Early and Appropriate Use of Ceftazidime-Avibactam in the Management of Multidrug-Resistant Gram-Negative Bacterial Infections in the Indian Scenario

Abstract

The increasing prevalence of antibiotic-resistant pathogens exerts a substantial burden on the healthcare infrastructure worldwide. The World Health Organization (WHO) has declared that multidrug-resistant (MDR) Gram-negative pathogens, especially, carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii, and Pseudomonas aeruginosa as the topmost priority while developing newer antimicrobials. The increasing prevalence of infectious diseases caused by MDR Gram-negative bacteria also poses a challenge when choosing the empiric antimicrobial therapy for seriously ill hospitalized patients. The infections caused by MDR Gram-negative organisms ultimately result in increased mortality, morbidity, prolonged hospital stay, and increased cost of management. To tackle these challenges, newer antimicrobials like ceftazidime-avibactam were explored. The article also discusses the in vitro activity and therapeutic efficacy of ceftazidime-avibactam along with its pharmacokinetic properties and the role it will play in the management of MDR Gram-negative organisms in the Indian setting. Several studies have highlighted the role of early and appropriate antibiotic use in the reduction of mortality in patients with Gram-negative infections. Timely initiation of appropriate antibiotic therapy for serious infections leads to favorable clinical outcomes. Early and appropriate use of ceftazidime-avibactam while treating MDR Gram-negative infections has been associated with improved clinical outcomes. The aim of this review is to highlight the efficacy of ceftazidime-avibactam in the treatment of MDR Gram-negative infections. We have also summarized the information on outcomes achieved by early and appropriate use of ceftazidime-avibactam.

Knowledge, Attitude, and Practice (KAP) Survey on the Management of Multidrug-Resistant Gram-Negative Infections With Innovative Antibiotics: Focus on Ceftazidime–Avibactam

“…This was also highlighted in several other studies, which showed that an interruption in the initiation of antibiotic therapy can lead to serious negative consequences [ 29 - 33 ]. Therefore, rapid diagnosis, identification of pathogens, and susceptibility testing are immensely important in strategizing management protocols and antibiotic use [ 28 , 29 ]. An observational study conducted by Satlin et al (2022) explained that β-lactamases KPC PCR testing was associated with a shorter time to receipt of active therapy and decreased 30-day mortality, and initial CAZ-AVI-targeted treatment was linked to lesser 30-day mortality than polymyxin [ 34 ].…”

“…These results are promising because most of the study patients had a wide range of difficult medical disorders and high-index sickness severity. Furthermore, these studies demonstrated that CAZ-AVI was effective, safe, and well-tolerated among patients [ 11 , 12 , 28 , 29 , 40 ].…”

Detection of Inflammatory Biomarkers Among Patients with Sepsis of Gram-Negative Bacteria: A Cross-Sectional Study

“…The effectiveness and safety of CZA globally have been demonstrated in managing MDR Gram-negative infections, including carbapenem-resistant Enterobacterales . 32 Due to the presence of CZA in medicine, most manufacturers use this antibiotic as a disc for susceptibility testing. In this study, the disc of CZA was used in AST and as a first trial in DDST-2 for ESBL as an inhibitor disc with a high rate of positive results compared to classical DDST-1.…”

Retrospective Tertiary Care‐Based Cohort Study on Clinical Characteristics and Outcomes of Ceftazidime‐Avibactam‐Resistant Carbapenem‐Resistant Klebsiella pneumoniae Infections

“…The advent of carbapenem-resistant Klebsiella pneumoniae (CRKP) with limited antibiotic therapeutic options has led to pertinent obstacles in clinical treatment leading to soaring morbidity, mortality, protracted hospital stay, and financial repercussions [ 1 – 3 ].…”

“…Ceftazidime-avibactam (CAZ-AVI) is an equitable substitute for colistin/tigecycline for empirical and targeted treatment of CRKP infections with decreased mortality and proven to be clinically effectual in crucial phase III noninferiority trials as well as in actual world settings [ 1 , 3 – 7 ].…”