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. 2020 Feb 9;9(2):71.
doi: 10.3390/antibiotics9020071.

Clinical Experience with Ceftazidime-Avibactam for the Treatment of Infections due to Multidrug-Resistant Gram-Negative Bacteria Other than Carbapenem-Resistant Enterobacterales

Antonio Vena  1   2 , Daniele Roberto Giacobbe  1   2 , Nadia Castaldo  3 , Annamaria Cattelan  4 , Cristina Mussini  5 , Roberto Luzzati  6 , Francesco Giuseppe De Rosa  7 , Filippo Del Puente  1   2 , Claudio Maria Mastroianni  8 , Antonio Cascio  9 , Sergio Carbonara  10 , Alessandro Capone  11 , Silvia Boni  12 , Chiara Sepulcri  1   2 , Marianna Meschiari  5 , Francesca Raumer  4 , Alessandra Oliva  8 , Silvia Corcione  7 , Matteo Bassetti  1   2
Affiliations

Clinical Experience with Ceftazidime-Avibactam for the Treatment of Infections due to Multidrug-Resistant Gram-Negative Bacteria Other than Carbapenem-Resistant Enterobacterales

Antonio Vena et al. Antibiotics (Basel). .

Abstract

Background: Experience in real clinical practice with ceftazidime-avibactam for the treatment of serious infections due to gram-negative bacteria (GNB) other than carbapenem-resistant Enterobacterales (CRE) is very limited.

Methods: We carried out a retrospective multicenter study of patients hospitalized in 13 Italian hospitals who received ≤72 h of ceftazidime-avibactam for GNB other than CRE to assess the rates of clinical success, resistance development, and occurrence of adverse events.

Results: Ceftazidime-avibactam was used to treat 41 patients with GNB infections other than CRE. Median age was 62 years and 68% of them were male. The main causative agents were P.aeruginosa (33/41; 80.5%) and extended spectrum beta lactamase (ESBL)-producing Enterobacterales (4/41, 9.8%). Four patients had polymicrobial infections. All strains were susceptible to ceftazidime-avibactam. The most common primary infection was nosocomial pneumonia (n = 20; 48.8%), primary bacteremia (n = 7; 17.1%), intra-abdominal infection (n = 4; 9.8%), and bone infection (n = 4; 9.8%). Ceftazidime-avibactam was mainly administered as a combination treatment (n = 33; 80.5%) and the median length of therapy was 13 days. Clinical success at the end of the follow-up period was 90.5%, and the only risk factor for treatment failure at multivariate analysis was receiving continuous renal replacement therapy during ceftazidime-avibactam. There was no association between clinical failures and type of primary infection, microbiological isolates, and monotherapy with ceftazidime-avibactam. Only one patient experienced recurrent infection 5 days after the end of treatment. Development of resistance to ceftazidime-avibactam was not detected in any case during the whole follow-up period. No adverse events related to ceftazidime-avibactam were observed in the study population.

Conclusions: Ceftazidime-avibactam may be a valuable therapeutic option for serious infections due to GNB other than CRE.

Keywords: ESBL-producing Enterobacterales; Pseudomonas aeruginosa; carbapenem-sparing regimen; ceftazidime-avibactam; nosocomial pneumonia.

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Conflict of interest statement

M.B. serves on scientific advisory boards for Angelini, AstraZeneca, Bayer, Cubist, Pfizer, Menarini, MSD, Nabriva, Paratek, Roche, Shionogi, Tetraphase, The Medicine Company, and Astellas Pharma Inc.; has received funding for travel or speaker honoraria from Algorithm, Angelini, Astellas Pharma Inc., AstraZeneca, Cubist, Pfizer MSD, Gilead Sciences, Menarini, Novartis, Ranbaxy, Teva. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical cure rates according to different types of infection.
Figure 2
Figure 2
Clinical cure rates according to the different causative agents.
See this image and copyright information in PMC

References

    1. Tangden T., Giske C.G. Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: Clinical perspectives on detection, treatment and infection control. J. Intern. Med. 2015;277:501–512. doi: 10.1111/joim.12342. - DOI - PubMed
    1. Cohen J. Confronting the threat of multidrug-resistant Gram-negative bacteria in critically ill patients. J. Antimicrob. Chemother. 2013;68:490–491. doi: 10.1093/jac/dks460. - DOI - PubMed
    1. Karakonstantis S., Kritsotakis E.I., Gikas A. Pandrug-resistant Gram-negative bacteria: A systematic review of current epidemiology, prognosis and treatment options. J. Antimicrob. Chemother. 2019 doi: 10.1093/jac/dkz401. - DOI - PubMed
    1. Vincent J.L., Rello J., Marshall J., Silva E., Anzueto A., Martin C.D., Moreno R., Lipman J., Gomersall C., Sakr Y., et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–2329. doi: 10.1001/jama.2009.1754. - DOI - PubMed
    1. Qin X., Tran B.G., Kim M.J., Wang L., Nguyen D.A., Chen Q., Song J., Laud P.J., Stone G.G., Chow J.W. A randomised, double-blind, phase 3 study comparing the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem for complicated intra-abdominal infections in hospitalised adults in Asia. Int. J. Antimicrob. Agents. 2017;49:579–588. doi: 10.1016/j.ijantimicag.2017.01.010. - DOI - PubMed