Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/130943
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Type: Journal article
Title: Treatment of invasive IMP-4 Enterobacter cloacae infection in transplant recipients using ceftazidime/avibactam with aztreonam: A case series and literature review
Author: Cairns, K.A.
Hall, V.
Martin, G.E.
Griffin, D.W.J.
Stewart, J.D.
Khan, S.F.
Abbott, I.J.
Meher-Homji, Z.
Morrissey, C.O.
Sia, C.
Love, J.
Corallo, C.E.
Bergin, P.
Sharma, A.
Gopal, B.
Spencer, A.
Peleg, A.Y.
Citation: Transplant Infectious Disease, 2020; 23(2):1-10
Publisher: Wiley
Issue Date: 2020
ISSN: 1398-2273
1399-3062
Statement of
Responsibility: 
Kelly A. Cairns, Victoria Hall, Genevieve E. Martin, David W.J. Griffin, James D. Stewart, Sadid F. Khan ... et al.
Abstract: Infections caused by carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat in both solid organ and stem cell transplant recipients. Invasive CPE infections in transplant recipients are associated with a high mortality, often due to limited therapeutic options and antibacterial toxicities. One of the most therapeutically challenging group of CPE are the metallo-β-lactamase (MBL)-producing Gram-negative bacteria, which are now found worldwide, and often need treatment with older, highly toxic antimicrobial regimens. Newer β-lactamase inhibitors such as avibactam have well-established activity against certain carbapenemases such as Klebsiella pneumoniae carbapenemases (KPC), but have no activity against MBL-producing organisms. Conversely, aztreonam has activity against MBL-producing organisms but is often inactivated by other co-existing β-lactamases. Here, we report four cases of invasive MBL-CPE infections in transplant recipients caused by IMP-4-producing Enterobacter cloacae who were successfully treated with a new, mechanism-driven antimicrobial combination of ceftazidime/avibactam with aztreonam. This novel antimicrobial combination offers a useful treatment option for high-risk patients with CPE infection, with reduced drug interactions and toxicity.
Keywords: E. cloacae
MBL
antimicrobial resistance
antimicrobials
metallo-beta-lactamase
Rights: © 2020 Wiley Periodicals LLC.
DOI: 10.1111/tid.13510
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