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2. Identifying Effective Durations of Antibiotic Therapy for the Treatment of Carbapenem-resistant Enterobacterales Bloodstream Infections: A Multicenter Observational Study

Author

Soto, Caitlin L, primary, Hsu, Alice J, additional, Lee, Jae Hyoung, additional, Dzintars, Kathryn, additional, Choudhury, Rebecca, additional, Jenkins, Timothy C, additional, McCreary, Erin K, additional, Quartuccio, Katelyn S, additional, Stohs, Erica J, additional, Zimmerman, Matty, additional, and Tamma, Pranita D, additional

Published
2023
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3. Identifying Effective Durations of Antibiotic Therapy for the Treatment of Carbapenem-resistant Enterobacterales Bloodstream Infections: A Multicenter Observational Study.

Author

Soto, Caitlin L, Hsu, Alice J, Lee, Jae Hyoung, Dzintars, Kathryn, Choudhury, Rebecca, Jenkins, Timothy C, McCreary, Erin K, Quartuccio, Katelyn S, Stohs, Erica J, Zimmerman, Matty, and Tamma, Pranita D

Subjects
*ANTIBIOTICS, *BACTEREMIA, *RESEARCH, *SCIENTIFIC observation, *CARBAPENEM-resistant bacteria, *ENTEROBACTERIACEAE diseases, *TREATMENT duration, *DISEASE relapse, *RISK assessment, *TREATMENT effectiveness, *DESCRIPTIVE statistics, *LONGITUDINAL method, *DISEASE risk factors, *EVALUATION, MORTALITY risk factors
Abstract

In a propensity-score-weighted cohort of 183 adults with carbapenem-resistant Enterobacterales bacteremia at 24 US hospitals, patients receiving short courses of active therapy (7–10 days, median 9 days) experienced similar odds of recurrent bacteremia or death within 30 days as those receiving prolonged courses of active therapy (14–21 days, median 14 days). [ABSTRACT FROM AUTHOR]

Published
2024
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24. The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children.

Author

Same, Rebecca G, Amoah, Joe, Hsu, Alice J, Hersh, Adam L, Sklansky, Daniel J, Cosgrove, Sara E, and Tamma, Pranita D

Subjects
ANTIBIOTICS, CONFIDENCE intervals, TREATMENT duration, TREATMENT effectiveness, RISK assessment, DESCRIPTIVE statistics, ODDS ratio, COMMUNITY-acquired pneumonia, HOSPITAL care of children, EVALUATION, CHILDREN
Abstract

Background National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated. Methods We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5–7 days) vs prolonged-course (8–14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Children with tracheostomies; healthcare-associated, hospital-acquired, or ventilator-associated pneumonia; loculated or moderate to large pleural effusion or pulmonary abscess; intensive care unit stay >48 hours; cystic fibrosis/bronchiectasis; severe immunosuppression; or unusual pathogens were excluded. The primary outcome was treatment failure, a composite of unanticipated emergency department visits, outpatient visits, hospital readmissions, or death (all determined to be likely attributable to bacterial pneumonia) within 30 days after completing antibiotic therapy. Results Four hundred and thirty-nine patients met eligibility criteria; 168 (38%) patients received short-course therapy (median, 6 days) and 271 (62%) received prolonged-course therapy (median, 10 days). Four percent of children experienced treatment failure, with no differences observed between patients who received short-course vs prolonged-course antibiotic therapy (odds ratio, 0.48; 95% confidence interval,.18–1.30). Conclusions A short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP. [ABSTRACT FROM AUTHOR]

Published
2021
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28. Association Between Vancomycin Trough Concentrations and Duration of Methicillin-Resistant Staphylococcus aureus Bacteremia in Children.

Author

Hsu, Alice J, Hamdy, Rana F, Huang, Yanjie, Olson, Jared A, Ghobrial, Shahira, Gerber, Jeffrey S, Hersh, Adam L, and Tamma, Pranita D

Subjects
*BACTEREMIA, *DOSE-effect relationship in pharmacology, *MEDICAL cooperation, *RESEARCH, *TIME, *RETROSPECTIVE studies, *VANCOMYCIN, *DISEASE duration, *METHICILLIN-resistant staphylococcus aureus, *CHILDREN
Abstract

In a multicenter retrospective study, we sought to determine the optimal vancomycin trough concentration that would impact the duration of methicillin-resistant Staphylococcus aureus bacteremia in children. We found that a median vancomycin trough concentration of <10 µg/mL within the first 72 hours may be associated with a longer duration of bacteremia compared to a median trough concentration of ≥10 µg/mL. [ABSTRACT FROM AUTHOR]

Published
2018
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37. Less Is More

Author

Tamma, Pranita D., primary, Turnbull, Alison E., additional, Harris, Anthony D., additional, Milstone, Aaron M., additional, Hsu, Alice J., additional, and Cosgrove, Sara E., additional

Published
2013
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40. Carbapenem Therapy Is Associated With Improved Survival Compared With Piperacillin-Tazobactam for Patients With Extended-Spectrum β-Lactamase Bacteremia.

Author

Tamma, Pranita D., Han, Jennifer H., Rock, Clare, Harris, Anthony D., Lautenbach, Ebbing, Hsu, Alice J., Avdic, Edina, and Cosgrove, Sara E.

Subjects
BACTEREMIA, CARBAPENEMS, PIPERACILLIN, TAZOBACTAM, BETA lactamases, CEPHALOSPORINS
Abstract

Background. The effectiveness of piperacillin-tazobactam (PTZ) for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia is controversial. We compared 14-day mortality of PTZ vs carbapenems as empiric therapy in a cohort of patients with ESBL bacteremia who all received definitive therapy with a carbapenem. Methods. Patients hospitalized between January 2007 and April 2014 with monomicrobial ESBL bacteremia were included. A decrease of >3 doubling dilutions in the minimum inhibitory concentration for third-generation cephalosporins tested in combination with 4 μg/mL of clavulanic acid was used to confirm ESBL status. The primary exposure was empiric therapy, defined as antibiotic therapy administered to a patient before ESBL status was known. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. The primary outcome was time to death from the first day of bacteremia. Propensity scores using inverse probability of exposure weighting (IPW) were used to estimate the probability that a patient would receive PTZ vs carbapenems empirically. We calculated overall hazard ratios for mortality censored at 14 days using Cox proportional hazards models on an IPW-adjusted cohort. Results. A total of 331 unique patients with ESBL bacteremia were identified. One hundred three (48%) patients received PTZ empirically and 110 (52%) received carbapenems empirically. The adjusted risk of death was 1.92 times higher for patients receiving empiric PTZ compared with empiric carbapenem therapy (95% confidence interval, 1.07-3.45). Conclusions. PTZ appears inferior to carbapenems for the treatment of ESBL bacteremia. For patients at high risk of invasive ESBL infections, early carbapenem therapy should be considered. Our findings should not be extended to β-lactam/β-lactamase inhibitor combinations in development, as limited clinical data are available for these agents. [ABSTRACT FROM AUTHOR]

Published
2015
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42. Successful Treatment of Persistent Burkholderia cepaciaComplex Bacteremia with Ceftazidime-Avibactam

Author

Tamma, Pranita D., Fan, Yunfan, Bergman, Yehudit, Sick-Samuels, Anna C., Hsu, Alice J., Timp, Winston, Simner, Patricia J., Prokesch, Bonnie C., and Greenberg, David E.

Abstract

ABSTRACTWe report our clinical experience treating a 2-month-old infant with congenital diaphragmatic hernia who experienced prolonged bacteremia with Burkholderia cepaciacomplex (Bcc) despite conventional antibiotic therapy and appropriate source control measures. The infection resolved after initiation of ceftazidime-avibactam. Whole-genome sequencing revealed that the isolate most closely resembled B. contaminansand identified the mechanism of resistance that likely contributed to clinical cure with this agent. Ceftazidime-avibactam should be considered salvage therapy for Bcc infections if other treatment options have been exhausted.

Published
2018
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