Browsing by Author "Evans, Scott"

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    Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study
    (2023) Reyes, Jinnethe; Komarow, Lauren; Chen, Liang; Ge, Lizhao; Hanson, Blake; Cober, Eric; Herc, Erica; Alenazi, Thamer; Kaye, Keith; Garcia, Julia; Li, Lanjuan; Kanj, Souha; Liu, Zhengyin; Oñate, Jose; Salata, Robert; Marimuthu, Kalisvar; Gao, Hainv; Zong, Zhiyong; Valderrama, Sandra; Yu, Yunsong; Tambyah, Paul; Weston, Gregory; Salcedo, Soraya; Abbo, Lillian; Xie, Qing; Ordoñez, Karen; Wang, Minggui; Stryjewski, Martin; Munita, Jose M.; Paterson, David; Evans, Scott; Hill, Carol; Baum, Keri; Bonomo, Robert; Kreiswirth, Barry; Virginia, Maria; Pate, Robin; Arias, Cesar; Chambers, Henry; Fowler,Vance; Doi, Yohei; Van Duin, David; Satlin, Michael; Antibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators
    Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. Methods: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. Findings: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses.Interpretation: The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. Funding: National Institutes of Health.
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    Priorities and Progress in Gram-positive Bacterial Infection Research by the Antibacterial Resistance Leadership Group: A Narrative Review
    (2023) Doernberg, Sarah; Arias, Cesar; Altman, Deena; Babiker, Ahmed; Boucher, Helen; Creech, C Buddy; Cosgrove, Sara; Evans, Scott; Fowler, Vance; Fritz, Stephanie; Hamasaki, Toshimitsu; Kelly, Brendan; Leal, Sixto; Liu, Catherine; Lodise, Thomas; Miller, Loren; Munita, Jose M.; Murray, Barbara; Pettigrew, Melinda; Ruffin, Felicia; Scheetz, Marc; Shopsin, Bo; Tran, Truc; Turne, Nicholas; Williams, Derek; Zaharoff, Smitha; Holland, Thomas; Antibacterial Resistance Leadership Group
    The Antibacterial Resistance Leadership Group (ARLG) has prioritized infections caused by gram-positive bacteria as one of its core areas of emphasis. The ARLG Gram-positive Committee has focused on studies responding to 3 main identified research priorities: (1) investigation of strategies or therapies for infections predominantly caused by gram-positive bacteria, (2) evaluation of the efficacy of novel agents for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci, and (3) optimization of dosing and duration of antimicrobial agents for gram-positive infections. Herein, we summarize ARLG accomplishments in gram-positive bacterial infection research, including studies aiming to (1) inform optimal vancomycin dosing, (2) determine the role of dalbavancin in MRSA bloodstream infection, (3) characterize enterococcal bloodstream infections, (4) demonstrate the benefits of short-course therapy for pediatric community-acquired pneumonia, (5) develop quality of life measures for use in clinical trials, and (6) advance understanding of the microbiome. Future studies will incorporate innovative methodologies with a focus on interventional clinical trials that have the potential to change clinical practice for difficult-to-treat infections, such as MRSA bloodstream infections.

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