Meropenem was FDA-approved in the United States in July of 1996 and is used today for a variety of infections including pneumonia, bacteremia, osteomyelitis, urinary tract … For patients with Escherichia coli or Klebsiella pneumoniae bloodstream infections and ceftriaxone resistance, treatment with piperacillin-tazobactam compared with meropenem did not result in a non-inferior 30-day mortality, according to data published in the Journal of the American Medical Association (ClinicalTrials.gov identifier: NCT02176122). 2011 Nov 10. She had a history of cardiac failure, hepatitis C virus–related liver cirrhosis, and chronic renal insufficiency. [7], In one study, mortality following bacteremic infection caused by ESBL producing E coli was significantly higher than non–ESBL-producing E coli. 6(6):344-9. Strongyloides stercoralis hyperinfection and central nervous system involvement in a patient with relapsing polychondritis. Lancet Infect Dis. [Medline]. 1995 Sep 1. 72(848):361-3. It is used to treat intra-abdominal infections for 14-21 days. 1998. [Medline]. Emphysematous pyelonephritis. Beta-lactamases are classified either by their structure or by their functional properties. The spread of CTX-M–positive bacteria considerably changes how the treatment of community-acquired infections is approached and limits the oral antibiotics that may be administered. According to Infectious Disease Physicians, 2010 8(3):159-66. Extended-spectrum β-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Phillips AD, Frankel G. Mechanisms of gut damage by Escherichia coli. The first transferrable β-lactamase was named TEM, after the name of a patient in Greece in the early 1960s with an E. coli–positive blood culture. metronidazole plus cefepime produces broad-spectrum coverage). aureus. for: Medscape. J Am Vet Med Assoc. 1983 Jul 28. Am J Med. For patients with Escherichia coli or Klebsiella pneumoniae bloodstream infections and ceftriaxone resistance, treatment with piperacillin-tazobactam compared with meropenem did not result in a non-inferior 30-day mortality, according to data published in the Journal of the American Medical Association (ClinicalTrials.gov identifier: NCT02176122).. 91(2):261-8. Neu HC. 1999 Jun. The concentration of meropenem in breast milk was evaluated in a study of a 41-year-old woman treated for a postpartum urinary tract infection caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli with meropenem 1 g IV q 8 h. Levels were taken from five samples, and ranged from 0.246 mcg/mL to 0.644 mcg/mL. 1999 Sep. 29(3):548-52. Meropenem Target Attainment vs. P. aeruginosa •Probability of target attainment is similar for doses of 1g IV q8h and 500mg IV q6h (both at the desired probability of ≥90%), up to an MIC of 2 mg/L. 1994. Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase-Producing E coli and Klebsiella pneumoniae Bloodstream Infection: The Search Continues. 1997. KEY POINTS Meropenem (Merrem) is an injectable carbapenem and beta-lactam antibiotic that interferes with bacterial cell wall synthesis in sensitive organisms Has activity versus a wide array of organisms, including multi-drug resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae DOES NOT cover MRSA or VRE Carbapenems like meropenem are generally considered … Dr Harris also reported receiving support to speak at an educational event sponsored by Pfizer. Ogunbosi BO, Moodley C, Naicker P, Nuttall J, Bamford C, Eley B. PLoS One. 12:616-25. Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth. Klein NC, Cunha BA. 2020 Nov 4;9(11):777. doi: 10.3390/antibiotics9110777. [Medline]. 1991 Aug. 84(8):1055-7. Am Fam Physician. 21:70-1. Dr Peleg reported receiving grants from MSD. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. Imipenem, doripenem, and meropenem also exhibit good activity against most strains of Pseudomonas aeruginosa and Acinetobacter species. Contemp Urol. Dr Tambyah reported receiving grants from the National University Health System, GlaxoSmithKline, Janssen, Shionogi, Sanofi-Pasteur, Visterra, Baxter, ADAMAS, Merlion Pharmaceuticals, Fabentech, and Inviragen. In severe infection, piperacillin and tazobactam, imipenem and cilastatin, or meropenem may be used. [Medline]. Meropenem and imipenem demonstrate good activity against Enterobacteriaceae, including strains producing ESBLs or AmpC (100% for E coli, 99% for other Enterobacteriaceae), meropenem usually being 2 to 4 fold more potent than imipenem [21–23].  |  Cancer. 1998 Aug. 27 Suppl 1:S100-6. It is used to treat uncomplicated UTI for 7 days and complicated UTI or pyelonephritis for 10-14 days. [11]. Ceftolozane/tazobactam: a novel cephalosporin/β-lactamase inhibitor combination with activity against multidrug-resistant gram-negative bacilli. 23(3):218-25. doi: 10.1371/journal.pone.0241776. Unasyn better for anaerobic infections above the waist, less so for intraabdominal infections (due to high rate of resistance in E.coli). Other β-Lactams. 2020 Oct 27;9:e54795. Paul M, Yahav D, Bivas A, Fraser A, Leibovici L. Cochrane Database Syst Rev. Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. Tabacof J, Feher O, Katz A, et al. Meropenem-vaborbactam (MEV) is a novel carbapenem–beta-lactamase inhibitor combination antibiotic approved by the U.S. Food and Drug Administration (FDA) for treatment of complicated urinary tract infections, including pyelonephritis, in adults. imodium-multi-symptom-relief-loperamide-simethicone-999320 1997 Sep. 11(3):465-83. Frank C, Werber D, Cramer JP, Askar M, Faber M, an der Heiden M, et al. 1998. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. [Medline]. JAMA. Design, setting, and participants: E. coliCO clinical isolate; lane 2, E. coliJF 568 strain expressing OmpC; lane 3, E. coli JF 701 strain lacking OmpC (9). 1995 Mar-Apr. three types of antimicrobials (meropenem, gentamicin and amikacin) against twenty five E. coli isolates.Among combinations the combination of meropenem with the other types of antimicrobials showed high synergistic effect when 1/4+1/4 MIC for each antimicrobial were used. Infect Dis Prac. Heart Lung. Adv Vet Sci Comp Med. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid. [Medline]. [Medline]. Intern Med. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. USA.gov. Dr Kanj reported receiving honoraria for speaking and serving on advisory boards for Pfizer, Merck, Bayer, Gilead, Hikma, and Aventis. Aztreonam is a monobactam that inhibits cell wall synthesis during bacterial growth. J Infect. Cunha BA. Infect Dis Prac. Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Harrington SM, Dudley EG, Nataro JP. An RGB-emitting molecular cocktail for the detection of bacterial fingerprints. Kappeli U, Hachler H, Giezendanner N, Beutin L, Stephan R. Human Infections with Non-O157 Shiga Toxin-producing Escherichia coli, Switzerland, 2000-2009. 66(3):303-14. [Medline]. Cunha BA. It is used to treat meningitis and bacteremia for 14-21 days and pneumonia, complicated UTI, or pyelonephritis for 14 days. 4. This website also contains material copyrighted by 3rd parties. Raveh D(1), Yinnon AM, Broide E, Rudensky B. Piperacillin and tazobactam is an antipseudomonal penicillin plus beta-lactamase inhibitor. Benetazzo L, Delannoy PY, Houard M, Wallet F, Lambiotte F, Vachée A, Batt C, Van Grunderbeeck N, Nseir S, Robineau O, Meybeck A. Data sources include IBM Watson Micromedex (updated 2 Nov 2020), Cerner Multum™ (updated 2 Nov 2020), … Acute pyelonephritis. Seven E. coli isolates had imipenem MICs ranging from 3 to 16 µg/mL (E-test, AB Biodisk). E coli pneumonia requires respiratory support, adequate oxygenation, and antibiotics, such as third-generation cephalosporins or fluoroquinolones. 2020 Apr 2;11(17):4403-4409. doi: 10.1039/d0sc01704c. EPIDEMIOLOGY OF ESBL E. COLI AND K. PNEUMONIAE UROPATHOGENS. Figure 1.. … Pyogenic liver abscess: diagnosis, bacteriology and treatment. Dr Paterson reported receiving grants and/or personal fees from Merck, Pfizer, Shionogi, Achaogen, AstraZeneca, Leo Pharmaceuticals, Bayer, GlaxoSmithKline, and Cubist. Batard E, Ollivier F, Boutoille D, Hardouin JB, Montassier E, Caillon J, et al. 2006 Jan. 254(1):12-8. Eur J Clin Microbiol. Am Fam Physician. [Medline]. We found that they were all resistant to meropenem … Current concepts in the treatment of urinary tract infections and prostatitis. Restaurants May Be Key Component to COVID-19 Spread, 'Breakthrough Finding' Reveals Why Certain COVID Patients Die, Wear a Mask While Having Sex, Canada's Top Doctor Suggests, Dyspnea, Fever, and Hemoptysis in a Diabetic Tobacco User, ECG Challenge: Abdominal Pain and Diarrhea in a Heart Disease Patient. [Medline]. 1991 Dec 30. 1991 Jan. 4(1):80-128. 56(3):853-6, 859-61. Infections due to gram-negative bacteria: an overview. Combination Therapy with Aminoglycoside in Bacteremiasdue to ESBL-Producing Enterobacteriaceae in ICU. 365(19):1771-80. [Medline]. Harris P, Tambyah P, Lye D, et al. 4. N Engl J Med. Eighty-eight percent of K. pneumoniae isolates were susceptible to meropenem, and 99.8% were susceptible to meropenem-vaborbactam (with a vaborbactam concentration of 8 µg/ml). Biliary tract infections: a guide to drug treatment. Diseases & Conditions, 2010 Author information: (1)Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel. Carbapenems (Imipenem, Meropenem, Ertapenem, Doripenem) – all have excellent anaerobic activity. They shorten the duration of diarrhea by 24-36 hours. These findings do not support use of piperacillin-tazobactam in this setting. Piperacillin-tazobactam may be an effective "carbapenem-sparing" option to treat extended-spectrum β-lactamase producers. The microbiologic eradication rate was also 1992 Feb 1. DuPont HL. 204(8):1168-75. The primary outcome was all-cause mortality at 30 days after randomization. In regard susceptibility of ESBL producing organisms to other antibiotic, 3% E.coli and 18.51% K. pneumoniae are susceptible to quinolone such as levofloxacin, ESBL producing E. coli and K. Escherichia coli endocarditis. The molec-ular mass marker (M) and corresponding sizes (in kilodaltons) are indicated on the left. Gold R. Bacterial meningitis--1982. Chi Hiong U Go, MD Assistant Professor, Department of Internal Medicine, Texas Tech University Health Science Center at Odessa Antibiotic concentration dependent susceptibility of urinary tract isolates. 2018 Sep 11;320(10):979-981. doi: 10.1001/jama.2018.12565. 1999 Mar. No fetal toxicity or malformations were observed in pregnant rats and Cynomolgus monkeys administered intravenous meropenem during organogenesis at doses up to 2.4 and 2.3 times the maximum recommended human dose (MRHD) based on body surface area comparison, respectively; in rats administered intravenous meropenem in late pregnancy and during lactation period, there were no … 2011 Feb. 17(2):180-5. 2011 Jul. These bacteria are resistant to the groups of antibiotics that are commonly used to treat these types of infections (penicillins, cephalosporins) and to antibiotics normally reserved for more severe infections (eg, fluoroquinolones, gentamicin). For E coli intra-abdominal abscess, antibiotics also must include anaerobic coverage (eg, ampicillin and sulbactam or cefoxitin). In multiple studies, meropenem-vaborbactam showed strong in vitro activity against E. coli, Enter-obacter spp., and K. pneumoniae. Empiric coverage should also include antiE faecalis coverage. Ms Lorenc reported receiving grants from the Australian Society for Antimicrobials, the International Society for Chemotherapy, and the National University Hospital Singapore. Meropenem, sold under the brandname Merrem among others, is a broad-spectrum antibiotic used to treat a variety of bacterial infections. Intern Med. The clinical impact of fluoroquinolone resistance in patients with E coli bacteremia. Of 1646 patients screened, 391 were included in the study. Antibiotic therapy for abdominal infection. Westphal JF, Brogard JM. Walmsley RS, David DB, Allan RN, Kirkby GR. Acute prostatitis. Levofloxacin is used for infections due to multidrug-resistant gram-negative organisms. To test the noninferiority of PT to meropenem in such infections, researchers performed a 26-center, 9-country randomized clinical trial comparing PT 4.5 g given intravenously every 6 hours (n=187) with meropenem 1 g IV every 8 hours (n=191) for 4 to 14 days, for treatment of bacteremia caused by ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae. Semin Perinatol. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Antimicrob Agents Chemother. Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. E coli enteric infections require fluid replacement with solutions containing appropriate electrolytes. [Medline]. Ampicillin and sulbactam is a drug combination of a beta-lactamase inhibitor with ampicillin. Introduction. 2(S2):35-40. 18:78-9. Harris PN, Peleg AY, Iredell J, Ingram PR, Miyakis S, Stewardson AJ, Rogers BA, McBryde ES, Roberts JA, Lipman J, Athan E, Paul SK, Baker P, Harris-Brown T, Paterson DL. Clin Infect Dis. Improved activity against Pseudomonas aeruginosa and Enterobacteriaceae spp. 2013 Dec 9. McDonald MI. Drugs, encoded search term (Escherichia coli (E coli) Infections) and Escherichia coli (E coli) Infections, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, FDA Approves First Agent for PSMA-PET Imaging in Prostate Cancer, Rinse and Repeat? Among E. coli isolates bla KPC was the only carbapenemase gene detected, and all isolates were susceptible to meropenem-vaborbactam at ≤ 8 µg/ml. Some of these include meningitis, intra-abdominal infection, pneumonia, sepsis, and anthrax. Phenotypic ESBL production was confirmed in 86.0% of isolates (85.0% of E coli and 92.5% of K pneumoniae). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Infect Dis Prac. E. coli strains to imipene m and meropenem (as i s envisaged in o ur s tudy: Tab le 3) is also in line with a recent study conducted in Lagos, Nigeria which showed 1988 Mar. Rev Infect Dis. 1997. It is given by injection into a vein.. Common side effects include nausea, diarrhea, constipation, headache, rash, and pain at the site of injection. FEMS Microbiol Lett. Antimotility agents are contraindicated in children and in persons with enteroinvasive E coli (EIEC) infection. Urine gram stain in urosepsis. Citation: Harris PNA et al. Infectious Diseases Society of America Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious DiseasesDisclosure: Nothing to disclose. 1995 Jul. 2019 Jun 18;321(23):2370. doi: 10.1001/jama.2019.6706. Acute acalculous cholecystitis. Ceftriaxone is a third-generation cephalosporin that arrests bacterial growth by binding to one or more penicillin-binding proteins. Please enable it to take advantage of the complete set of features! Tan JS, File TM. E. coliCO clinical isolate; lane 2, E. coliJF 568 strain expressing OmpC; lane 3, E. coli JF 701 strain lacking OmpC (9). Please confirm that you would like to log out of Medscape. Acute uncomplicated E coli pyelonephritis in young women is treated with fluoroquinolone or TMP/SMZ for 14 days. Lepelletier D, Caroff N, Reynaud A, Richet H. Escherichia coli: epidemiology and analysis of risk factors for infections caused by resistant strains. Oral nonabsorbable antibiotic that can be used to treat bacterial infections of the colon. 2015 Jan 27;16:24. doi: 10.1186/s13063-014-0541-9. The next day, urine and blood cultures grow an Escherichia coli producing an extended spectrum β lactamase (ESBL), conferring resistance to cefotaxime and gentamicin but not to meropenem. high-level resistance to mecillinam and low-level resistance to carbapenems, with the exception of meropenem to which these strains were susceptible; in common with TL2740, the combination of imipenem and aztreonam was synergic against these isolates. It is unknown whether ertapenem is associated with similar clinical response and microbiologic cure rates as those achieved … Treat E coli perinephric abscess or prostatitis with at least 6 weeks of antibiotics. eCollection 2020 May 7. lactamase enzymes, meropenem-vaborbactam has limited or no activity, so in the Asia-Pacific region where MLBs are prevalent it was least effective, but and was most effective against US strains where KPC is prevalent. Chem Sci. Mead PS, Griffin PM. /viewarticle/941704 Lancet. JAMA. E coli meningitis requires antibiotics, such as third-generation cephalosporins (eg, ceftriaxone). 365(19):1763-70. 1994 Apr 15. Drugs. It is used to treat community-acquired pneumonia for 7-14 days, acute pyelonephritis and complicated UTI for 10 days, and traveler's diarrhea for 5 days. Traditionally, these infections can be effectively treated by the carbapenem class of drugs. It is used to treat complicated UTIs/pyelonephritis and bacteremia for 7-14 days, intra-abdominal infections for 14-21 days, and pneumonia for 14 days. The MIC of ertrapenem, imipenem and meropenem were < 0.5, < 1 and < 0.25μg/ml and MIC of pipera-tazabactam was in the range of < 4 to 16 μg/ml. Ortega AM, Cunha BA. Antimicrobials known to be useful in cases of traveler's diarrhea include doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), fluoroquinolones, rifaximin, and rifamycin. The carbapenem antibiotics imipenem, meropenem, ertapenem, and doripenem have a broad antimicrobial spectrum, 199 with activity against almost all aerobic and anaerobic pathogens, although Enterococcus faecium are resistant. Urosepsis. Chi Hiong U Go, MD is a member of the following medical societies: American College of Physicians-American Society of Internal MedicineDisclosure: Nothing to disclose. E. coli, Klebsiella pneumoniae, Klebsiella oxytoca ... Main differences compared to meropenem: 1) Lacks coverage of pseudomonas and acinetobacter. 2008 Mar. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. COVID-19 is an emerging, rapidly evolving situation. 1997 Nov-Dec. 26(6):501-3. E coli pneumonia requires respiratory support, adequate oxygenation, and antibiotics, such as third-generation cephalosporins or fluoroquinolones. 4 The first ESBL enzyme of sulphydryl variable type was identified in a Klebsiella strain isolated in Germany in 1983. J Crit Ill. 1997. [Medline]. Harvey D, Holt DE, Bedford H. Bacterial meningitis in the newborn: a prospective study of mortality and morbidity. 2018 Feb 27;319(8):788-799. doi: 10.1001/jama.2018.0438. Clin Microbiol Rev. Rifaximin is a nonabsorbed (< 0.4%), broad-spectrum antibiotic specific for enteric pathogens of the GI tract (ie, gram-positive, gram-negative, aerobic, anaerobic). 2010 Sep. 54(9):3790-8. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Doi Y, Park YS, Rivera JI, Adams-Haduch JM, Hingwe A, Sordillo EM, et al. The concentrations of fosfomycin inhibiting 50% (MIC 50 ) and 90% (MIC 90 ) of isolates were 1 or less and 4 μg/mL, respectivelyl; 99.4% of isolates were susceptible to fosfomycin. [9], Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting. Different classes of antibiotics differentially influence shiga toxin production. Dr Harris reported receiving grants from the Australian Society for Antimicrobials; the International Society for Chemotherapy; the National University Hospital Singapore; the Study, Education, and Research Committee of Pathology; and the Royal College of Pathologists of Australasia Foundation.  |  [Medline]. Arch Intern Med. [Medline]. Koutkia P, Mylonakis E, Flanigan T. Enterohemorrhagic Escherichia coli O157:H7--an emerging pathogen. In regard susceptibility of ESBL producing organisms to other antibiotic, 3% E.coli and 18.51% K. pneumoniae are susceptible to quinolone such as levofloxacin, ESBL producing E. coli and K. [Medline]. In an open-label, randomized, noninferiority trial evaluating the efficacy of piperacillin-tazobactam vs. meropenem for definitive therapy in treating bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae, piperacillin-tazobactam therapy did not result in noninferior 30-day, all-cause mortality compared to meropenem. 1982 Nov. 142(12):2157-9. Tarun Madappa, MD, MPH Attending Physician, Department of Pulmonary and Critical Care Medicine, Christus Spohn-Shoreline Hospital [Medline]. Raveh D(1), Yinnon AM, Broide E, Rudensky B. Enteropathogenic Escherichia coli. Gram positive and gram negative coverage Streptococcus species (incl some Enterococci), Listeria, H. flu, E. coli Proteus mirabilis, Salmonella, Shigella DO NOT USE IF PENICILLINASE PRODUCING Combinations with beta-lactamase inhibitors: Non anti-pseudomonal Amoxicillin plus clavulanate (po - Augmentin) Extends H. flu and Staph coverage Meropenem-vaborbactam (MEV) is a novel carbapenem–beta-lactamase inhibitor combination antibiotic approved by the U.S. Food and Drug Administration (FDA) for treatment of complicated urinary tract infections, including pyelonephritis, in adults. [Medline]. All isolates were phenotypically ESBL-positive by disk testing (confirmatory test, NCCLS). [Medline]. 56(5):641-8. Glandt M, Adachi JA, Mathewson JJ, Jiang ZD, DiCesare D, Ashley D. Enteroaggregative Escherichia coli as a cause of traveler's diarrhea: clinical response to ciprofloxacin. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjE3NDg1LW1lZGljYXRpb24=. E. coli CO strain was recovered from a 50-year-old immunocompromised woman who was hospitalized for a combined liver and heart transplant. It is used to treat mild-to-moderate UTI for 7-14 days, acute uncomplicated cystitis for 3 days, severe-to-complicated UTI for 7-14 days, infectious diarrhea for 5-7 days, and chronic bacterial prostatitis for 4-6 weeks. Int J Infect Dis. 15:14-24. Most (54.2%) ESBL-producing strains that cause community-associated episodes belonged to ST131 or its related sequence types. [Medline]. Antibiotics for Ceftriaxone-Resistant Gram-Negative Bacterial Bloodstream Infections. 1998 May. 2018 Sep 11;320(10):984-994. doi: 10.1001/jama.2018.12163. Antib Clinician. Bacteremic Escherichia coli pneumonia. Acute focal bacterial pyelonephritis. Gram-negative bacilli. A randomized clinical trial. Metapopulation ecology links antibiotic resistance, consumption, and patient transfers in a network of hospital wards. 1967 Oct. 120(4):472-7. Clin Infect Dis. Dr Falcone reported receiving personal fees from MSD, Angelini, and Astellas and grants from Gilead. The results revealed that although the level of hospital use of quinolones influenced the incidence of quinolone resistance in E coli hospital isolates, the consumption of 2 other classes of antibiotics, cephalosporins and tetracyclines, is also associated with quinolone resistance. doi: 10.7554/eLife.54795. Wanke CA. Gram-Negative Coverage 1,2 Carbapenems also have good activity against most Gram-negative bacteria, including Enterobacter, E. coli, Morganella morganii, and Klebsiella. The increase in ESBL-producing E coli (ESBL-EC) among community-onset urinary tract infections (UTI) is an important public health concern as these organisms are resistant to multiple antimicrobial agents. Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. 2:129-35. To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. Background: Infections caused by extended-spectrum β-lactamase (ESBL)producing gram-negative organisms are a growing concern in hospitalized patients. Trials. Camins BC, Marschall J, De Vader SR, Maker DE, Hoffman MW, Fraser VJ. 3 months or older: 40 mg/kg IV every 8 hours [Medline]. E. coli resistance to Ampicillin-sulbactam is emerging in some areas; check local susceptibility data. Dr Bassetti reported receiving grants and/or personal fees from Pfizer, MSD, Astellas, Menarini, Roche, Tetraphase, Achaogen, Angelini, AstraZeneca, Bayer, Basilea, Cidara, Gilead, MSD, Paratek, Pfizer, The Medicines Company, and Vifor. Johnson JR. Virulence factors in Escherichia coli urinary tract infection. 1994. Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. 1990 Mar. Schindzielorz A, Edberg SC, Bia FJ. For E coli intra-abdominal abscess, antibiotics also must include anaer… [Medline]. Am J Med. Preventing complications through prompt diagnosis and proper therapy. [Medline]. Meropenem-vaborbactam (Vabomere) Meropenem is a carbapenem antibiotic and vaborbactam is a beta-lactamase inhibitor. Investigators … Meropenem is a carbapenem antibiotic for parenteral use, that is relatively stable to human dehydropeptidase-1 (DHP-1) and therefore, does not require the addition of an inhibitor of DHP-1. [Medline]. 1993 Jan. 1(1):5-18. Gram positive and gram negative coverage Streptococcus species (incl some Enterococci), Listeria, H. flu, E. coli Proteus mirabilis, Salmonella, Shigella DO NOT USE IF PENICILLINASE PRODUCING Combinations with beta-lactamase inhibitors: Non anti-pseudomonal Amoxicillin plus clavulanate (po - Augmentin) Extends H. flu and Staph coverage 33:231-52. Clinical Case, 2001 Adv Ther. In 2005, our institution initiated a protocol for use of ertapenem, a carbapenem, as the first-line treatment option for these infections. [Medline]. J Diarrhoeal Dis Res. For the very resistant P. aeruginosa, doripenem and meropenem are highly potent because [Medline]. KEY POINTS Meropenem (Merrem) is an injectable carbapenem and beta-lactam antibiotic that interferes with bacterial cell wall synthesis in sensitive organisms Has activity versus a wide array of organisms, including multi-drug resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae DOES NOT cover MRSA or VRE Carbapenems like meropenem are … The molec-ular mass marker (M) and corresponding sizes (in kilodaltons) are indicated on the left. [Medline]. 5. Escherichia coli culture on MacConkey agar. In this trial, 30-day mortality was reduced for patients with ESBL E. coli and K. pneumoniae bloodstream infections treated with meropenem compared to piperacillin-tazobactam [28]. Doxycycline inhibits protein synthesis and thus, bacterial growth, by binding to the 30S and possibly 50S ribosomal subunits of susceptible bacteria.