Superbugs Going Superbad: Ceftazidime-Avibactam Salvage Therapy for Klebsiella pneumoniae and Transcatheter Mitral-Valve Repair in Heart Failure

Andre Madison, General Internal Medicine (GIM) fellow at Western University, is back on The Rounds Table with Michael Juba, clinical pharmacist at London Health Sciences Centre in Infectious Disease and Anti-Microbial Stewardship.  Together they are covering the efficacy of ceftazidime-avibactam salvage therapy for Klebsialla pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae and transcatheter mitral-valve repair in heart failure.

Carbapenemases, enzymes that break down antibiotics called carbapenems which are often our last resort, are becoming more prevalent.  A newer drug called ceftazidime-avibactam, which has been approved in Europe for treatment of hospital-acquired pneumonia and other infections, has recently been looked at as an agent to potentially treat organisms with carbapenemases.  Michael covers a retrospective trial on the efficacy of ceftazidime-avibactam in patients with KPC-producing Klebisella pneumoniae bacteremia and compared the mortality among patients who did and did not receive this antibiotic.

There is good evidence for mitral valve repair for primary mitral regurgitation, in which there is a structural abnormality of the mitral valve.  Secondary mitral regurgitation occurs because of distortion of the left ventricle.  What is the evidence behind mitral valve repair in the latter?  Andre covers the COAPT trial, a randomized control trial of patients with symptomatic heart failure with moderate to severe secondary mitral regurgitation.  He compares patients who received transcatheter mitral-valve repair versus a control group of patients that were medically optimized and evaluates if the former led to a reduction in heart failure-related admissions and other secondary outcomes.

Next, The Good Stuff segment.  Michael tells listeners about the increasing tolerance of Enterococcus faecium to handwashing alcohols and Andre covers a perspective piece by a radiologist on how health care practitioners respond when patients may be in denial about their illness.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Andre Maddison @MaddisonAndre and Michael Juba @juba_the_hutt.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. Ceftazidime-Avibactam Salvage Therapy: https://www.ncbi.nlm.nih.gov/pubmed/29893802

2. Transcatheter Mitral-Valve Repair: https://www.nejm.org/doi/full/10.1056/NEJMoa1806640

Good Stuff

1. Enterococcus faecium and Handwashing Alcohols: https://www.ncbi.nlm.nih.gov/pubmed/30068573 

2. The Grace of Denial: https://www.nejm.org/doi/full/10.1056/NEJMp1810685 

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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