Ciprofloxacin for the Treatment of Infections Caused by Carbapenemase-Producing Gram-Negative Bacteria.

Background

There is no experience with ciprofloxacin for the treatment of carbapenemase-producing Gram-negative bacteria (CP-GNB) infections.

Methods

This is a retrospective single-centre study where we describe the clinical evolution of all consecutive adult patients who received ciprofloxacin monotherapy for the treatment of CP-GNB infections. Primary outcomes were clinical failure (defined as death, lack of clinical improvement or a switch to another drug) at day 14 and 30-day all-cause mortality.

Results

Nineteen patients were included. Fifteen (79%) were men, the median age was 74 years (IQR 66-79) and the median Charlson comorbidity index was five (IQR 3-6.5). The most frequent infections were: nine complicated urinary tract infections, three soft tissue infections and three intra-abdominal infections. Twenty CP-GNBs were isolated (one patient had a coinfection): nine VIM-type-producing Enterobacterales, nine OXA-48-type-producing Enterobacterales and two VIM-type-producing Pseudomonas aeruginosa. Six (32%) patients had positive blood cultures, and one presented with septic shock. The median duration of ciprofloxacin treatment was 14 days (IQR 10-15). One patient presented with clinical failure at day 14. There was no 30-day mortality. Two patients exhibited microbiological recurrence at day 90. There were no reported adverse effects.

Conclusions

Monotherapy with ciprofloxacin may be an alternative treatment for selected, clinically stable patients with ciprofloxacin-susceptible CP-GNB infections.