title: Carbapenem-resistance in gram-negative bacilli and intravenous minocycline: an antimicrobial stewardship approach at the Detroit Medical Center.
abstract: In the era of carbapenem-resistance in Acinobacter baumannii and Enterobacteriaceae, there are limited treatment options for these pathogens. It is essential that clinicians fully assess all available therapeutic alternatives for these multidrug-resistant organisms. We herein describe the approach of the antimicrobial stewardship team at the Detroit Medical Center (DMC) for the evaluation and use of intravenous (IV) minocycline for the treatment of these resistant organisms, given potential advantages of IV minocycline over tigecycline and doxycycline. In vitro analyses at the DMC demonstrated good activity against A. baumannii (78% susceptibility), including 74% of carbapenem-resistant strains, but limited activity against our carbapenem-resistant K.pneumoniae (12% susceptibility.) Based in part on these results, IV minocycline was added to the formulary, primarily for the treatment of carbapenem-resistant A. baumannii. Early experience has been positive: 6/9 (67%) of patients who received IV minocycline had infections due to these organisms cured, including 6/7 (86%) who received doses of 200 mg twice daily.
authors.affiliation: Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center Wayne State University School of Medicine, Detroit.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.affiliation: Wayne State University School of Medicine, Detroit.
authors.forename: Anupama
authors.initials: A
authors.lastname: Neelakanta
authors.affiliation: Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Mynatt
authors.affiliation: Wayne State University School of Medicine, Detroit.
authors.forename: Sarit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Wayne State University School of Medicine, Detroit Detroit Medical Center University Laboratories.
authors.forename: Paul
authors.initials: P
authors.lastname: Lephart
authors.affiliation: Wayne State University School of Medicine, Detroit Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Michigan.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage* / Q000494:pharmacology*; D010607:Pharmacy Service, Hospital
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D008911:Minocycline
keywords: A. baumannii; colistin; minocycline; multidrug-resistant; tetracycline