Comparative effectiveness of ceftolozane/tazobactam against pediatric gram-negative drug-resistant isolates.

2021

1-6

2021 Mar 01

1973-9478

<p>Ceftolozane/tazobactam (C/T), a cephalosporin/beta-lactamase inhibitor combination, was evaluated vs. 10 comparators against 299 pediatric extended-spectrum-cephalosporin-resistant or carbapenem-resistant (ESC-R/CR) Gram-negative Enterobacteriaceae from three freestanding pediatric centers. Isolates were from urine or other sterile sites of children and adolescents through 21 years of age. Susceptibilities were assayed by microbroth dilution via custom Sensititre plates (Thermo Fisher Scientific). Susceptibility was determined using the Sensititre Vizion® system (Thermo Fisher Scientific). Susceptibility breakpoint criteria were those of the Clinical and Laboratory Standards Institute (CLSI) for 2017, except for colistin (EUCAST 2019). Overall, 87.5% isolates were C/T susceptible (MIC ≤2 μg/ml; MIC 0.25/4 μg/ml). Susceptibility to C/T was detected more frequently as compared to all other antimicrobials tested except for colistin (95.4%) and meropenem (97.4%). Percent susceptibility to C/T was high for (91%) and . (73.3%). C/T demonstrated good activity and high potency against most beta-lactam resistant pediatric Enterobacteriaceae from three geographically diverse U.S. regions.</p>

10.1080/1120009X.2021.1888030

J Chemother

33645447

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children's Oncology Group.

2020

2020 Oct 20

1097-0142

<p><strong>BACKGROUND: </strong>To the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line-associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited.</p>

<p><strong>METHODS: </strong>In the current multicenter, randomized, double-blind, placebo-controlled trial, patients aged ≥2 months and &lt;22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once-daily bathing with 2% CHG-impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration.</p>

<p><strong>RESULTS: </strong>The study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05-4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, -0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032).</p>

<p><strong>CONCLUSIONS: </strong>The data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT.</p>

10.1002/cncr.33271

Cancer

33079403

Antibiotic prophylaxis is associated with subsequent resistant infections in children with an initial extended-spectrum cephalosporin-resistant Enterobacteriaceae infection.

2017

2017 Mar 13

1098-6596

<p>The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and occurrence of subsequent resistant infections in children with index infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae We also investigated the concordance of index and subsequent isolates. Extended-spectrum cephalosporin-resistant E. coli and Klebsiella spp. isolated from normally sterile sites of patients aged &lt;22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC/fimH (E. coli) or tonB (K. pneumoniae) type were identical to the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between index and first subsequent infection was 123 days (interquartile range 43, 225). In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 (71%) of 17 patients with E. coli ST131-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.</p>

10.1128/AAC.02656-16

Antimicrob. Agents Chemother.

28289030