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Observational Study
. 2022 Sep;41(9):1173-1182.
doi: 10.1007/s10096-022-04482-9. Epub 2022 Aug 8.

Ceftazidime-avibactam treatment in bacteremia caused by OXA-48 carbapenemase-producing Klebsiella pneumoniae

O Lima  1   2 , A Sousa  3   4 , R Longueira-Suárez  3   4 , A Filgueira  5 , C Taboada-Martínez  3 , C Portela-Pino  3 , A Nodar  3 , F Vasallo-Vidal  6 , L Martinez-Lamas  6 , A Pérez-Landeiro  7 , M Rubianes  3 , M T Pérez-Rodríguez  3   4
Affiliations
Observational Study

Ceftazidime-avibactam treatment in bacteremia caused by OXA-48 carbapenemase-producing Klebsiella pneumoniae

O Lima et al. Eur J Clin Microbiol Infect Dis. 2022 Sep.

Abstract

Therapeutic options for bacteremia caused by carbapenem-resistant Enterobacterales (CRE) OXA-48-type are limited. The objective of this study was to analyze clinical success of CAZ-AVI compared with best available therapy (BAT) in patients with Klebsiella pneumoniae carbapenemase-producing OXA-48-type bacteremia (CRKp-OXA-48). We conducted a retrospective, single-center observational study in adult patients with CRKp-OXA-48 between December 2015 and May 2019. We collected the patients' clinical and epidemiological characteristics, antibiotic treatment (CAZ-AVI vs. BAT), and evolution. Factors associated with clinical success were analyzed using binary logistic regression. The study included 76 patients with CRKp-OXA-48-type bacteremia 33 received CAZ-AVI and 43 BAT. CAZ-AVI was mainly used in monotherapy (91%). Clinical success was more common in patients < 70-year-old (OR 4.79, 95% CI [1.435-16.002], p = 0.011) and CAZ-AVI treatment (OR 6.69, 95% CI [1.68-26.604], p = 0.007). Kaplan-Meier survival curve of 14-day mortality showed a lower mortality in patients who received CAZ-AVI (log rank 0.013). However, CAZ-AVI did not achieve statistical difference in IPTW for 14- and 30-day mortality (aOR 0.1, 95% CI [0.02-1.22], p = 0.076 and aOR 1.7, 95% CI [0.48-5.98], p = 0.413, respectively). CAZ-AVI treatment might be associated with a greater clinical success in CRKp-OXA-48 bacteremia.

Keywords: Bacteremia; Carbapenemase; Ceftazidime–avibactam; Klebsiella pneumoniae; Mortality; OXA-48-type.

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