Infecciones asociadas a enterobacterias productoras de carbapenemasas OXA-48 en pacientes quirúrgicos: consumo de antibióticos y evolución de sensibilidades

OBJECTIVE: To assess antibiotic consumption, susceptibility patterns and targeted treatment for OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) related infections in surgical patients in a General Surgery Department. MATERIAL AND METHODS: Retrospective review of patients with a positive cult...

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Detalles Bibliográficos
Autores principales: Mora-Guzmán, Ismael, Rubio-Pérez, Inés, Domingo-Garcia, Diego, Martín-Pérez, Elena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedad Española de Quimioterapia 2020
Materias:
Original Breve
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712339/
https://www.ncbi.nlm.nih.gov/pubmed/33059423
http://dx.doi.org/10.37201/req/081.2020
Descripción
Sumario:OBJECTIVE: To assess antibiotic consumption, susceptibility patterns and targeted treatment for OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) related infections in surgical patients in a General Surgery Department. MATERIAL AND METHODS: Retrospective review of patients with a positive culture for OXA-48 and associated clinical data of infection, while hospitalized in a General Surgery Department from January 2013 to December 2018. RESULTS: Sixty-five patients with 66 isolations (OXA-48) were included: Klebsiella pneumoniae, 57 (86.5%); Enterobacter cloacae, 5 (7.6%); Escherichia coli, 3 (4.5%); Morganella morganii, 1 (1.5%). The most frequent source was intra-abdominal infection (n=39, 60%), and previous antibiotic consumption was: piperacillin-tazobactam (48%), meropenem (45%), ciprofloxacin (25.5%), ertapenem (16.5%), imipenem (12%), amikacin (12%), tigecycline (12%). Temporal trends (2013/14, 2015/16 and 2017/18) in susceptibility patterns were (percentages): ceftazidime-avibactam X-X-100; amikacin 100-96-84 (p=0.518); tigecycline 100-92-80 (p=0.437); colistin 100-67-66 (p<0.001); meropenem 37-64-72 (p=0.214); imipenem 51-41-77 (p=0.109); gentamicin 13-19-18 (p=0.879); ertapenem 35-0-0 (p<0.001). Median duration of the targeted antibiotic therapy was 14 [IQR 9-20] days; antibiotics used were: tigecycline (57%); meropenem (40.5%); amikacin (37.5%); ceftazidime-avibactam (9%); imipenem (7.5%); colistin (7.5%). Global mortality rate at 30 days was 12% (8 patients). Targeted treatment was appropriate (antibiogram) in 87.7%, and targeted combination scheme was administered in 76.9%, which included a carbapenem in 49.2%. CONCLUSIONS: OXA-48-related-intra-abdominal infection is significant in surgical patients, with substantial broad-spectrum antibiotic consumption. Useful targeted therapy includes ceftazidime-avibactam, amikacin, tigecycline, meropenem, and imipenem.

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