Efficacy of ceftazidime-avibactam in the treatment of infections due to Carbapenem-resistant Enterobacteriaceae

Abstract

Background Carbapenem-resistant Enterobacteriaceae (CRE) represent an important global threat. The aim of this study is to describe the clinical course and outcomes of patients with CRE infections treated with ceftazidime-avibactam (CAZ-AVI) compared to patients treated with other agents. Methods A retrospective cohort study of patients with established CRE infections from January 2017 until August 2018 was conducted. All patients who received CAZ-AVI and all cultures with carbapenem-resistant isolates were screened. We compared patients who received CAZ-AVI for CRE infections with patients who received other agents. Results A total of 38 consecutive patients with CRE infections were identified. Age and baseline comorbidities were similar between the two groups. The median time from admission to isolation of CRE culture was 22.5 days in the CAZ-AVI group and 17 days in the comparative group ( P = 0.7). The incidence of CRE bacteremia was similar between the two groups: 7 patients (70%) in the CAZ-AVI group and 15 patients (53.6%) in the comparative group ( P = 0.47). The most common type of CRE infections in both groups was hospital acquired pneumonia (HAP). Klebsiella pneumoniae was the predominant pathogen in both groups. A carbapenemase gene was detected in 35 (92%) patients; the OXA-48 gene was the predominant gene identified in 28 (74%) isolates. Eight out of ten patients in the CAZ-AVI group and fifteen out of twenty-eight in the comparative group achieved clinical remission ( P = 0.14). After thirty days, all-cause mortality was observed in five patients in the CAZ-AVI group and 16 patients in the comparative group, accounting for 50 and 57% respectively. Conclusions In patients with established OXA-48-type CRE infection, CAZ-AVI is a reasonable alternative to standard therapy. These findings need to be confirmed in prospective studies. Electronic supplementary material The online version of this article (10.1186/s12879-019-4409-1) contains supplementary material, which is available to authorized users.

Ceftazidime-Avibactam Combination Therapy Compared to Ceftazidime-Avibactam Monotherapy for the Treatment of Severe Infections Due to Carbapenem-Resistant Pathogens: A Systematic Review and Network Meta-Analysis

“…The focus of infection in the 83% (419/503) of patients was bacteremia; only in 3 of these 6 retrospective studies bacteremia was aggregated with other focus of infection: In the study by King et al [26], two fifths of the patients (23/60) had bacteremia, in the study by Sousa et al [8], almost half of the patients (26/57) have bacteremia. In the study by Alraddadi et al [27], more than a half of patients (22/38) have bacteremia.…”

“…Non-clinical improvement was evaluated in only 4 studies [6,8,26,27], including 186 patients and microbiological failure was evaluated in only 4 studies [5,8,26,27], including 363 patients (Table 2). Therefore, due to the small number of patients, we did not proceed to quantitative synthesis for the secondary outcomes.…”

Update of the treatment of nosocomial pneumonia in the ICU

“…On the other hand, CAZ/AVI was associated with better survival rates in patients with bacteraemia who required rescue treatment in infections caused by KPC-producing Enterobacteriaceae [89]. In case of infection caused by a CAZ/AVI-susceptible OXA-48 strain, CAZ/AVI could be an option to treat it [90].…”

<p>Carbapenem-Resistant <em>Enterobacter cloacae</em> Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality</p>

“…Bacteria belonging to Enterobacterales, such as Escherichia coli, Klebsiella pneumoniae, Enterobacter, Citrobacter, Serratia, Proteus, and Morganella, often cause nosocomial infections. 1,2 During the last decade, the emergence of carbapenem-resistant Enterobacteriaceae (CRE), which led to limited treatment options, has become the main cause of clinical anti-infective treatment failure. 3,4 It is worth noting that carbapenem-resistant Enterobacter cloacae (CR-ECL), which is one of the most common species that has been focused on in studies of a single species of Enterobacterales, 5 has been reported in many countries such as Korea, the United States, India, and China.…”