<p>Optimal Management of Complicated Infections in the Pediatric Patient: The Role and Utility of Ceftazidime/Avibactam</p>

Abstract

Antimicrobial resistance poses a substantial threat to global public health. The pursuit of new antibiotics has decreased and very few options have been investigated for the treatment of complicated multidrug-resistant Gram-negative (MDR-GN) infections in adult population and even less in pediatric patients. Ceftazidime-avibactam (CAZ-AVI) is novel cephalosporin/β-lactamase inhibitor (BL-BLI) combination with broad antibacterial spectrum. The aim of this review is to describe the current and future role CAZ-AVI in the pediatric population with suspected or confirmed MDR-GN infections.

Antibiotic Resistant Bloodstream Infections in Pediatric Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant: Factors Associated with Development of Resistance, Intensive Care Admission and Mortality

“…Knowledge of this aspect could have important implications since new antibiotics as ceftazidime-avibactam or meropenem-vaborbactam [ 30 , 31 ] are not effective against some carbapenemases frequently identified in pediatric patients [ 26 ], while ceftolozane-tazobactam could have some effectiveness against these strains [ 32 ]. Unfortunately, while some pediatric pharmacological data are available for ceftazidime-avibactam [ 33 ] and ceftolozane-tazobactam [ 34 , 35 ], they are scarce and fragmented, when not available at all, for meropenem-vaborbactam [ 36 ], cefiderocol [ 37 ], and cefepime-zidebactam [ 38 ], drugs that could be effective against bacteria resistant to the other antibiotics. We do not have data on the in vitro effectiveness of the new antibiotics in our patient population since they were tested in a negligible proportion of strains, if any, maybe because of scarce availability and/or the restriction or absence of authorizations in pediatrics.…”

Using ceftazidime-avibactam for persistent carbapenem-resistant Serratia marcescens infection highlights antimicrobial stewardship challenges with new beta-lactam-inhibitor combination antibiotics

“…When faced with clinical failure and persistent bacteraemia despite treatment, we investigated using CA as a last attempt to cure our patient, as in vitro activity and good clinical outcomes against class D carbapenemase OXA-48 have been described. [3,7,8] CA is a new BLIC antibiotic effective against specific carbapenemases, i.e. OXA-48 and Klebsiella pneumoniae carbapenemase (KPC).…”

“…OXA-48 and Klebsiella pneumoniae carbapenemase (KPC). [3,9] It is currently available as a section 21 drug and is costly in SA. While characterisation of the type of carbapenemase produced by CRE is routinely provided by our public laboratory, susceptibility testing for CA is not offered by us or routinely offered by other public laboratories.…”

“…[10] Paediatric specific data, especially in children <3 months old with infections other than those of the abdominal and urinary tracts, are urgently required, especially in neonates, where antibiotic therapy is often extended to include 'meningitis cover' . [3] Finally, a pertinent question regarding AMS is whether the agent should have been used earlier in the course of management or as a last resort, potentially limiting overall antimicrobial exposure and morbidity.…”

“…Additional risk factors for CRE infection included placement of central venous pressure (CVP) catheters and mechanical ventilation during periods of clinical instability. [3] On day 21 of admission, she developed a low-grade fever. Clinically, no source of infection was found, but procalcitonin increased from 0.3 µg/L to 3 µg/L over 72 hours.…”