Ceftazidime/Avibactam for the Treatment of Carbapenem-Resistant Pseudomonas aeruginosa Infection in Lung Transplant Recipients

Abstract

Background Experience of ceftazidime-avibactam (CAZ/AVI) for carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection in recipients after lung transplantation (LT) is relatively limited. Methods A retrospective observational study was conducted on lung transplant recipients receiving CAZ/AVI therapy for CRPA infection. The primary outcomes were the 14-day and 30-day mortality. The secondary outcomes were clinical cure and microbiological cure. Results Among 183 LT recipients, a total of 15 recipients with CRPA infection who received CAZ/AVI therapy were enrolled in this study. The mean age of recipients was 54 years and 73.3% of recipients were male. The median time from infection onset to initiation of CAZ/AVI treatment was 4 days (IQR, 3–7) and the mean duration of CAZ/AVI therapy was 10 days. CAZ/AVI was mainly administered as monotherapy in LT recipients (80%). Among these eligible recipients, 14-day and 30-day mortality were 6.7% and 13.3%, respectively. The clinical cure and microbiological cure rates of CAZ/AVI therapy were 53.3% and 60%, respectively. Three recipients (20%) experienced recurrent infection. In addition, the mean lengths of ICU stay and hospital stay were 24 days and 35 days, respectively, among LT recipients. Conclusion CAZ/AVI may be an alternative and promising regimen for CRPA eradiation in lung transplant recipients.

The changing landscape of infections in the lung transplant recipient

“…Newer antibiotics agents recommended based on mechanism of resistance and pathogen include Cefiderocol (CFDC), a novel siderophore cephalosporin; b-lactam-b-lactamase combinations such as ceftaizidime-avibactam (CAZ/ AVI), ceftolozane-tazobactam (C/T); and carbapenem-b-lactamase combinations meropenem-vaborbactam and imipenem-relebactam. Several studies and case reports describing the use of newer agents for the treatment of gram-negative infections in lung transplant are listed in (Table 2) [51][52][53][54][55][56][57][58].…”

Ceftazidime-Avibactam Combination Therapy versus Monotherapy for the Treatment Carbapenem-Resistant Gram-Negative Bacterial Infections: A Retrospective Observational Study

“…[4][5][6][7] However, the emergence and spread of carbapenemases threatens their efficacy as the last line of defense against multidrugresistant bacteria. 8,9 For domestic use, the most prevalent carbapenemases are Klebsiella pneumoniae carbapenemases (KPC), 10 which belong to the Ambler class A enzymes and can hydrolyze all available traditional β-lactam antibiotics.…”