Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms

Fosfomycin has shown promising in vitro activity against multidrug-resistant (MDR) urinary pathogens; however, clinical data are lacking. We conducted a retrospective chart review to describe the microbiological and clinical outcomes of urinary tract infections (UTIs) with MDR pathogens treated with fosfomycin tromethamine. Charts for 41 hospitalized patients with a urine culture for an MDR pathogen who received fosfomycin tromethamine from 2006 to 2010 were reviewed. Forty-one patients had 44 urinary pathogens, including 13 carbapenem-resistant Klebsiella pneumoniae (CR-Kp), 8 Pseudomonas aeruginosa, and 7 vancomycin-resistant Enterococcus faecium (VRE) isolates, 7 extended-spectrum beta-lactamase (ESBL) producers, and 9 others. In vitro fosfomycin susceptibility was 86% (median MIC, 16 |mg/ml; range, 0.25 to 1,024 |ULg/ml). Patients received an average of 2.9 fosfomycin doses per treatment course. The overall microbiological cure was 59%; failure was due to either relapse (24%) or reinfection UTI (17%). Microbiological cure rates by pathogen were 46% for CR-Kp, 38% for P. aeruginosa, 71% for VRE, 57% for ESBL producers, and 100% for others. Microbiological cure (n = 24) was compared to microbiological failure (n = 17). There were significantly more solid organ transplant recipients in the microbiological failure group (59% versus 21%; P = 0.02). None of the patients in the microbiological cure group had a ureteral stent, compared to 24% of patients within the microbiological failure group (P = 0.02). Fosfomycin demonstrated in vitro activity against UTIs due to MDR pathogens. For CR-KP, there was a divergence between in vitro susceptibility (92%) and microbiological cure (46%). Multiple confounding factors may have contributed to microbiological failures, and further data regarding the use of fosfomycin for UTIs due to MDR pathogens are needed

Carbapenem-resistant Enterobacteriaceae: A review of treatment and outcomes

The emergence of carbapenem resistance in Enterobacteriaceae is an important threat to global health. Reported outcomes of infections with carbapenem-resistant Enterobacteriaceae (CRE) are poor. Very few options remain for the treatment of these virulent organisms. Antibiotics which are currently in use to treat CRE infections include aminoglycosides, polymyxins, tigecycline, fosfomycin, and temocillin. In addition, the role of combination therapy, including carbapenem containing regimens, remains to be defined. There are several important concerns regarding all of these treatment options such as limited efficacy, increasing reports of resistance, and specific toxicities. Data from retrospective studies favor combination therapy over single-agent therapy for the treatment of CRE bloodstream infections. In summary, new antibiotics are greatly needed, as is additional prospective research

Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is an emerging multidrug-resistant nosocomial pathogen. This is a retrospective chart review describing the outcomes and treatment of 60 cases of CR-Kp bloodstream infections. All CR-Kp isolated from blood cultures were identified retrospectively from the microbiology laboratory from January 2007 to May 2009. Clinical information was collected from the electronic medical record. Patients with 14-day hospital mortality were compared to those who survived 14 days. The all-cause in-hospital and 14-day mortality for all 60 CR-Kp bloodstream infections were 58.3% and 41.7%, respectively. In this collection, 98% of tested isolates were susceptible in vitro to tigecycline compared to 86% to colistimethate, 45% to amikacin, and 22% to gentamicin. Nine patients died before cultures were finalized and received no therapy active against CR-Kp. In the remaining 51 patients, those who survived to day 14 (n = 35) were compared to nonsurvivors at day 14 (n = 16). These patients were characterized by both chronic disease and acute illness. The 90-day readmission rate for hospital survivors was 72%. Time to active therapy was not significantly different between survivors and nonsurvivors, and hospital mortality was also similar regardless of therapy chosen. Pitt bacteremia score was the only significant factor associated with mortality in Cox regression analysis. In summary, CR-Kp bloodstream infections occur in patients who are chronically and acutely ill. They are associated with high 14-day mortality and poor outcomes regardless of tigecycline or other treatment regimens selected

Search for Higgs-like bosons decaying into long-lived exotic particles

A search is presented for massive long-lived particles, in the 20–60 GeV/c2 mass range with lifetimes between 5 and 100 ps. The dataset used corresponds to 0.62fb-1 of proton-proton collision data collected by the LHCb detector at s=7TeV. The particles are assumed to be pair-produced by the decay of a Higgs-like boson with mass between 80 and 140 GeV/c2. No excess above the background expectation is observed and limits are set on the production cross-section as a function of the long-lived particle mass and lifetime and of the Higgs-like boson mass

Observation of B +→ J / ψ 3 π +2 π - and B +→ ψ (2 S) π +π +π - decays

The decays B +→ J / ψ 3 π +2 π - and B +→ ψ (2S) π +π +π - are observed for the first time using a data sample corresponding to an integrated luminosity of 3.0 fb- 1, collected by the LHCb experiment in proton–proton collisions at the centre-of-mass energies of 7 and 8TeV. The branching fractions relative to that of B +→ ψ (2S) K + are measured to be (Formula Presented.), where the first uncertainties are statistical and the second are systematic

First study of the CP-violating phase and decay-width difference in Bs 0→ψ(2S)ϕ decays

A time-dependent angular analysis of Bs 0→ψ(2S)ϕ decays is performed using data recorded by the LHCb experiment. The data set corresponds to an integrated luminosity of 3.0fb−1 collected during Run 1 of the LHC. The CP-violating phase and decay-width difference of the Bs 0 system are measured to be ϕs=0.23−0.28 +0.29±0.02rad and ΔΓs=0.066−0.044 +0.041±0.007ps−1, respectively, where the first uncertainty is statistical and the second systematic. This is the first time that ϕs and ΔΓs have been measured in a decay containing the ψ(2S) resonance