Clinical characteristics and outcomes of patients with multidrug-resistant Gram-negative bacterial infections treated with ceftazidime/avibactam

Kuang, Huan; Zhong, Chengliang; Wang, Yuan-Fang; Hui, Yang; Ao, Keping; Zong, Zhiyong; Lv, Xiaoju

doi:10.1016/j.jgar.2020.10.023

Cited by 17 publications

(35 citation statements)

References 12 publications

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“…Another prominent adverse reaction observed in this study was that 27.4% patients treated with a high-dose of TGC suffered diarrhoea, similar to the rate (34.3%) of the study by Chen et al (35). In contrast, there were no differences with regard to kidney, liver and coagulation indices and diarrhoea before and after CAZ-AVI treatment, thus con rming the safety pro le of CAZ-AVI observed in previous studies (19,20,38).…”

Section: Discussionsupporting

confidence: 90%

“…The clinical cure rates and microbiological success in the CAZ-AVI group were signi cantly higher than those of the TGC group after PS analysis, but there was no statistical differences in 28-day survival rates in the critically ill patients two treatment regimens. Several previous reports of CRE infections treated with CAZ-AVI based combination regimes similarly reported favourable outcomes in these patients (15,19,28). Additionally, safety evaluation between TGC and CAZ-AVI showed that TGC regime was associated with a greater occurrence of adverse reactions, including liver injury, coagulation disorder and diarrhoea.…”

Section: Discussionmentioning

confidence: 67%

“…Clinical success was de ned as the normalization of non-microbiological indicators (such as radiological examinations and laboratory tests) or resolution in clinical symptoms (such as respiratory secretions volume and signs of fever) (19). Microbiological cure success was de ned as culture-con rmed eradication of the pathogen; no pathogen growth in the nal cultured specimen during the entirety of the hospital stay.…”

Section: Outcome Measurementsmentioning

confidence: 99%

“…Avibactam, a novel synthetic non-β-lactam (diazabicyclooctane), enhances the antibacterial activity of ceftazidime against Enterobacteriaceae and some gram-negative nonfermentative bacilli by inhibiting carbapenemases without affecting the activity of ceftazidime (17,18). Although certain studies have demonstrated the effectiveness and safety of Ceftazidime-avibactam (CAZ-AVI), and shown that it is superior to colistin for the treatment of CRE in vivo (14,15), there is still considerable uncertainty regarding the optimal clinical treatment when comparing the outcomes of CRKP-infected HAP or VAP patients treated with CAZ-AVI to those treated with TGC (19,20). The aim of the present study was to assess the safety patterns and outcomes of CRKP de ned as either HAP or VAP in patients treated with either CAZ-AVI or TGC.…”

Section: Introductionmentioning

confidence: 99%

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

Shi¹,

Hu²,

Liu³

et al. 2021

Preprint

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 67%

Section: Outcome Measurementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Shi¹,

Hu²,

Liu³

et al. 2021

Preprint

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“…CAZ-AVI, a novel combination of cephalosporin and β-lactamase inhibitor, was rst approved for treatment of complicated intra-abdominal infections and complicated urinary tract infections by U.S. Food and Drug Administration in February 2015 [7]. In China, CAZ-AVI has been of great concern for its con rmed clinical e cacy against CRKP infection by inhibiting the activities of extended-spectrum βlactamase (ESBL), AmpC-producing β-lactamase, Klebsiella pneumoniae carbapenemase (KPC) and OXA-48 carbapenemase since its initial marketing in September 2019 [8][9][10][11].…”

mentioning

confidence: 99%

Ceftazidime-avibactam in combination with in vitro non-susceptible antimicrobials versus ceftazidime-avibactam in monotherapy in critically ill patients with carbapenem-resistant Klebsiella pneumoniae infection

Zheng¹,

Zhang²,

Wang³

et al. 2021

Preprint

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Background: There is no clinical study investigating if using CAZ-AVI combination schemes with an in vitro non-susceptible antimicrobial could be superior to CAZ-AVI monotherapy against CRKP clinically. Methods: We performed a retrospective, cohort study at two tertiary hospitals in China for patients with CRKP infection who treated by CAZ-AVI at least 72 hours. A Cox-proportional hazards regression model was set up to evaluate covariates which potentially affected 30-day mortality. Results: Sixty-two patients were eligible in our study, 41 (66.1%) received CZA-AVI combination therapy and 21 (33.9%) received CZA-AVI monotherapy. The overall 30-day mortality was 33.9% (21 patients): 24.4% (10/41) and 47.6% (11/21), P=0.028, in combination and monotherapy groups, respectively. Combination therapy was significantly associated with lower 30-day mortality (HR 0.167, 95%CI 0.060-0.465, P=0.001), while higher APACHE II score, use of vasoactive drug and comorbidity of organ transplantation were considered as factors on increasing mortality. The propensity score showed no significant alteration with other variables after adding it into the final model. In the subgroup analysis, the protective effect revealed when combination with carbapenems, tigecycline or fosfomycin were applied, and in the following subgroups of patients: with sepsis, with CrCl > 50 mL/min, stayed in ICU ≤30 days or underwent mechanical ventilation. Conclusions: CAZ-AVI combination with another in vitro non-susceptible antimicrobial, especially carbapenems, fosfomycin and tigecycline, could significantly decrease 30-day mortality rate for critically ill patients with CRKP infection. Further investigation should be carried out to confirm this conclusion and find out the autofit antimicrobials in CAZ-AVI combination schemes.

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Update of clinical application in ceftazidime–avibactam for multidrug-resistant Gram-negative bacteria infections

2022

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Clinical characteristics and outcomes of patients with multidrug-resistant Gram-negative bacterial infections treated with ceftazidime/avibactam

Cited by 17 publications

References 12 publications

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

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

Ceftazidime-avibactam in combination with in vitro non-susceptible antimicrobials versus ceftazidime-avibactam in monotherapy in critically ill patients with carbapenem-resistant Klebsiella pneumoniae infection

Update of clinical application in ceftazidime–avibactam for multidrug-resistant Gram-negative bacteria infections

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