1618 - Meropenem-vaborbactam vs standard of care for multidrug resistant carbapenem-resistant Enterobacteriaceae

Background: Antimicrobial resistance to gram negative organisms is an increasing issue worldwide, particularly with regards to extended-spectrum B-lactamase (ESBL) and carbapenem-resistant Enterobacteriaeceae (CRE) producing organisms. Meropenem/vaborbactam (M-V) is an approved antimicrobial for treatment of some CRE infections. This study compares the outcomes of patients with CRE who were treated with M-V to standard of care (SoC) therapy.Table 1. Results


Methods: A retrospective chart analysis was performed which analyzed 25 patients in the M-V group and 25 patients in the SoC group at an 800-bed tertiary care hospital in Southeast Michigan. Patients were matched by type of infection. Variables included basic demographics, infection source, bacterial species, as well as 30-day readmission, ICU admission, and creatinine pre- and post-treatment. The primary outcome of interest was 30-day mortality and clinical outcome (cure/improved/failure). Secondary outcomes included microbiological outcome (eradication/presumed eradication/persistence/presumed persistence) and acute kidney injury (AKI) on therapy. The data was analyzed using SPSS version 14.0.

Results: The most commonly used antibiotics in the SoC group were ceftazidime-avibactam (64%) and cefepime (32%). In both groups, the most common infection source was intra-abdominal (56%). The most commonly isolated pathogen in each group was Klebsiella pneumoniae (52% in M-V and 48% in SoC). Mortality and re-admission at 30 days did not differ statistically between the two groups. However, patients who received M-V were found to be more likely to achieve clinical cure, although this did not achieve statistical significance. Patients who were treated with SoC were significantly more likely to achieve an improved clinical outcome and presumed microbiological eradication (p=0.001 and 0.01 respectively). Of the 50 patients, only 26 patients (52%) met criteria to analyze for AKI. Patients who received M-V were more likely to have AKI (16% compared to 8%) but this did not reach statistical significance.

Conclusion: M-V is an important option for care of patients with infections due to MDR gram-negative bacteria. However, further studies are warranted to determine whether its use is associated with reduced mortality and improved clinical outcomes.