Ceftazidime-avibactam alone or in combination with Aztreonam versus Polymyxins in the management of carbapenem-Resistant Klebsiella pneumoniae nosocomial Infections (CAPRI study): a retrospective cohort study from South India

Abstract

Introduction Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections commonly cause hospital-acquired infections. The study aimed to compare the outcomes of CRKP infections between patients receiving ceftazidime avibactam +/− aztreonam and polymyxins in a hospital setting with a high prevalence of New Delhi Metallo Beta Lactamase production. Methods We conducted a retrospective cohort study from January 2020 to September 2022 in critically ill adult patients admitted to a non-COVID-19 medical intensive care unit with CRKP infection. The patients were followed up for a total of 30 days or death, whichever was later. Results Of a total of 106 patients included in the study, 65 patients received polymyxins and 41 patients received ceftazidime–avibactam +/− aztreonam. Higher 30-day mortality was noted in the polymyxin group (56.9% vs. 29.2%, P = 0.005). The mean time to event (mortality) in ceftazidime–avibactam +/− aztreonam was 23.9 + 1.5 days which was significantly higher compared to polymyxins (17.9 + 1.2 days, p = 0.006). On Cox regression analysis, after adjusting for the covariates, the hazard ratio for time to event with the use of polymyxin was 2.02 (95% CI: 1.03–3.9). Conclusion Ceftazidime–avibactam + aztreonam is possibly associated with better clinical outcomes in patients infected with CRKP.

Outcomes of 23 patients diagnosed with New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae infection treated with ceftazidime/avibactam and aztreonam at a single center in Poland

“…Four out of the analyzed patients died; three of them had a neoplastic disease, and one had a COVID-19 infection. This represents a lower mortality rate than in the Sree et al [16] (29.9%) analysis but higher than in the study by Zhang et al [19] (7.1%), although the latter analyzed hematologic patients.…”

“…Aztreonam is inactivated by ESBLs, KPC, and other cephalosporinases but remains stable against hydrolysis by MBLs. Thus, adding aztreonam to CZA enhances its activity by protecting aztreonam from the attack of ESBLs [15,16].…”

Clinical Outcomes and Risk Factors for Death in Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumoniae Treated with Ceftazidime-Avibactam: A Retrospective Study

“…Previous studies have reported a mortality rate of 8-37.5% among patients treated by CAZ-AVI for CRKP. 8,[17][18][19][20] In this study, we report a 30-day mortality rate of 28.2%. The difference may be because of the patients' age, site of infection, and severity of disease.…”