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. 2019 Dec 6;6(12):ofz522.
doi: 10.1093/ofid/ofz522. eCollection 2019 Dec.

Real-World Experience With Ceftazidime-Avibactam for Multidrug-Resistant Gram-Negative Bacterial Infections

Sarah C J Jorgensen  1 , Trang D Trinh  1   2 , Evan J Zasowski  1   3 , Abdalhamid M Lagnf  1 , Sahil Bhatia  1 , Sarah M Melvin  1 , Molly E Steed  4 , Samuel P Simon  5 , Sandra J Estrada  6   7 , Taylor Morrisette  1   8 , Kimberly C Claeys  9 , Joshua R Rosenberg  5 , Susan L Davis  1   10 , Michael J Rybak  1   11   12
Affiliations

Real-World Experience With Ceftazidime-Avibactam for Multidrug-Resistant Gram-Negative Bacterial Infections

Sarah C J Jorgensen et al. Open Forum Infect Dis. .

Abstract

Background: We conducted this study to describe the clinical characteristics, microbiology, and outcomes of patients treated with ceftazidime-avibactam (CZA) for a range of multidrug-resistant Gram-negative (MDR-GN) infections.

Methods: This is a multicenter, retrospective cohort study conducted at 6 medical centers in the United States between 2015 and 2019. Adult patients who received CZA (≥72 hours) were eligible. The primary outcome was clinical failure defined as a composite of 30-day all-cause mortality, 30-day microbiological failure, and/or failure to resolve or improve signs or symptoms of infection on CZA.

Results: In total, data from 203 patients were evaluated. Carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas spp were isolated from 117 (57.6%) and 63 (31.0%) culture specimens, respectively. The most common infection sources were respiratory (37.4%), urinary (19.7%), and intra-abdominal (18.7%). Blood cultures were positive in 22 (10.8%) patients. Clinical failure, 30-day mortality, and 30-day recurrence occurred in 59 (29.1%), 35 (17.2%), and 12 (5.9%) patients, respectively. On therapy, CZA resistance developed in 1 of 62 patients with repeat testing. Primary bacteremia or respiratory tract infection and higher SOFA score were positively associated with clinical failure (adjusted odds ratio [aOR] = 2.270, 95% confidence interval [CI] = 1.115-4.620 and aOR = 1.234, 95% CI = 1.118-1.362, respectively). Receipt of CZA within 48 hours of infection onset was protective (aOR, 0.409; 95% CI, 0.180-0.930). Seventeen (8.4%) patients experienced a potential drug-related adverse effect (10 acute kidney injury, 3 Clostridioides difficile infection, 2 rash, and 1 each gastrointestinal intolerance and neutropenia).

Conclusions: Ceftazidime-avibactam is being used to treat a range of MDR-GN infections including Pseudomonas spp as well as CRE.

Keywords: carbapenem-resistant Enterobacteriaceae; ceftazidime-avibactam; multidrug-resistant Pseudomonas aeruginosa.

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References

    1. Munita JM, Aitken SL, Miller WR, et al. . Multicenter evaluation of ceftolozane/tazobactam for serious infections caused by carbapenem-resistant Pseudomonas aeruginosa. Clin Infect Dis 2017; 65:158–61. - PMC - PubMed
    1. Doi Y, Bonomo RA, Hooper DC, et al. ; Gram-Negative Committee of the Antibacterial Resistance Leadership Group (ARLG)a Gram-negative bacterial infections: research priorities, accomplishments, and future directions of the antibacterial resistance leadership group. Clin Infect Dis 2017; 64Suppl_1:S30–5. - PMC - PubMed
    1. Munoz-Price LS, Poirel L, Bonomo RA, et al. . Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2013; 13:785–96. - PMC - PubMed
    1. Benattar YD, Omar M, Zusman O, et al. . The effectiveness and safety of high-dose colistin: prospective cohort study. Clin Infect Dis 2016; 63:1605–12. - PubMed
    1. Mingeot-Leclercq MP, Tulkens PM. Aminoglycosides: nephrotoxicity. Antimicrob Agents Chemother 1999; 43:1003–12. - PMC - PubMed