Off-Label Use of Ceftazidime/Avibactam for the Treatment of Pan-Drug-Resistant Klebsiella pneumoniae in a Neonate: Case Report and Literature Review

Mangarov, Iliya; Georgieva, Ralitsa; Petkova, Valentina; Nikolova, Irina

doi:10.3390/antibiotics12081302

Cited by 1 publication

(1 citation statement)

References 27 publications

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“…Ji et al 15 described the use of CZA for septic arthritis/osteomyelitis case caused by KPC-producing K. pneumoniae in a 45-day-old infant and observed no adverse effects. The most recent reports by Marino et al 17 described 8 preterm neonatal cases and by Mangarov et al 31 described 1 preterm neonate with BSI due to CRKP successfully treated with CZA, without any adverse event.…”

Section: Discussionmentioning

confidence: 99%

Off-label Use of Ceftazidime/Avibactam in Neonatal Intensive Care Unit: A Real-life Experience and Literature Review

Ftergioti,

Degli Antoni,

Kontou

et al. 2024

Pediatric Infectious Disease Journal

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Background: Multi/extensively drug-resistant bacterial infections have recently increased and new antimicrobial options are needed for difficult-to-treat infections. Ceftazidime/avibactam (CZA) has been approved for patients aged 3 months to 18 years, but real-life data on its off-label use in neonates and young infants are still scarce. Materials: We report demographic, clinical and microbiological data as well as outcome and safety of all cases of infants treated with CZA between January 1, 2021 and September 30, 2022 in a tertiary neonatal intensive care unit. We also review all neonatal cases previously reported. Results: Twenty-one patients [17 males, with median gestational age 29+2 (IQR 6+6) weeks] received 31 CZA courses at a dose of 20–50 mg/kg/dose of ceftazidime q8h for suspected or proved multi/extensively drug-resistant infections. Median postnatal age at the onset of treatment was 44 days (IQR: 94 days). Twelve bacteremias, 2 urinary tract infections and 1 ventilator-acquired pneumonia were recorded. Twelve (39%) treatments were targeted, while 19 (61%) were empirically started due to known colonization with Klebsiella pneumoniae carbapenemase-producing Gram-negative bacteria. All patients had received multiple antibiotics prior and concomitantly with CZA. The most common pathogen identified at targeted administrations was carbapenem-resistant Klebsiella pneumoniae (83%). No serious adverse events attributed to the drug were detected. Twenty-one courses of CZA administration to 20 neonates with a median gestational age of 28.5 (IQR 3.5) weeks were previously reported without significant related adverse events. Conclusions: Favorable clinical and microbiological responses in neonatal intensive care unit patients treated with CZA off-label were observed without significant and unexpected adverse events in critically ill neonates.

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Section: Discussionmentioning

confidence: 99%