Impact of a Rapid Molecular Test for Klebsiella pneumoniae Carbapenemase and Ceftazidime-Avibactam Use on Outcomes After Bacteremia Caused by Carbapenem-Resistant Enterobacterales.

BACKGROUND: Patients with bacteremia due to carbapenem-resistant Enterobacterales (CRE) experience delays until appropriate therapy and high mortality rates. Rapid molecular diagnostics for carbapenemases and new ß-lactam/ß-lactamase inhibitors may improve outcomes. METHODS: We conducted an observational study of patients with CRE bacteremia from 2016 to 2018 at 8 New York and New Jersey medical centers and assessed center-specific clinical microbiology practices. We compared time to receipt of active antimicrobial therapy and mortality between patients whose positive blood cultures underwent rapid molecular testing for the Klebsiella pneumoniae carbapenemase (KPC) gene (blaKPC) and patients whose cultures did not undergo this test. CRE isolates underwent antimicrobial susceptibility testing by broth microdilution and carbapenemase profiling by whole-genome sequencing. We also assessed outcomes when ceftazidime-avibactam and polymyxins were used as targeted therapies. RESULTS: Of 137 patients with CRE bacteremia, 89 (65%) had a KPC-producing organism. Patients whose blood cultures underwent blaKPC PCR testing (n = 51) had shorter time until receipt of active therapy (median: 24 vs 50 hours; P = .009) compared with other patients (n = 86) and decreased 14-day (16% vs 37%; P = .007) and 30-day (24% vs 47%; P = .007) mortality. blaKPC PCR testing was associated with decreased 30-day mortality (adjusted odds ratio: .37; 95% CI: .16-.84) in an adjusted model. The 30-day mortality rate was 10% with ceftazidime-avibactam monotherapy and 31% with polymyxin monotherapy (P = .08). CONCLUSIONS: In a KPC-endemic area, blaKPC PCR testing of positive blood cultures was associated with decreased time until appropriate therapy and decreased mortality for CRE bacteremia, and ceftazidime-avibactam is a reasonable first-line therapy for these infections.

Myocarditis in SARS-CoV-2: A Meta-Analysis.

There has been a rise in cardiovascular events following the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a strain that caused coronavirus disease 2019 (COVID-19). Although rare, there has been an increase in reports of myocarditis secondary to both individuals infected by the strain and those who received the COVID-19 mRNA vaccine. The focus of this study is to determine the risk of myocarditis associated with the COVID-19 vaccine and SARS-CoV-2 infection. Relevant literature was collected using the search engines PubMed, Google Scholar, and the WHO Global Literature on Coronavirus Disease. Randomized controlled clinical trials and cohort studies reporting the risk of myocarditis induced by SARS-CoV-2 infection and COVID-19 vaccines were used. A meta-analysis was conducted using the inverse variance method using RevMan application software. A meta-analysis of the compiled data showed a mean risk ratio of 4.74 (95% confidence interval (CI) = 2.40 to 9.36; p < 0.0000100), which indicates there is a significant difference in the risk of COVID-19-induced myocarditis in those with unspecified vaccination status compared to the non-infected population. A meta-analysis of the selected data found a mean risk ratio of 5.01 (95% CI = 4.14 to 6.08; p < 0.0000100), indicating a significant difference in the risk of COVID-19-induced myocarditis between those who are unvaccinated and the non-infected population. Upon a meta-analysis of the selected data set, a mean risk ratio of 2.55 (95% CI = 0.840 to 7.74; p = 0.100) was found, indicating no significant difference in the risk of vaccine-induced myocarditis between those with a vaccinated vaccination status and that of the non-infected population. The result of this meta-analysis showed that infection with SARS-CoV-2 in unvaccinated patients carries a statistically significant increased risk of acquiring myocarditis while those receiving the vaccination do not share this same risk.