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. 2023 Jun;27(6):444-450.
doi: 10.5005/jp-journals-10071-24481.

Ceftazidime-avibactam with or without Aztreonam vs Polymyxin-based Combination Therapy for Carbapenem-resistant Enterobacteriaceae: A Retrospective Analysis

Parikshit S Prayag  1 , Sampada A Patwardhan  2 , Shweta Panchakshari  1 , Ramya Sambasivam  1 , Surabhi Dhupad  1 , Rajeev N Soman  3 , Amrita P Prayag  4
Affiliations

Ceftazidime-avibactam with or without Aztreonam vs Polymyxin-based Combination Therapy for Carbapenem-resistant Enterobacteriaceae: A Retrospective Analysis

Parikshit S Prayag et al. Indian J Crit Care Med. 2023 Jun.

Abstract

Introduction: Gram-negative sepsis remains one of the most difficult to treat infections in intensive care units (ICUs). Carbapenems are often considered to be robust and reliable options for treating infections due to Gram-negative bacteria. The dominance of carbapenem-resistant enterobacteriaceae (CRE) has emerged as one of the greatest challenges faced by the medical community today. Carbapenem-resistant enterobacteriaceae may be resistant to all beta lactam antimicrobials including carbapenems and often, are even resistant to other classes of drugs. There are limited studies comparing polymyxin-based therapies with ceftazidime-avibactam (CAZ-AVI)-based therapies for treating infections caused by CRE.

Methods: A retrospective study comparing outcomes between patients with bacteremia caused by CRE treated with polymyxin-based combination therapy and CAZ-AVI-based therapy (with or without aztreonam).

Results: Of total 104 patients, 78 (75%) were in the CAZ-AVI group. There was no significant difference in the underlying comorbidities between the two groups. The incidence of nephrotoxicity was significantly higher in the polymyxin group (p = 0.017). Ceftazidime-avibactam-based therapy was 66% less likely to be associated with day 14 mortality (p = 0.048) and 67% less likely to be associated with day 28 mortality (p = 0.039) as compared with polymyxin-based therapy.

Conclusion: Ceftazidime-avibactam-based therapy may be a superior option to polymyxin-based therapy for infections caused by CRE. This can have significant practical applications, in terms of optimizing therapy for the individual patient as well as sparing polymyxins and reducing the use of polymyxins in our hospitals.

How to cite this article: Prayag PS, Patwardhan SA, Panchakshari S, Sambasivam R, Dhupad S, Soman RN, et al. Ceftazidime-avibactam with or without Aztreonam vs Polymyxin-based Combination Therapy for Carbapenem-resistant Enterobacteriaceae: A Retrospective Analysis. Indian J Crit Care Med 2023;27(6):444-450.

Keywords: Carbapenem-resistant enterobacteriaceae; Carbapenems; Ceftazidime-avibactam; Gram-negative sepsis; Polymyxin.

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Conflict of interest statement

Source of support: Nil Conflict of interest: Dr Amrita P Prayag is associated as the Associate Editor of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of this editorial board member and her research group.

Figures

Fig. 1
Fig. 1
Process of patient selection
Fig. 2
Fig. 2
Relative number of patients in the CAZ-AVI group and the polymyxin group
Fig. 3
Fig. 3
Pattern of enzymes produced by the Klebsiella pneumoniae isolates
Fig. 4
Fig. 4
Pattern of enzymes produced by the Escherichia coli isolates
See this image and copyright information in PMC

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