. 2021. https://doi.org/10.3390/antibiotics10030314 .
doi: 10.3390/antibiotics10030314
pubmed: 34827343
pmcid: 8614883
Smith MJ, Gerber JS, Hersh AL. Inpatient antimicrobial stewardship in pediatrics: a systematic review. 2015. https://academic.oup.com/jpids/article/4/4/e127/2580220 .
Flannery DD, Akinboyo IC, Mukhopadhyay S et al. Antibiotic susceptibility of Escherichia coli among infants admitted to neonatal intensive care units across the US from 2009 to 2017. JAMA Pediatr 2021; 175(2):168–175. https://doi.org/10.1001/jamapediatrics.2020.4719 .
doi: 10.1001/jamapediatrics.2020.4719
pubmed: 33165599
Coffin SE, Abanyie SF, Bryant K et al. Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship. Infect Control Hosp Epidemiol . 2021;42(5):519–522. https://doi.org/10.1017/ice.2020.1267 .
doi: 10.1017/ice.2020.1267
pubmed: 33239122
Flannery DD, Chiotos K, Gerber JS, Puopolo KM. Neonatal multidrug resistant Gram-negative infection: epidemiology, mechanisms of resistance, and management HHS Public Access. Pediatr Res. 2022;91(2):380–91. http://www.nature.com/authors/editorial_policies/license.html#terms .
Lautenbach E, Perencevich EN. Addressing the emergence and impact of multidrug-resistant gram-negative organisms: a critical focus for the next decade. Infect Control Hosp Epidomiol. 2016. https://doi.org/10.1086/675592 .
doi: 10.1086/675592
Folgori L, Bielicki L. Future challenges in pediatric and neonatal sepsis: emerging pathogens and antimicrobial resistance. J Pediatr Intensive Care. 2019;8(1):17–24.
doi: 10.1055/s-0038-1677535
pubmed: 31073504
pmcid: 6506670
Patel S, Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol . 2010;37(3):547–63. https://doi.org/10.1016/j.clp.2010.06.004 .
doi: 10.1016/j.clp.2010.06.004
pubmed: 20813270
pmcid: 4440667
Logan LK, Renschler JP, Gandra S, et al. Carbapenem-resistant Enterobacteriaceae in children, United States, 1999–2012. Emerg Infect Dis. 2015. https://doi.org/10.3201/eid2111.150548 .
doi: 10.3201/eid2111.150548
pubmed: 26486124
pmcid: 4622248
Larru B, Gong W, Vendetti N et al. Bloodstream infections in hospitalized children: epidemiology and antimicrobial susceptibilities. Pediatr Infect Dis J . 2016;35(5):507–10. https://doi.org/10.1097/INF.0000000000001057 .
doi: 10.1097/INF.0000000000001057
pubmed: 26766146
Katsube T, Echols R, Wajima T. 739. Prediction of cefiderocol pharmacokinetics and probability of target attainment in pediatric subjects for proposing dose regimens. Open Forum Infect Dis. 2019; 6(Suppl 2): S330–S331. https://doi.org/10.1093/ofid/ofz360.807 .
doi: 10.1093/ofid/ofz360.807
pmcid: 6811267
European Medicines Agency. Cefiderocol-summary of product characteristics. 2020. https://www.ema.europa.eu/en/documents/product-information/fetcroja-epar-product-information_en.pdf . Accessed 21 Sept.
Folgori L, Bielicki J, Heath PT Sharland M.. Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment. https://doi.org/10.1097/QCO.0000000000000371 .
doi: 10.1097/QCO.0000000000000371
pubmed: 28306563
Ding Y, Wang Y, Hsia Y, Sharland M, Heath PT. Systematic review of carbapenem-resistant Enterobacteriaceae causing neonatal sepsis in China. Ann Clin Microbiol Antimicrob. 2019;18:36. https://doi.org/10.1186/s12941-019-0334-9 .
doi: 10.1186/s12941-019-0334-9
pubmed: 31727088
pmcid: 6857301
Pragosa H, Marçal M, Gonçalves E, Martins F, Lopo-Tuna M. Multi-drug-resistant Enterobacteriaceae in a Portuguese neonatal intensive care unit. J Hosp Infect. 2017;96(2):130–1.
doi: 10.1016/j.jhin.2017.03.015
pubmed: 28433397
Sands K, Carvalho MJ, Portal E, et al. Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nat Microbiol 2021;6(4):512-523. https://doi.org/10.1038/s41564-021-00870-7 .
doi: 10.1038/s41564-021-00870-7
pubmed: 33782558
pmcid: 8007471
Okomo U, Akpalu ENK, Le Doare K, et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect Dis. 2019;19(11):1219–34. https://doi.org/10.1016/S1473-3099(19)30414-1 .
doi: 10.1016/S1473-3099(19)30414-1
pubmed: 31522858
Smith A, Anandan S, Veeraraghavan B, Thomas N. Colonization of the preterm neonatal gut with carbapenem-resistant Enterobacteriaceae and its association with neonatal sepsis and maternal gut flora. J Glob Infect Dis. 2020;12(2):101–4.
doi: 10.4103/jgid.jgid_104_19
pubmed: 32773998
pmcid: 7384683
Akturk H, Sutcu M, Somer A, et al. Carbapenem-resistant Klebsiella pneumoniae colonization in pediatric and neonatal intensive care units: risk factors for progression to infection. Brazilian J Infect Dis. 2016;20(2):134–40. http://www.sciencedirect.com/science/article/pii/S1413867016300216 .
Turner P, Pol S, Soeng S, et al. High prevalence of antimicrobial-resistant Gram-negative colonization in hospitalized Cambodian infants. Pediatr Infect Dis J. 2016;35(8):856–61. https://doi.org/10.1097/INF.0000000000001187 .
doi: 10.1097/INF.0000000000001187
pubmed: 27124686
pmcid: 4957964
Abdel-Hady H, Hawas S, El-Daker M, El-Kady R. Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatol . 2008 Oct;28(10):685–90. https://doi.org/10.1038/jp.2008.73 .
doi: 10.1038/jp.2008.73
pubmed: 18580881
Huang Y, Zhuang S, Du M. Risk factors of nosocomial infection with extended-spectrum β-lactamase-producing bacteria in a neonatal intensive care unit in China. Infection. 2007;35(5):339–45.
doi: 10.1007/s15010-007-6356-9
pubmed: 17721736
Singh N, Patel KM, Léger MM, et al. Risk of resistant infections with Enterobacteriaceae in hospitalized neonates. Pediatr Infect Dis J. 2002;21(11):1029–1033. https://doi.org/10.1097/00006454-200211000-00010 .
doi: 10.1097/00006454-200211000-00010
pubmed: 12442024
Yin L, He L, Miao J, et al. Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China. Infect Prev Pract. 2021;3(3): 100147.
doi: 10.1016/j.infpip.2021.100147
pubmed: 34647006
pmcid: 8498732
Denkel LA, Schwab F, Kola A, et al. The mother as most important risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-E). https://academic.oup.com/jac/article/69/8/2230/2911117 .
Stapleton PJM, Murphy M, McCallion N, Brennan M, Cunney R, Drew RJ. Outbreaks of extended spectrum beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2016;101(1):F72–8. https://doi.org/10.1136/archdischild-2015-308707 .
doi: 10.1136/archdischild-2015-308707
pubmed: 26369370
Pessoa-Silva CL, Meurer Moreira B, Câmara Almeida V, et al. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: Risk factors for infection and colonization. J Hosp Infect. 2003;53(3):198–206.
doi: 10.1053/jhin.2002.1373
pubmed: 12623321
Ho T, Buus-Frank ME, Edwards EM, et al. Adherence of newborn-specific antibiotic stewardship programs to CDC recommendations. Pediatrics. 2018;142(6):1–16.
doi: 10.1542/peds.2017-4322
Onorato L, Macera M, Calò F, et al. The effect of an antimicrobial stewardship programme in two intensive care units of a teaching hospital: an interrupted time series analysis. Clin Microbiol Infect. 2020;26(6):782.e1–782.e6.
doi: 10.1016/j.cmi.2019.10.021
pubmed: 31678230
European Commission. EU Guidelines for the prudent use of antimicrobials in human health. Off J Eur Union. 2017. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52017XC0701(01)&from=ET .
Center for Disease Control and Prevention. The core elements of hospital antibiotic stewardship programs, 2014. https://www.cdc.gov/antibiotic-use/%0Ahealthcare/pdfs/core-elements.pdf%0A . Accessed 21 Sept 2022.
Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. 2016. https://academic.oup.com/cid/article/62/10/e51/2462846 . Accessed 21 Sept 2022.