Ceftazidime-avibactam Versus Tigecycline for the Treatment of Carbapenem-resistant Klebsiella Pneumoniae-induced Pneumonia in Critically Ill Patients

Abstract

Background: To assess the safety patterns and outcomes of ceftazidime-avibactam (CAZ-AVI) versus tigecycline (TGC) for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) pneumonia defined as either hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).Methods: Clinical and microbiological cure rates, 28-day survival rates, and safety evaluation were compared between patients treated with CAZ-AVI versus those treated with TGC in a retrospective study. Conventional multivariate logistic regression analysis and three propensity score (PS) analyses were performed to control for confounding variables.Results: A total of 105 cases were included in the study; 62 patients (59%) received TGC, and 43 patients (41%) received CAZ-AVI. Clinical cure rates and microbiological cure success of CAZ-AVI were superior to TGC [51.2% versus 29.0%(P=0.022) and74.4% versus 33.9%（P<0.001）, respectively]. There were no significant differences between the two groups with regard to 28-day survival rates (66.1% versus 69.8%, P=0.695). In analyses of conventional multivariate logistic regression and propensity score (PS) analysis, patients in the CAZ-AVI group were more likely to have achieved clinical cure and microbiological success compared with patients in the TGC group. However, the difference between the two groups with regard to 28-day survival rates were not significant. In terms of safety evaluation, generally, the CAZ-AVI group had a lower incidence of adverse reactions when compared with the TGC group.Conclusions: CAZ-AVI may be a suitable alternative to TGC for the treatment of HAP or VAP caused by CRKP in critically ill patients.