Identifying patients with HAP/VAP at high-risk of MDR Gram-negative infections

Risk Factors in a HAP/VAP Patient:1-3

Patient Profile

Patient Profile: Charles - 78 year old Male

Patient History

  • Smoker for >45 years 
  • Immunosuppressed
  • Frequent travel
  • Chronic renal insufficiency 
  • Recent fall at home 

Symptoms: Developed after 4 days in hospital following fall at home - wheezing, purulent sputum, leukocytosis,  tachypnea, cough, sweating

Diagnosis: Hospital - acquired pneumonia

Suspected Pathogens:

  • MDR Gram-negative pathogens including K. pneumoniae, E. coli, P. aeruginosa
  • Based on patient's disease severity, there is concern about potential involvement of carbapenem-resistant strains

Failure to treat early and appropriately can lead to fatal outcomes in patients with serious Gram-negative infections4,5 

Mortality rate:

Mortality Rate

Identifying patients at risk of MDR Gram-negative infections is vital for appropriate selection of adequate , early antimicrobial  therapy to reduce the risk of fatal outcomes.4

The combination of ceftazidime and avibactam provides broad-spectrum Gram-negative coverage, including in vitro activty against: 11-14

Footnotes:

∞The example described here is not an actual patient, but rather a fictitious representation of a scenario for which ZAVICEFTA could be considered.

*30-day mortality rate among patients with P. aeruginosa bacteraemia who received ‘delayed effective antimicrobial therapy’.6

†30-day mortality among 909 patients with BSIs caused by ESBL-producing K.pneumoniae (n=222) and E. coli (n=687).7

‡28-day mortality among 205 patients with BSIs caused by carbapenemase-producing K.pneumoniae (KPC and/or VIM).8

§30-day mortality among 40 patients with BSIs caused by OXA-48 producing Enterobacteriaceae.9

||Overall mortality among 53 patients with BSIs caused by KPC-producing K. pneumoniae.10

Abbreviations:

CRE, carbapenem-resistant Enterobacteriaceae; E. coli, Escherichia coli; ESBL, extended-spectrum β-lactamase; K. pneumoniae, Klebsiella pneumoniae; KPC, Klebsiella pneumoniae carbapenemase; MDR, multi-drug resistant; OXA, oxacillinase; P. aeruginosa, Pseudomonas aeruginosa; VIM, verona integron-encoded metallo-β-lactamase.

References:

1. Bassetti M, et al. Exp Rev Anti Infect Ther 2017;15:55–65; 2. Miller BM, et al. Am J Infect Control 2016;44:134–7; 3. De Waele J, et al. Intensive Care Med 2018;44:189–96; 4. Bonine NG, et al. Am J Med Sci 2019;357:10 3–10; 5. Raman G, et al. BMC Infect Dis 2015;15:395; 6.  Kang CI, et al. Clin Infect Dis 2003;37:745–51; 7. Scheuherman O, et al. Infect Control Hosp Epidemiol 2018;39:660–7; 8. Daikos GL, et al. Antimicrob Agents Chemother 2014;58:2322–8; 9. Navarro-San Francisco C, et al. Clin Microbiol Infect 2012;19:E72–9; 10. Zarkotou O, et al. Clin Microbiol Infect 2011;17:1798–803; 11. Liscio JL, et al. Int J Antimicrob Agents 2015;46:266–71; 12. Mazuski JE, et al. Surg Infect  (Larchment) 2017;18:1–76; 13. Pogue JM, et al.  Clin Infect Dis 2019;68:519–24; 14. Zhanel GG, et al.  Drugs 2013;73:159–77.

Prescribing Information
Meronem IV 1g – SPC 
Legal Category: POM.       Basic NHS Cost: 10 vial pack £206.28
Meronem IV 500mg – SPC 
Legal Category: POM.       Basic NHS Cost: 10 vial pack £103.14

 

Piperacillin/tazobactam
Tazocin 2 g/0.25 g Powder for Solution for Infusion – SPC
Legal category: POM.       Basic NHS cost: 1 vial pack £7.65 
Tazocin 4  g/0.5 g Powder for Solution for Infusion – SPC
Legal category: POM.       Basic NHS cost: 1 vial pack £15.17 
 
Tygacil 50 mg Powder for Solution for Infusion – SPC
Legal Category: POM.       Basic NHS Cost: 10 vial pack £323.10
 
ZAVICEFTA® 2 g/0.5 g Powder for Concentrate for Solution for Infusion – SPC
Legal category: POM.       Basic NHS price: 10 vial pack £857.00.

PP-ZVA-GBR-0861. June 2020