Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 25:15:655-667.
doi: 10.2147/IDR.S350976. eCollection 2022.

Ceftazidime/Avibactam versus Polymyxin B in the Challenge of Carbapenem-Resistant Pseudomonas aeruginosa Infection

Juan Chen #  1 , Qiqiang Liang #  1 , Xinyi Chen  1 , Jing Wu  1 , Yanchao Wu  1 , Gaoqin Teng  1 , Man Huang  1
Affiliations

Ceftazidime/Avibactam versus Polymyxin B in the Challenge of Carbapenem-Resistant Pseudomonas aeruginosa Infection

Juan Chen et al. Infect Drug Resist. .

Abstract

Purpose: Ceftazidime/avibactam (CAZ/AVI) monotherapy and polymyxin B-based combination therapy are currently two treatment options for patients with carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection; however, few studies have contrasted the relative efficacy of the two antibiotic regimens. The purpose of this study was to compare the effectiveness of CAZ/AVI and polymyxin B against CRPA infection and analyze the independent predictors of 30-day mortality or survival.

Patients and methods: This single-center retrospective observational study included patients with CRPA infection treated with CAZ/AVI or polymyxin B between January 2018 and December 2020. The primary outcomes were the 14-day and 30-day mortality. The secondary outcomes were in-hospital mortality and bacterial clearance. Baseline characteristics and outcomes were compared between the two groups, and COX regression analysis was used to identify predictors of 30-day mortality.

Results: A total of 136 patients with CRPA infection were enrolled, including 51 patients in the CAZ/AVI group and 85 patients in the polymyxin B group. The 14-day mortality (5.9% vs 27.1%, p=0.002), 30-day mortality (13.7% vs 47.1%, p<0.001) and in-hospital mortality (29.4% vs 60.0%, p=0.001) in the CAZ/AVI group were significantly lower than the polymyxin B group. The bacterial clearance rate (45.1% vs 12.9%, p<0.001) in the CAZ/AVI group were higher than in the polymyxin B group. After adjustment by propensity score matching, the CAV/AVI group still had lower 30-day mortality (14.3% vs 42.9%, p=0.018) and higher bacterial clearance rate (42.9% vs 14.3%, p=0.018) than the polymyxin B group. The multivariate COX analysis showed that the age was identified as independent predictor of 30-day mortality while CAZ/AVI therapy and central venous catheterization emerged as independent predictors of 30-day survival.

Conclusion: CAZ/AVI therapy was superior to polymyxin B therapy for patients with CRPA infection, and provided significant survival benefits, but further larger studies were needed to substantiate our findings.

Keywords: carbapenem-resistant Pseudomonas aeruginosa; ceftazidime/avibactam; effectiveness; mortality; polymyxin B.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Kaplan–Meier curves of patients with CRPA infection treated with CAZ/AVI or polymyxin B.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Babiker A, Clarke LG, Saul M, et al. Changing epidemiology and decreased mortality associated with Carbapenem-resistant Gram-negative bacteria from 2000–2017. Clin Infect Dis. 2020. doi:10.1093/cid/ciaa1464 - DOI - PMC - PubMed
    1. Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18(3):318–327. doi:10.1016/s1473-3099(17)30753-3 - DOI - PubMed
    1. European Centre for Disease Prevention and Control. Healthcare-associated infections acquired in intensive care units. In: ECDC. Annual epidemiological report for 2016. Stockholm: ECDC; 2018.
    1. Hu Y, Liu C, Wang Q, et al. Emergence and expansion of a carbapenem-resistant pseudomonas aeruginosa clone are associated with plasmid-borne bla (KPC-2) and virulence-related genes. mSystems. 2021;6(3). doi:10.1128/mSystems.00154-21 - DOI - PMC - PubMed
    1. Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia due to Pseudomonas aeruginosa: part I: epidemiology, clinical diagnosis, and source. Chest. 2011;139(4):909–919. doi:10.1378/chest.10-0166 - DOI - PubMed

LinkOut - more resources