Ceftazidime–Avibactam-Based Versus Tigecycline-Based Regimen for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae-Induced Pneumonia in Critically Ill Patients

Abstract

Introduction:The aim of the present study was to assess the safety profile and outcomes of a ceftazidime-avibactam (CAZ-AVI)-based regimen and compare them with those of a tigecycline (TGC)-based regimen in intensive care unit (ICU) for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP), which is classified into hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Methods: Clinical and microbiological cure rates, 28-day survival rates, and safety evaluation findings were compared between patients treated with CAZ-AVI-based regimen and those treated with TGC-based regimen in this retrospective study. Conventional multivariate logistic regression analysis and regression adjustment analysis with propensity score (PS) were performed to control for confounding variables.Results: A total of 105 cases of critically ill ICU patients with CRKP-induced HAP or VAP were included in the present study from July 2019 to September 2020; 62 patients (59%) received TGC-based regimen and 43 patients (41%) received CAZ-AVI-based regimen. The most common concomitant agent in the CAZ-AVI group and TGC group was carbapenem (44.2% versus 62.9%, P = 0.058), while only a small proportion of the study population received CAZ-AVI and TGC monotherapy (20.9% versus 6.5%, P = 0.027). The clinical and microbiological cure rates of the CAZ-AVI group were superior to those of the TGC group [51.2% versus 29.0% (P = 0.022) and 74.4% versus 33.9% (P \ 0.001), respectively]. No significant differences in the 28-day survival rates were identified between the two groups (69.8% versus 66.1%, P = 0.695). Conventional multivariate logistic regression and PS analyses showed that patients who had used CAZ-AVI were more likely to have achieved a clinical cure [4.767 (95%CI 1.694-13.414), P=0.003;3.405 (95%CI 1.304-8.889), P=0.012] and microbiological success [6.664 (95%CI 2.626-16.915), P\0.001;7.778 (95%CI 2.717-22.265), P\0.001] than patients who used TGC. However, the difference in the 28-day survival rates between the two groups was not significant. According to the safety evaluation findings, the CAZ-AVI

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

“…Several studies have demonstrated that CAZ-AVI is more effective against CRKP than polymyxins and tigecycline. 7–10 However, the risk factors associated with treatment failure of CAZ-AVI remain unclear. Additionally, previous in vitro studies have shown that CAZ-AVI, when combined with other agents, exhibits high synergistic activity against CRKP.…”

Carbapenem-Resistant Klebsiella pneumoniae: Diversity, Virulence, and Antimicrobial Resistance

“… 56 In another study, ceftazidime–avibactam was a promising therapeutic option for the treatment of CRKP-induced pneumonia. 57 This variation in the susceptibility patterns may be attributed to the difference in the prescribed antibiotics from certain geographic areas to others and heterogeneity of CRKP strains side by side with the strain variability according to the clinical sites.…”

What to Do with the New Antibiotics?

“…For the carbapenemase-producing Enterobacterales -related infections (including KPC- and OXA-48-producing strains), several retrospective studies have compared CZA with colistin [ 39 , 40 , 41 , 42 ] or tygecycline [ 43 ], showing a better clinical cure rate with CZA.…”