Acta Scientific Microbiology (ISSN: 2581-3226)

Research Article Volume 6 Issue 2

Clinical Evolution of Carbapenemase Producing Gram-negative Bacteria Infections Treated by Monotherapy Versus Dual Therapy

Abbas Samaha, Jacques Choucair*, Gebrayel Saliba, Nabil Chehata, Marie Chedid and Racha Ibrahim

Saint Joseph University, Faculty of Medicine, Infectious Diseases Department, Hotel Dieu de France, Beyrouth, The Lebanon

*Corresponding Author: Jacques Choucair, Saint Joseph University, Faculty of Medicine, Infectious Diseases Department, Hotel Dieu de France, Beyrouth, The Lebanon.

Received: December 07, 2022; Published: January 24, 2023


Introduction: During the last few years, the emergence of carbapenemase producing gram-negative bacteria infections has been reported worldwide. These infections are very difficult to treat since there is no consensus on the antibiotic treatment modalities.

Methods: This study is an observational, retrospective study reviewing the clinical course and prognosis of patients treated for carbapenemase secreting Enterobacteriaceae infection, according to different antibiotic treatment protocols. The population consists of all patients infected by enterobacteriaceae with a decreased sensitivity to carbapenems, between September 2014 and January 2016. The primary objective of this study is to compare the recurrence and mortality rates between the group of patients treated with a monotherapy and the one receiving a combination antibiotic therapy.

Results: Amongst the 29 patients that received a monotherapy, 15 patients (51.7%) had a recurrent infection compared to 9 patients (33.3%) out of 27 that received a combination therapy without a statistically significant difference between these 2 groups. The interval of trust is [0,16- 1,38] (p-value at 0.467 > 0.05).

10 patients (34.5%) out of the 29 patients who received a single antibiotic died compared to 14 (51.9%) of the 27 patients who received a combined antibiotherapy. There was no statistical significant difference between these 2 groups: [0,7-6] is the interval of trust for this analysis with a p-value at 2.046 > 0.05.

Conclusions: The number of antibiotics used, whether one or more, does not influence the recurrence rate of carbapenemase-secreting enterobacteriaceae. And the type of therapy used, has no effect on the mortality rate, following a carbapenemase-secreting enterobacteriaceae.

Keywords: Penicillin G; Carbapenemase; Enzymes


  1. Waclaw B. “Evolution of drug resistance in bacteria”. Advances in Experimental Medicine and Biology 915 (2016): 49-67.
  2. Hammoudi Halat D., et al. “Heterogeneity of carbapenem resistance mechanisms among Gram-negative pathogens in Lebanon: Results of the first cross-sectional countrywide study”. Microbial Drug Resistance 6 (2017): 733-743.
  3. Dandachi I., et al. “Understanding the epidemiology of multi-drug resistant Gram-negative bacilli in the middle east using a one health approach”. Frontiers in Microbiology 10 (2019): 1941.
  4. Rizk NA., et al. “Challenges to antimicrobial stewardship in the countries of the Arab league: Concerns of worsening resistance during the COVID-19 pandemic and proposed solutions”. Antibiotics (Basel)11 (2021): 1320.
  5. Nordmann P and Poirel L. “Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria”. Clinical Infectious Diseases7 (2019): S521-528.
  6. Meletis G., et al. “Carbapenemase reports from the Balkans: a systematic review”. InfezMed2 (2014): 85-106.
  7. Schill F., et al. “Prevalence and characterization of extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase producing Enterobacteriaceae in fresh pork meat at processing level in Germany”. International Journal of Food Microbiology 257 (2017): 58-66.
  8. Paul M., et al. “Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial”. Lancet Infectious Diseases4 (2018): 391-400.
  9. De la Calle C., et al. “Clinical characteristics and prognosis of infections caused by OXA-48 carbapenemase producing Enterobacteriaceae in patients treated with ceftazidime-avibactam” 53.4 (2019): 520-524.
  10. Nutman A., et al. “Colistin plus meropenem for carbapenem-resistant Gram-negative infections: in vitro synergism is not associated with better clinical outcomes”. Clinical Microbiology and Infection 9 (2020): 1185-1191.
  11. Önal U., et al. “Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae”. Journal of Chemotherapy1 (2020): 15-20.
  12. Schmid A., et al. “Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis”. 9.1 (2019): 15290.
  13. Almangour TA., et al. “Ceftazidime-avibactam versus colistin for the treatment of infections due to carbapenem-resistant Enterobacterales: A multicenter cohort study”. Infection and Drug Resistance 15 (2022): 211-221.
  14. BelénGutiérrez-Gutiérrez., et al. “Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study”. Lancet Infectious Diseases7 (2017): 726-734.


Citation: Jacques Choucair., et al. “Clinical Evolution of Carbapenemase Producing Gram-negative Bacteria Infections Treated by Monotherapy Versus Dual Therapy". Acta Scientific Microbiology 6.2 (2023): 86-91.


Copyright: © 2022 Jacques Choucair., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate30%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is June 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US