Efficacy of Ceftazidime-Avibactam in the Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infection After Kidney Transplantation

Abstract

The clinical efficacy of ceftazidime-avibactam (CAZ-AVI) in treating carbapenem-resistant Klebsiella pneumoniae (CRKP)-infected recipients after kidney transplantation (KT) has not been well evaluated. We aimed to assess its efficacy in a single-center cohort of KT recipients infected with CRKP. Materials and Methods: We retrospectively observed KT recipients diagnosed with CRKP infection from June 2019 to July 2021. The primary outcome was 30-day mortality and secondary outcomes were 14-day clinical cure and 14-day microbiological cure. Logistic regression analysis was used to evaluate the relationship between CAZ-AVI treatment and prognosis. Results: A total of 54 CRKP-infected KT recipients were recorded in this study. Twenty-two recipients received CAZ-AVI and 32 received other antibiotic regimens. Recipients in both groups had similar baseline characteristics, with the most common site of infection being surgical site infections (n=27; 50.0%) and bloodstream infections (n=23; 42.6%). Recipients treated with CAZ-AVI had significantly lower 30-day mortality (3/22 vs 14/32, P=0.019), significantly higher 14-day clinical cure (18/22 vs 17/32, P=0.030) and 14-day microbiological cure (19/22 vs 15/32, P=0.003) compared with recipients receiving other treatment regimens. Kaplan-Meier survival curves for 30-day mortality confirmed the findings (log-rank=0.014). In a multivariate logistic regression model, receiving CAZ-AVI was found to be an independent protective factor for 30-day mortality (odds ratio=0.148, 95% confidence interval, 0.027-0.800; P=0.026). No significant side effects were recorded. Conclusion: CAZ-AVI may be more valuable than other antibiotic regimens for the treatment of CRKP infection after kidney transplantation, and further large randomized controlled trials are needed to assess its efficacy.

Clinical Outcomes and Risk Factors for Death following Carbapenem-Resistant Klebsiella pneumoniae Infection in Solid Organ Transplant Recipients

“…In contrast, CAZ-AVI—superior to polymyxins and tigecycline—is considered to be the preferred treatment for patients with severe CRKP infection ( 20 , 28 , 29 ). Thus, treatment of an antibiotic regimen containing CAZ-AVI was an independent protective factor for 30-day mortality in kidney transplant ( 30 ). However, only a subset of patients received CAZ-AVI as empirical (4.3%) and targeted therapy (28.7%) in our study.…”

Risk Factors and Outcomes of Acute Graft Pyelonephritis with Bacteremia Due to Multidrug-Resistant Gram-Negative Bacilli among Kidney Transplant Recipients

“…This practice allows the early modification of antibiotic treatments, and may improve the poor prognosis associated with inappropriate empirical antibiotic treatment in MDR Gram-negative BSIs in our KT population. In addition, new antibiotics with greater activity and a better toxicity profile against MDR Gram-negative bacilli are now available, such as ceftolozane–tazobactam, cefiderocol [ 34 , 35 ], or beta-lactam combinations with new beta-lactamase inhibitors [ 36 ]—such as ceftazidime–avibactam—that could improve the evolution of infections caused by MDR Gram-negative microorganisms in KT recipients.…”

Effect of Carbapenem-Resistant Klebsiella pneumoniae Infection on the Clinical Outcomes of Kidney Transplant Recipients

“…The promising efficacy of CZA, usually selected as salvage treatment, for the control of CRKP infection were also observed in the previous reports. 25 , 30 , 31 …”

“…The promising efficacy of CZA, usually selected as salvage treatment, for the control of CRKP infection were also observed in the previous reports. 25,30,31 The present study has some limitations. The total sample size of CRKP-infected cases was limited, and this retrospective study was conducted at a single institute; thus, the conclusions reached may not be applicable to other institutions.…”