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High mortality, comorbidities persist in patients with severe CRE infection
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SAN DIEGO — Patients with carbapenem-resistant Enterobacteriaceae experience significant mortality and comorbidity, according to recent findings presented here at ICAAC 2015.
“First and foremost, the patients with CRE are very different,” Michael Dudley, PharmD, FIDSA, senior vice president and chief scientific officer of The Medicines Company, told Infectious Disease News. “They’ve got lots of underlying diseases. They’ve been in the ICU for a long time, a lot of them have renal dysfunction, a lot of them have immunosuppression — all of those are things that oftentimes aren’t studied in routine clinical trials.”
Researchers conducted a retrospective analysis of 257 CRE patients at 22 health care centers in the United States, United Kingdom, Italy and Greece over a 6-month period. Baseline data, treatment and outcomes were collected for each patient. Cases were categorized based on various indications, which included complicated UTI or acute pyelonephritis (cUTI/AP; n = 76), hospital-associated bacterial pneumonia (HABP; n = 21), ventilator-associated bacterial pneumonia (VABP; n = 20) and bacteremia (n = 140), all of which resulted from CRE infection.
Overall 28-day mortality among CRE patients was 28%, and ranged from 35% for HABP cases to 18% for cUTI/AP cases. Clinical cure was achieved by only 57% of all patients, while 52% achieved microbiological eradication. Immunosuppression, chronic renal insufficiency and septic shock upon presentation were commonly present among all indications, and univariate analysis across and within each indication showed no significant mortality benefits with any single agent or combination therapy.
These results demonstrate a need for new CRE treatments that demonstrate efficacy in this highly affected patient population, according to the researchers.
“What we found is that the best available therapy right now isn’t very good,” Dudley said. “Whether you gave one drug, whether you gave three drugs, or whether you gave certain combinations of drugs, none of them seem to be working very well within this patient population.” –by Dave Muoio
Reference:
Alexander E, et al. Abstract L-53. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: The researchers are employees of the Medicines Company, which funded study and is currently conducting a phase 3 trial of an experimental CRE treatment.