Efficacy of Ceftazidime-Avibactam Versus Polymyxin B and Risk Factors Affecting Clinical Outcomes in Patients With Carbapenem-Resistant Klebsiella pneumoniae Infections a Retrospective Study

Abstract

Background: The worldwide outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become an urgent public health problem. High mortality and lack of effective treatments further pose new challenges to control this infection. However, studies about the evaluation of available antibiotics for CRKP infection are limited. The present study aimed to compare the efficacy of polymyxin B versus ceftazidime-avibactam (CAZ/AVI) in Chinese patients with CRKP infections and to identify risk factors affecting 7-day bacterial eradication and 28-day all-cause mortality.Methods: From January 8, 2018, to July 6, 2020, a total of 115 adult CRKP infected patients from two tertiary teaching hospitals in Shanghai, China were enrolled based on the inclusion and exclusion criteria. By reviewing electronic medical records of these patients, demographic and clinical data were extracted. The selected patients were divided into polymyxin B and CAZ/AVI groups according to primary antibiotic exposure to compare therapeutic effects. Binary logistic and cox’s regression analysis were performed to identify risk factors for 7-day bacterial eradication and all-cause mortality.Results: One hundred and five patients were treated with polymyxin B (67.8%) or CAZ/AVI (32.2%). Patients in the CAZ/AVI group had significantly lower rates of 28-day mortality (8.1 vs 29.5%, p = 0.013), higher microbiological eradication and 28-day clinical success. Multivariate analysis showed that Charlson comorbidity index (≥3) and prior antibiotic use within 90 days were independent risk factors for poor microbiological eradication. Cox’s regression analysis indicated that the length of hospitalization after CRKP infection and baseline creatinine clearance negatively affected 28-day mortality.Conclusion: CAZ/AVI was more effective than polymyxin B and appeared to be a promising drug for CRKP infection, especially for critically ill patients.

Ceftazidime/Avibactam-Based Versus Polymyxin B-Based Therapeutic Regimens for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infection in Critically Ill Patients: A Retrospective Cohort Study

“…The results from our study also showed that patients who received CAZ/AVI-based antimicrobial therapy would have a significantly higher probability of CRKP clearance than those receiving PMB-based antimicrobial therapy in vivo, which was consistent with the conclusion of Fang et al’s article [ 5 ].…”

“…Several in vitro and in vivo studies have discussed the effectiveness of CAZ/AVI and PMB, which proved that these two agents were both reliable treatment options for patients with CRKP infections [22][23][24][25]. Fang et al drew the conclusion that CAZ/AVI-based therapy was more effective than PMB-based therapy in treating CRKP infection by implementing a retrospective analysis to compare the efficacy between these two therapies [5]. Nevertheless, suitable therapeutic combined agents with CAZ/AVI remain unclear.…”

“…Carbapenem-resistant Klebsiella pneumoniae (CRKP), the most common pathogen amidst the various strains of CREs, is considered as a nationwide clinical therapeutic challenge in China [3,4]. According to the corresponding statistics from the China Antimicrobial Surveillance Network, rapidly increasing incidence and prevalence rates of CRKP infection have been observed from 2.9% in 2005 to 25% in 2021 [5]. K. pneumoniae carbapenemase (KPC) is the most clinically common carbapenemase in CRKP strains in China [6][7][8].…”

“…It is acknowledged that ceftazidime/avibactam (CAZ/AVI) and polymyxins [polymyxin B (PMB) & colistin] reveal their own antibacterial effects as the effective agents against CRKP infection [2,9,10]. As far as we know, clinical studies about comparing clinical efficacy between CAZ/AVI and polymyxinbased therapeutic regimens are still rare [5,11]. Consequently, it is worthwhile conducting several further clinical investigations to provide sufficient evidence for making guidelines on treatment of CRKP infection with CAZ/AVI and PMB-based therapeutic regimens.…”

Risk Factors for Mortality and Outcomes in Hematological Malignancy Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections

“…41 Furthermore, several previous retrospective studies have supported the superiority of CAZ/AVI in the treatment of CRKP infection. [42][43][44] Given the modest number of patients who received CAZ in the current study, the efficacy of CAZ/AVI in patients with CRKP BSI needs to be confirmed in larger-scale trials.…”