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Meta-Analysis
. 2025 Apr;44(4):767-778.
doi: 10.1007/s10096-025-05044-5. Epub 2025 Jan 22.

Efficacy of Ceftazidime-avibactam in treating Gram-negative infections: a systematic review and meta-analysis

Nahal Khoshdel  1 , Melina Noursalehigarakani  1 , Zahra Sadat Seghatoleslami  2 , Fahimeh Hadavand  1 , Elaheh Eghbal  1 , Mohammad Javad Nasiri  3 , Elena Simula  4 , Parnian Ahmed  1 , Leonardo Antonio Sechi  5
Affiliations
Meta-Analysis

Efficacy of Ceftazidime-avibactam in treating Gram-negative infections: a systematic review and meta-analysis

Nahal Khoshdel et al. Eur J Clin Microbiol Infect Dis. 2025 Apr.

Abstract

Introduction: Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections.

Methods: We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success.

Results: A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02).

Conclusions: This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.

Keywords: Antibiotic resistance; CAZ-AVI; CAZ-non-susceptible pathogens; Ceftazidime-avibactam; Clinical success; Efficacy; Gram-negative infections; Meta-analysis; Microbiological success; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: All authors have consented to the publication of this manuscript. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study retrieval and eligibility
Fig. 2
Fig. 2
Clinical success of CAZ-AVI against Gram-negative pathogens
Fig. 3
Fig. 3
Funnel plot assessing the studies included in clinical assessment
Fig. 4
Fig. 4
Microbiological success of CAZ-AVI against Gram-negative pathogens
Fig. 5
Fig. 5
Funnel plot assessing the studies included in microbiological assessment
Fig. 6
Fig. 6
Clinical success of CAZ-AVI against Gram-negative CAZ-NS pathogens
Fig. 7
Fig. 7
Microbiological success of CAZ-AVI against Gram-negative CAZ-NS pathogens
See this image and copyright information in PMC

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