Analysis of Ceftazidime/Avibactam Use for Treating Carbapenem-Resistant Infections in Critically Ill Patients With Thermal or Inhalation Injuries

Abstract

Rising antimicrobial resistance is a pressing public health concern. An increase in carbapenem-resistant organisms has led to increased use of novel antibiotics, such as ceftazidime/avibactam (CZ/AV). However, recent studies have shown increasing treatment failures and resistance rates associated with ceftazidime/avibactam use. The efficacy of CZ/AV has not been studied in patients with thermal or inhalation injuries, where pharmacokinetic derangements are common and patients are often subject to longer lengths of stay and several antimicrobial courses that may lead to higher resistance rates. The objective of this study was to evaluate the outcomes of patients with thermal and inhalation injuries including clinical success, the frequency of adverse effects, and emergence of resistance. In the 17 courses of CZ/AV evaluated, clinical success occurred in 71% (12/17) of courses. Enterobacter cloacae was the most commonly treated pathogen. Resistance developed in 18% (3/17) of courses, but follow-up sensitivities were not evaluable for every case. Although lower than desired, clinical success rates in this sample were similar to other reported populations treated with CZ/AV. However, the emergence of resistance occurred more frequently and was likely underreported in this sample. Although limited by its small sample size, this study emphasizes the concern of growing antimicrobial resistance among even novel antibiotics. Resistance can develop during the initial course, stressing the importance of infection prevention and antimicrobial stewardship. Furthermore, attention and resources should be given to proper pharmacokinetic analysis of medications given in severely ill, hypermetabolic populations.

The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes

“…Within worldwide single-center reports and/or small-sample-sized studies, the evidence supports CAZ-AVI’s excellent effectiveness in managing carbapenem-resistant Enterobacterales infections, including CRKP ones, which have been highlighted in a range from 33.3% to 81.8% [ 34 , 57 , 58 , 59 ]. Reported studies have further highlighted CAZ-AVI-associated microbiological clearances ranging from 36.7% to 79.5% among several kinds of carbapenem-resistant Enterobacterales infections [ 37 , 60 , 61 ].…”

A Retrospective Case-Control Study of Eravacycline for the Treatment of Carbapenem-Resistant Acinetobacter Infections in Patients With Burn Injuries

“…Extensive thermal injuries frequently lead to an increased length of hospital stay due to the time required to regrow healthy dermal tissue and eventual wound closure. 17 Thermal injuries lead to a deficiency in one’s natural, protective barrier to infection, increased susceptibility to multiple pathogens, and often require multiple courses of antibiotics. 18 For patients surviving the initial 72 h post-burn injury, the most common cause of death is sepsis.…”