Effectiveness, safety and risk of selection of carbapenem-resistant bacteria in the treatment of severe in-hospital infections with cefepime/sulbactam in comparison with carbapenems

Suvorova M.P.; Bykov A.O.; Yakovlev S.V.; Protsenko D.N.; Sychev I.N.; Mirzakhamidova S.S.; Burmistrova E.N.

doi:https://doi.org/10.17116/anaesthesiology202003159

Suvorova M.P.

GBOU VPO "Pervyĭ MGMU im. I.M. Sechenova" Minzdrava Rossii;
gorodskaia klinicheskaia bol'nitsa #7 DZ Moskvy

Bykov A.O.

Pirogov Russian National Research Medical University, Moscow, Russia

Yakovlev S.V.

Department of Pediatric Oromaxillofacial Surgery Faculty of Stomatology Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Russian Ministry of Health, Moscow, Russia

Protsenko D.N.

GBUZ «City clinical hospital named after S.S. Yudin» of Moscow health department, Moscow, Russia;
FGBOU VO «Russian national research medical University named after N.I. Pirogov» of Ministry of health of Russia, Moscow, Russia

SPIN RSCI: 1019-8216
Scopus AuthorID: 6603277055
ResearcherID: P-9224-2018
ORCID: 0000-0002-5166-3280

Sychev I.N.

Yudin Municipal Clinical Hospital, Moscow, Russia

Mirzakhamidova S.S.

Yudin Municipal Clinical Hospital, Moscow, Russia

Burmistrova E.N.

GBOU VPO "Pervyĭ MGMU im. I.M. Sechenova" Minzdrava Rossii;
gorodskaia klinicheskaia bol'nitsa #7 DZ Moskvy

Effectiveness, safety and risk of selection of carbapenem-resistant bacteria in the treatment of severe in-hospital infections with cefepime/sulbactam in comparison with carbapenems

Authors:

Suvorova M.P., Bykov A.O., Yakovlev S.V., Protsenko D.N., Sychev I.N., Mirzakhamidova S.S., Burmistrova E.N.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2020;(3): 59‑69

DOI: 10.17116/anaesthesiology202003159

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To cite this article:

Suvorova MP, Bykov AO, Yakovlev SV, Protsenko DN, Sychev IN, Mirzakhamidova SS, Burmistrova EN. Effectiveness, safety and risk of selection of carbapenem-resistant bacteria in the treatment of severe in-hospital infections with cefepime/sulbactam in comparison with carbapenems. Russian Journal of Anesthesiology and Reanimatology. 2020;(3):59‑69. (In Russ.)
https://doi.org/10.17116/anaesthesiology202003159

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Abstract:

Objective. To analyze application of a new combination of beta-lactam antibiotic and beta-lactamase inhibitor (cefepime/sulbactam) as a carbapenem-replacement technology for the treatment of severe in-hospital infections. Material and methods. We conducted a single-center, comparative, retrospective, non-interventional study. The trial included patients who received cefepime/sulbactam or carbapenem as a first-line treatment in an emergency hospital for the period from July to November 2019. The target number of patients who received at least one dose of the antibiotic was 50 in each group. Clinical and bacteriological effectiveness of the treatment, incidence of superinfection and selection of carbapenem-resistant bacteria after the onset of therapy were evaluated in both groups. Results. Treatment outcomes were evaluated in 45 patients treated with cefepime/sulbactam and in 47 patients treated with carbapenem (meropenem, ertapenem, imipenem or doripenem). The majority of patients in both groups had severe infection: 58.7% — sepsis, 29.3% — septic shock, over 80% of patients were at the ICU. The most common infection (43.5%) was nosocomial pneumonia including VAP. The studied antibiotics were prescribed empirically in most cases (83 patients) including monotherapy in 80.4% of patients. Positive clinical effect (71.1 and 61.7%, respectively) and eradication of the pathogen (87.5 and 73.0%) were observed in the majority of patients who received cefepime/sulbactam or carbapenem (p>0.05). There was significantly less incidence of superinfection in cefepime/sulbactam group compared to carbapenem therapy (22.2 and 53.3%, respectively, p=0.001). K. pneumoniae (44.8%) and A. baumannii (34.5%) predominated among the microorganisms that caused superinfection during treatment with carbapenems. Selection of carbapenem-resistant microorganisms after antibacterial therapy onset (in 5.3 days on the average) was more common in case of carbapenems (74.5%) compared to cefepime/sulbactam (20%) (p=0.0001). Carbapenem-resistant bacteria were represented by K. pneumoniae, P. aeruginosa and A. baumannii. Moreover, the last one was found only if carbapenems were administered (21 out of 35 patients) (p=0.0001). Administration of cefepime/sulbactam was associated with reduced ICU-stay after antibacterial therapy onset by 6 days (10.7±1.56 and 16.3±2.11 days, p=0.037). Conclusion. Cefepime/sulbactam is characterized by equal effectiveness with carbapenems as a first-line antibiotic therapy of severe infections in the ICU. Moreover, these drugs result significantly less risk of superinfection (RR=0.402, 95% CI 0.220—0.735) and selection of carbapenem-resistant bacteria (RR=0.269, 0.146—0.493) compared to carbapenems. As a result, reduced ICU-stay is observed.

Keywords:

cefepime/sulbactam

carbapenem

carbapenem-sparing treatment

carbapenem-replacement therapy

multidrug-resistant infections

superinfection

carbapenem-resistant pathogens

gram-negative

resistance selection

clinical study

Authors:

Suvorova M.P.

GBOU VPO "Pervyĭ MGMU im. I.M. Sechenova" Minzdrava Rossii;
gorodskaia klinicheskaia bol'nitsa #7 DZ Moskvy

Bykov A.O.

Pirogov Russian National Research Medical University, Moscow, Russia

Yakovlev S.V.

Department of Pediatric Oromaxillofacial Surgery Faculty of Stomatology Moscow State University of Medicine and Dentistry named after A.I. Evdokimov Russian Ministry of Health, Moscow, Russia

Protsenko D.N.

SPIN RSCI: 1019-8216
Scopus AuthorID: 6603277055
ResearcherID: P-9224-2018
ORCID: 0000-0002-5166-3280

Sychev I.N.

Yudin Municipal Clinical Hospital, Moscow, Russia

Mirzakhamidova S.S.

Yudin Municipal Clinical Hospital, Moscow, Russia

Burmistrova E.N.

GBOU VPO "Pervyĭ MGMU im. I.M. Sechenova" Minzdrava Rossii;
gorodskaia klinicheskaia bol'nitsa #7 DZ Moskvy

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