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Observational Study
. 2023 Jul;23(7):1022-1034.
doi: 10.1016/j.ajt.2023.03.011. Epub 2023 Apr 5.

Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae

Elena Pérez-Nadales  1 , Mario Fernández-Ruiz  2 , Alejandra M Natera  3 , Belén Gutiérrez-Gutiérrez  4 , Alessandra Mularoni  5 , Giovanna Russelli  5 , Ligia Camera Pierrotti  6 , Maristela Pinheiro Freire  7 , Marco Falcone  8 , Giusy Tiseo  8 , Mario Tumbarello  9 , Francesca Raffaelli  10 , Edson Abdala  11 , Marta Bodro  12 , Elena Gervasi  13 , María Carmen Fariñas  14 , Elena M Seminari  15 , Juan José Castón  16 , Juan Antonio Marín-Sanz  17 , Víctor Gálvez-Soto  17 , Meenakshi M Rana  18 , Belén Loeches  19 , Pilar Martín-Dávila  20 , Álvaro Pascual  4 , Jesús Rodríguez-Baño  4 , José María Aguado  2 , Luis Martínez-Martínez  21 , Julián Torre-Cisneros  22 ; REIPI/INCREMENT-SOT Study Group
Collaborators, Affiliations
Observational Study

Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae

Elena Pérez-Nadales et al. Am J Transplant. 2023 Jul.

Abstract

We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.

Keywords: INCREMENT-SOT project; bloodstream infections; carbapenem-resistant Klebsiella pneumoniae; ceftazidime-avibactam; solid-organ transplantation.

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