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. 2025 Sep;14(9):2143-2156.
doi: 10.1007/s40121-025-01210-6. Epub 2025 Aug 8.

Comparison of Effectiveness between Ceftazidime/Avibactam and Other Active Therapies for Oxacillinase-48-Producing Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Taiwan

Szu-Yu Liu  1 , Chien Chuang  1   2 , Chih-Han Juan  1   2 , Yu-Chien Ho  1 , Sheng-Hua Chou  3 , Yi-Ru Huang  1 , Wan Chin  1 , Hsiang-Ling Ho  4   5 , Yi-Tsung Lin  6   7
Affiliations

Comparison of Effectiveness between Ceftazidime/Avibactam and Other Active Therapies for Oxacillinase-48-Producing Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Taiwan

Szu-Yu Liu et al. Infect Dis Ther. 2025 Sep.

Abstract

Introduction: Oxacillinase-48 (OXA-48)-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported in Taiwan. Real-world studies regarding effective treatments for these infections are limited, and recommendations from international guidelines are controversial. The aim of this study was to compare clinical outcomes of OXA-48-producing CRKP bacteremia between patients treated with ceftazidime/avibactam (CZA) and those receiving other active therapies.

Methods: Unique adult patients with OXA-48-producing CRKP bacteremia who received CZA or other therapies in vitro for at least 3 days between June 2017 and December 2024 at Taipei Veterans General Hospital were enrolled. Clinical characteristics and outcomes were compared among the treatment groups. OXA-48 strains were detected using polymerase chain reaction (PCR) followed by Sanger sequencing.

Results: Of 45 patients included in this study, 18 were treated with CZA, and 27 were treated with other active therapies. Four patients received combination therapy. Most strains were OXA-48 producers (n = 42), and the rest were OXA-181 producers. No significant difference in 30-day mortality rate was observed between the treatment groups (22.2% versus 33.3%, p = 0.420), and even in critically ill patients (28.6% versus 43.8%, p = 0.389). Acute Physiology and Chronic Health Evaluation II (APACHE II) score (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01-1.15, p = 0.028) was an independent risk factor for 30-day mortality, and colistin-based therapy (HR 3.02, 95% CI 1.00-9.13, p = 0.050) showed marginal significance with 30-day mortality. CZA use was not associated with 30-day mortality.

Conclusions: Our findings revealed that CZA and other active therapies showed similar outcomes, but colistin-based regimens should be used cautiously.

Keywords: Bacteremia; Carbapenem-resistant Klebsiella pneumoniae; Ceftazidime/avibactam; OXA-48.

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Conflict of interest statement

Declarations. Conflicts of Interest: Szu-Yu Liu, Chien Chuang, Chih-Han Juan, Yu-Chien Ho, Sheng-Hua Chou, Yi-Ru Huang, Wan Chin, Hsiang-Ling Ho, and Yi-Tsung Lin declare no competing interests. Dr. Chih-Han Juan acquires an additional affiliation with the Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan, starting 31 July 2025. Dr. Yi-Tsung Lin has held an additional affiliation with the Center for Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan, since 16 July 2025. Ethical Approval: This study protocol was approved by the Institutional Review Board of Taipei Veterans General Hospital (2025-07-009BC) As a retrospective observational study, the study posed minimal risk to participants, thus the requirement for informed consent was waived. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki of 1964 and its later amendments.

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