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. 2024 Dec;43(12):2361-2369.
doi: 10.1007/s10096-024-04948-y. Epub 2024 Oct 1.

Clinical experience with ceftazidime/avibactam for the treatment of extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in neonates and children

Ozlem Ozgur Gundeslioglu  1   2 , Zeliha Haytoglu  3   4 , Hatice Hale Gumus  3   5 , Faruk Ekinci  3   6 , Filiz Kibar  3   5 , Ummuhan Cay  3   7 , Derya Alabaz  3   7 , Ferda Ozlu  3   8 , Ozden Ozgur Horoz  3   6 , Rıza Dincer Yıldızdas  3   6
Affiliations

Clinical experience with ceftazidime/avibactam for the treatment of extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in neonates and children

Ozlem Ozgur Gundeslioglu et al. Eur J Clin Microbiol Infect Dis. 2024 Dec.

Abstract

Purpose: Klebsiella pneumoniae is a significant cause of healthcare-associated infections, resulting in high morbidity and mortality rates due to limited treatment options. In this study, we aimed to evaluate the treatment outcomes and the safety of Ceftazidime-avibactam in infections caused by extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in pediatric patients.

Methods: This study included pediatric patients who received ceftazidime-avibactam treatment due to extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae infections, monitored in the pediatric intensive care, neonatal intensive care, and pediatric wards of Cukurova University Faculty of Medicine between 2022 and 2023. Patients' microbiological responses, clinical responses, medication side effects, and 30-day survival rates were evaluated.

Results: Eleven pediatric patients were included in the study, of whom nine were male (81.8%). The median age at the initiation of ceftazidime-avibactam treatment was 15 months (range: 14 days-183 months). Sepsis was diagnosed in 9 patients (81.8%). Two premature infants (27 and 35 weeks) were admitted to the neonatal ICU. Regarding the Klebsiella pneumoniae strains, 10 (91%) were extensively drug-resistant (XDR), and 1 (9%) was pandrug-resistant (PDR). Eight strains (72.7%) were carbapenem-resistant, and 9 (81.8%) were colistin-resistant. Microbiological response was noted in 8 patients (72.7%), clinical response was evident in 6 patients (54.5%). The 30-day survival rate was 54.5%, with six patients surviving.

Conclusion: In our study, ceftazidime-avibactam has been identified as a significant treatment option for resistant Klebsiella pneumoniae infection in critically ill children and premature infants with sepsis and organ failure, and it has been found to be well tolerated.

Keywords: Carbapenem resistant Klebsiella pneumoniae; Ceftazidim-avibactam; Children; Extensively drug-resistant Klebsiella pneumoniae; Pandrug resistant Klebsiella pneumoniae.

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Conflict of interest statement

Declarations. Ethical considerations: Ethical approval for the study was obtained from the Cukurova University Faculty of Medicine Ethics Committee (05.04.2024–143/20). This study was conducted in compliance with the principles of the Declaration of Helsinki, Good Clinical Practice guidelines and local regulatory requirements. Due to the retrospective nature of the present research, no personal informed consent was required. Competing interests: The authors declare no competing interests.

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