6533b7cffe1ef96bd1258f27
RESEARCH PRODUCT
Ceftazidime-avibactam use for klebsiella pneumoniae carbapenemase-producing k. pneumoniae infections: A retrospective observational multicenter study
Mirko CompagnoGiampaolo CortiMaddalena PeghinFrancesca RaffaelliAnnalisa SaracinoCristina MussiniSpinello AntinoriMaddalena GiannellaRoberto CaudaMarianna RossiGennaro De PascaleElena GuffantiEnrico Maria TrecarichiGiancarlo CeccarelliTeresa SpanuElisabetta MantengoliAntonio CascioMario VendittiLoredana SarmatiCarlo TasciniSilvia CorcioneSilvia CorcioneDaniele Roberto GiacobbeMassimo FantoniLinda BussiniPaolo BonfantiAlessandra MularoniMarianna MeschiariNour ShbakloGiusy TiseoMario TumbarelloMario TumbarelloRoberto LuzzatiAngela Raffaella LositoAlessandra OlivaPierluigi VialeAlessandro RussoFrancesco Giuseppe De RosaGaetano BrindicciIvan GentileAlberto CoronaAndrea De GasperiPaolo GrossiMarco FalconeAlessandro CaponeCristina RovelliMatteo Bassettisubject
Microbiology (medical)Adultmedicine.medical_specialtyAzabicyclo CompoundcarbapenemasesBacterial ProteinMicrobial Sensitivity TestsNeutropeniaCeftazidimebeta-Lactamasesbeta-LactamaseCarbapenemasecarbapenemaseBacterial ProteinsRetrospective StudieLower respiratory tract infectionInternal medicineDrug CombinationAnti-Bacterial AgentmedicineHumansKPC-producing Klebsiella pneumoniaeRetrospective StudiesSeptic shockbusiness.industryCeftazidime-avibactamMicrobial Sensitivity Testceftazidime-avibactamMortality rateCarbapenemases; Ceftazidime-avibactam; KPC-producing Klebsiella pneumoniae; Adult; Anti-Bacterial Agents; Azabicyclo Compounds; Bacterial Proteins; Ceftazidime; Drug Combinations; Humans; Microbial Sensitivity Tests; Retrospective Studies; beta-Lactamases; Klebsiella Infections; Klebsiella pneumoniaeKPC-producing Klebsiella pneumoniae; carbapenemases; ceftazidime-avibactammedicine.diseaseCeftazidime/avibactamSettore MED/17KPC-producing Klebsiella pneumoniae; carbapenemases; ceftazidime-avibactam; Adult; Anti-Bacterial Agents; Azabicyclo Compounds; Bacterial Proteins; Ceftazidime; Drug Combinations; Humans; Microbial Sensitivity Tests; Retrospective Studies; beta-Lactamases; Klebsiella Infections; Klebsiella pneumoniaeAnti-Bacterial AgentsKlebsiella InfectionsDrug CombinationsKlebsiella pneumoniaeInfectious DiseasesCohortPropensity score matchingObservational studybusinessAzabicyclo Compoundsmedicine.drugHumanKlebsiella Infectiondescription
Abstract Background A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae. Methods We retrospectively analyzed observational data on use and outcomes of CAZ-AVI therapy for infections caused by Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens versus CAZ-AVI monotherapy. Results The cohort comprised 577 adults with bloodstream infections (n = 391) or nonbacteremic infections involving mainly the urinary tract, lower respiratory tract, and intra-abdominal structures. All received treatment with CAZ-AVI alone (n = 165) or with ≥1 other active antimicrobials (n = 412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs 25.0%, P = .79). In multivariate analysis, mortality was positively associated with presence at infection onset of septic shock (P = .002), neutropenia (P < .001), or an INCREMENT score ≥8 (P = .01); with lower respiratory tract infection (LRTI) (P = .04); and with CAZ-AVI dose adjustment for renal function (P = .01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P = .006). All associations remained significant after propensity score adjustment. Conclusions CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug’s seemingly more limited efficacy in LRTIs and potential survival benefits of prolonging CAZ-AVI infusions to ≥3 hours.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-02-22 |