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    Home > Active Ingredient News > Infection > Also use cefoperazone sulbactam to treat this resistant bacteria?

    Also use cefoperazone sulbactam to treat this resistant bacteria?

    • Last Update: 2022-03-08
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and reference Chinese and foreign guides.
    Different opinions? The rise of antimicrobial resistance is still a global problem that threatens human health.
    In clinical practice, the rational selection of antibiotics to treat infections caused by drug-resistant pathogens is still a challenging task
    .

     Among them, the third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE) is a very difficult infection in clinical practice.
    So, what drugs are recommended by the current domestic and foreign guidelines for the treatment of this bacteria? In December 2021, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) issued the "Guidelines for the Treatment of Multidrug-resistant Gram-Negative Bacilli Infections" [1], proposing guidelines for 3GCephRE.
    Treatment recommendations
    .

     Figure 1: ESCMID's "Guidelines for the Treatment of Multidrug-resistant Gram-Negative Bacilli Infections" The guideline recommends against the use of cephamycins in the treatment of 3GCephRE-infected patients (conditionally not recommended, low level of evidence); at the same time, cefoperazone- There is insufficient evidence for the treatment of sulbactam in patients with 3GCephRE infection, so no recommendation can be made
    .

    Figure 2: Screenshot of the original guideline.
    For bloodstream infection (BSI) and severe infection caused by 3GCephRE, carbapenems (imipenem or meropenem) are recommended as targeted therapy (strong recommendation, medium level of evidence).
    )
    .

    Figure 3: Screenshot of the original text of the guideline In September 2020, the Infectious Diseases Society of America (IDSA) issued the "Guidelines for the Treatment of Antibiotic-Resistant Gram-Negative Bacteria Infections", targeting extended-spectrum β-lactamase-producing bacteria ( Urinary tract infection or non-urinary tract infection caused by ESBLs-producing bacteria), the drugs of choice are carbapenems [2]
    .

     Figure 4: "Guidelines for the Treatment of Antibiotic-Resistant Gram-Negative Bacteria Infections" issued by IDSA If the in vitro drug susceptibility test results show sensitivity, amoxicillin/clavulanate potassium, aminoglycosides, and fluoroquinolones can be selected down the stairs.
    ciprofloxacin, levofloxacin, nitrofurantoin, and tramazosin
    .

     There are no recommendations for the treatment of cephamycins or cefoperazone-sulbactam in this guideline
    .

     Not only European and American guidelines, but in Japan's "Management of Sepsis and Catheter-Associated Bloodstream Infections (2021)" [3], the recommendations are as follows: For patients at high risk of ESBLS-producing bacterial infection who meet one of the following criteria Need to use carbapenems: 1.
    History of ESBLS-producing bacteria; 2.
    Recent use of antimicrobials (especially β-lactam antibiotics); 3.
    Organ dysfunction, such as chronic respiratory disease and liver disease 4.
    History of invasive treatment of urinary system; 5.
    Admission to long-term care institutions
    .

    The domestic guideline is "wet and rain" However, reviewing the previous Chinese guidelines/consensus, there are the following recommendations for cephamycin and cefoperazone-sulbactam
    .

    1 "Chinese expert consensus on emergency diagnosis and treatment of extended-spectrum β-lactamase-producing Enterobacter infection (2020)" [4] Recommendations: (1) Respiratory tract infection: Piperacillin/tazol is recommended for the treatment of community-acquired ESBL-E pneumonia Bactam or cefoperazone/sulbactam, ertapenem, cephamycins,
    etc.

    For hospital-acquired and ventilator-associated pneumonia, a β-lactam/β-lactamase inhibitor combination regimen can be used for non-critical infections, and carbapenems can be used for severe infections
    .

     (2) Intra-abdominal infection: The incidence of hospital-acquired intra-abdominal infection ESBL-E is higher.
    For mild to moderate community-acquired ESBL-E intra-abdominal infection, monotherapy can be selected, and piperacillin/tazoba is recommended.
    tantan, amikacin or ertapenem; carbapenem antibiotics should be used for severe community-acquired and hospital-acquired ESBL-E intra-abdominal infections
    .

     (3) Urinary tract infection: Acute uncomplicated lower urinary tract infection caused by ESBL-E can be treated with oral nitrofurantoin or fosfomycin tromethamine
    .

    For complicated urinary tract infections caused by ESBL-E, β-lactam/β-lactamase inhibitors or ertapenem can be used, and carbapenems can be directly used in patients with secondary septic shock
    .

     (4) Bloodstream infection: First of all, the source of infection should be identified, and primary lesions should be actively treated.
    For example, intravascular catheter-related bloodstream infection should be removed.
    The first choice for the treatment of severe ESBL-E bloodstream infections, β-lactams/β-lactamase inhibitors can be considered for bloodstream infections of mild-to-moderate or low-risk origin
    .

     It can be seen that the consensus recommends cefoperazone-sulbactam and cephamycin for ESBL-E respiratory tract infections
    .

    2 "Expert Consensus on Coping Strategies for Enterobacteriaceae Bacterial Infections Produced in Extended Spectrum β-Lactamases in China (2014)" [5] High-risk patients with ESBLs-producing bacterial infections are recommended to use carbapenems combined with aminoglycoside antibiotics (including amikacin, tobramycin, etc.
    )
    .

    For patients with low risk stratification, β-lactam/β-lactamase inhibitor mixtures (such as cefoperazone/sulbactam and piperacillin/tazobactam, etc.
    ) can be selected, or Cephamycin antibiotics (cefmetazole, cefoxitin, or cefminox) are combined with aminoglycoside antibiotics
    .

     3 "Expert Consensus on Prevention and Control of Extended Spectrum β-Lactamase-Producing Bacterial Infections (2010)" [6] 1.
    β-lactam/β-lactamase inhibitor compound preparation: ESBLs-producing bacteria have Combinations of antibiotics combined with clavulanic acid, sulbactam, or tazobactam are more sensitive
    .

     2.
    Such drugs can be firstly used for mild to moderate infections caused by ESBIs-producing bacteria, but due to the unsatisfactory clinical efficacy of β-lactams/β-lactamase inhibitor compounds on ESBIs-producing bacteria, the Patients with severe bacterial infection of ES-BLs should not be the first choice drug
    .

    Cefoperazone/sulbactam and piperacillin/tazobactam have stronger antibacterial effects among the β-lactam/β-lactamase inhibitor compounds on the market
    .

     3.
    Cephamycins: In vitro studies have shown that cephamycins have good antibacterial effects on ESBLs-producing bacteria, and can be used as secondary drugs for ESBLs-producing bacteria, and can also be used in combination with aminoglycoside antibiotics
    .

    Cephamycins include cefmetazole and cefoxitin
    .

      At the same time, it was also found in the "Guidelines for the Clinical Application of Antibacterial Drugs" [7] that: "Cephamycins are stable to most extended-spectrum β-lactamases (ESBLs), but their treatment of ESBLs-producing bacteria causes The efficacy of infection has not been proven
    .

    ” Figure 5: The original text of the “Guidelines for the Clinical Application of Antibacterial Drugs” Through the review of the above data, we can see that most of the relevant infection guidelines/consensus in China recommend cephamycin, cefoperazone- Sulbactam is used for the treatment of 3GCephRE, however, it is no longer recommended in Europe, America and Japan due to insufficient evidence-based medical evidence
    .

    Summary: As far as some clinical experience of Xiaoyao is concerned, although cefoperazone-sulbactam has been observed to be effective in the treatment of Acinetobacter baumannii, the treatment for other 3GCephRE infections is often inferior to that of piperacillin- Tazobactam, far less than carbapenem antibiotics
    .

    There was no significant difference in the therapeutic effect of cephamycin antibiotics with that of second- and third-generation cephalosporins
    .

     What do you think after reading it? Leave a message to discuss
    .

     References: [1] Paul M, Carrara E, Retamar P, et al.
    European Society of clinical microbiology and infectious diseases (ESCMID) guidelines for the treatment of infections caused by Multidrug-resistant Gram-negative bacilli (endorsed by ESICM -European Society of intensive care Medicine).
    Clin Microbiol Infect.
    2021 Dec 16:S1198-743X(21)00679-0.
    doi: 10.
    1016/j.
    cmi.
    2021.
    11.
    025.
    [2]Tamma PD , Aitken SL , Bonomo RA , et al al.
    Infectious Diseases Society of America Antimicrobial Resistant Treatment Guidance: Gram-Negative Bacterial Infections[J].
    Clinical Infectious Diseases, 2020, 72(7).
    [3]Arakawa S , Kasai M , Kawai S , et al.
    The JAID/ JSC guidelines for management of infectious diseases 2017 – Sepsis and catheter-related bloodstream infection[J].
    Journal of Infection and Chemotherapy, 2021(Suppl.
    2).
    [4]Emergency diagnosis and treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae infection in China Expert consensus group.
    Chinese expert consensus on emergency diagnosis and treatment of extended-spectrum β-lactamase-producing Enterobacteriaceae infection[J].
    Chinese Journal of Emergency Medicine, 2020,29(12):1520-1526.
    DOI:10.
    3760/cma.
    j.
    issn.
    1671-0282.
    2020.
    12.
    004.
    [5] Zhou Hua, Li Guanghui, Chen Baiyi, et al.
    Expert consensus on coping strategies for Enterobacteriaceae bacterial infection with extended-spectrum β-lactamases produced in China [J].
    Chinese Journal of Medicine, 2014, 94(24): 1847- 1856.
    DOI: 10.
    3760/cma.
    j.
    issn.
    0376-2491.
    2014.
    24.
    003.
    [6] Expert Committee on the Prevention and Control of Extended-spectrum β-Lactamase-Producing Bacterial Infections.
    Expert Consensus on the Prevention and Control of Extended-Spectrum β-Lactamase-Producing Bacterial Infections [J].
    Chinese Journal of Experimental and Clinical Infectious Diseases (Electronic Edition), 2010, 4(2): 207-214.
    [7] Guidelines for Clinical Application of Antibacterial Drugs: 2015 Edition/Revision of "Guidelines for Clinical Application of Antibacterial Drugs" Group Editor-in-Chief.
    Beijing: People's Medical Publishing House, 2015.
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