Delayed appropriate antibiotic therapy with meropenem and vaborbactam (MVB) for more than 48 hours increased the risk of negative clinical outcomes (NCO) in patients with gram-negative bacterial infections (GNBI), highlighting the importance of timely antibiotic selection, according to research presented at IDWeek, held virtually from October 21 to 25, 2020.

Investigators conducted a multi-center, retrospective cohort study from October 2017 through March 2020 to determine the impact of delayed appropriate therapy with MVB on NCO among patients with GNBI. Adult patients treated with MVB for greater than 72 hours were included, while patients who received alternative antibiotics for GNBI prior to MVB or patients with unknown dates for index culture were excluded. The primary outcome was NCO, defined as 30-day mortality and/or microbiological recurrence.

In the cohort of 91 patients, the most frequent sources of infection were respiratory (32/91) and intra-abdominal (18/91). Most commonly targeted pathogens were Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae. Classification and regression tree analysis-derived breakpoint identified that NCO increased from 17.6% in early treatment patients to 38.6% in delayed treatment patients.

Independent predictors of NCO included delayed MVB (adjusted odds ratio [aOR], 0.277; 95% CI, 0.081-0.941; P =.040), Acute Physiology and Chronic Health Evaluation II score (P =.004), nosocomial infection (P =.031), heart failure (P =.032), and intraabdominal infection (P =.030). 


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Study findings “underscore the importance of early MVB initiation to achieve 30-day survival and/or lack of 30-day recurrence,” investigators concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Alosaimy S, Lagnf AM, Morrisette T, et al. Predictors of negative clinical outcomes among patients treated with meropenem-vaborbactam for serious gram-negative bacterial infections: impact of delayed appropriate antibiotic selection. Presented at: IDWeek 2020; October 21-25, 2020. Poster 1575.