Ceftazidime/Avibactam versus Polymyxin B in the Challenge of Carbapenem-Resistant Pseudomonas aeruginosa Infection

Abstract

Purpose Ceftazidime/avibactam (CAZ/AVI) monotherapy and polymyxin B-based combination therapy are currently two treatment options for patients with carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection; however, few studies have contrasted the relative efficacy of the two antibiotic regimens. The purpose of this study was to compare the effectiveness of CAZ/AVI and polymyxin B against CRPA infection and analyze the independent predictors of 30-day mortality or survival. Patients and Methods This single-center retrospective observational study included patients with CRPA infection treated with CAZ/AVI or polymyxin B between January 2018 and December 2020. The primary outcomes were the 14-day and 30-day mortality. The secondary outcomes were in-hospital mortality and bacterial clearance. Baseline characteristics and outcomes were compared between the two groups, and COX regression analysis was used to identify predictors of 30-day mortality. Results A total of 136 patients with CRPA infection were enrolled, including 51 patients in the CAZ/AVI group and 85 patients in the polymyxin B group. The 14-day mortality (5.9% vs 27.1%, p=0.002), 30-day mortality (13.7% vs 47.1%, p<0.001) and in-hospital mortality (29.4% vs 60.0%, p=0.001) in the CAZ/AVI group were significantly lower than the polymyxin B group. The bacterial clearance rate (45.1% vs 12.9%, p<0.001) in the CAZ/AVI group were higher than in the polymyxin B group. After adjustment by propensity score matching, the CAV/AVI group still had lower 30-day mortality (14.3% vs 42.9%, p=0.018) and higher bacterial clearance rate (42.9% vs 14.3%, p=0.018) than the polymyxin B group. The multivariate COX analysis showed that the age was identified as independent predictor of 30-day mortality while CAZ/AVI therapy and central venous catheterization emerged as independent predictors of 30-day survival. Conclusion CAZ/AVI therapy was superior to polymyxin B therapy for patients with CRPA infection, and provided significant survival benefits, but further larger studies were needed to substantiate our findings.

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

“…It was in line with a previous retrospective cohort study of critically ill patients with CRPA infection, which showed a low mortality rate at 14-day (5.9%) and 30-day (13.7%) in the CAZ/AVI treatment group. 21 Besides, Jorgensen et al reported that the 30-day mortality was 17.5% among the patients with CAZ/AVI treatment for MDR-PA infection in their cohort, 22 which was concordant with the data of our study. Consistently, another study evaluating the potential efficacy of CAZ/AVI in MDR and XDR-PA infection, suggested the 30-day mortality were 12.5%, along with clinical cure rate of 50%.…”

“…CAZ/AVI is a new β-lactam/β-lactamase inhibitor, which has been approved by FDA for the treatment of complicated urinary tract infections, complicated intra-abdominal infections, hospital-acquired pneumonia, and infections caused by Gram-negative organisms in patients with limited treatment options. 19,20 Available studies had reported the efficacy and safety of CAZ/AVI for refractory P. aeruginosa infection, [21][22][23][24][25] but there is rather limited evidence in lung transplant patients. Thus, the purpose of this study was to investigate the therapeutic efficacy of CAZ/AVI against CRPA infection in lung transplant cases.…”

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

“… 33 , 34 Some studies have shown that the duration of antimicrobial drug use may be a protective factor. 35 In our study, this may be due to the small sample size, but it also reflects the fact that clinical symptoms improve during treatment, allowing for the continued use of antimicrobial drugs until the infection is under control.…”

Clinical Characteristics and Prognosis of Bloodstream Infection with Carbapenem-Resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancies

“…The CAZ/AVI group had a significantly higher bacterial clearance rate than the polymyxin B group. 38 Our expert consensus on PA lower respiratory tract infections also states that for CRPA infections, ceftazidime avibactam can be used as a first-line treatment option when sensitivity to it is confirmed by drug sensitivity. 39 The 28-day mortality rate of 64 patients in this study was 37.5%, of which 11 patients died before the return of the drug sensitivity.…”