Real-world study of ceftazidime-avibactam in the treatment of multidrug-resistant gram-negative bacterial infections
10.12092/j.issn.1009-2501.2023.09.006
- Author:
Daoli JIANG
1
;
Xiaohua CHOU
1
;
Zhidong LIU
1
;
Wei LI
1
;
Bo ZHANG
1
;
Dongmei LV
1
;
Tao WANG
1
;
Sang XU
2
;
Defei TAN
3
;
Yi FANG
4
Author Information
1. Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University
2. Department of Pharmacy, Yixing People's Hospital
3. Department of Pharmacy, The First People's Hospital of Zhenjiang
4. Phase I Clinical Trial Center, Peking University People's Hospital
- Publication Type:Journal Article
- Keywords:
carbapenem-resistant enterobatceriaceae;
ceftazidime-avibactam;
multidrug-resistant gram-negative bacterial;
Pseudomonas spp
- From:
Chinese Journal of Clinical Pharmacology and Therapeutics
2023;28(9):1008-1017
- CountryChina
- Language:Chinese
-
Abstract:
AIM: To describe and evaluate the clinical characteristics, treatment management and clinical outcomes of ceftazidime-avibactam (CZA) in the treatment of patients with multidrug-resistant gram-negative bacterial (MDR-GNB) infections. METHODS: A retrospective cohort study was performed on patients hospitalized in the Affiliated Hospital of Xuzhou Medical University from September 2019 to December 2021. Adult patients who received CZA for ≥ 72 hours consecutively were eligible for inclusion. The primary outcome was clinical failure, defined as a composite of 30-day all-cause mortality, microbiological failure and / or failure to resolve or improve signs and symptoms of infection during treatment with CZA. RESULTS: A total of 198 patients with MDR-GNB infections were described and evaluated, including 132 in the carbapenem-resistant Enterobatceriaceae (CRE) cohort and 66 in the Pseudomonas spp. cohort. The main infection sites were lung infection (92.42%), abdominal infection (10.61%), and intracranial infection (10.61%), among which 63 patients (31.82%) were positive for blood culture. Clinical failure, 30-day all-cause mortality and microbiological failure occurred in 61 (30.81%), 33(16.67%) and 11(5.56%) patients, respectively. Body mass index (BMI), acute physiology and chronic health evaluation scoring system (APACHE Ⅱ) and polymicrobial infections were positively associated with clinical outcome failureadjusted OR 1.109, 95%CI 1.017, 1.209; adjusted OR 1.071, 95%CI 1.015, 1.129; adjusted OR 2.844, 95%CI 1.391, 5.814, however, initiation of CZA within 48 hours of admission was protective (adjusted OR 0.424, 95%CI 0.205, 0.879). A total of 15 patients had adverse reactions possibly related to CZA, including 2 cases of rash, 6 cases of nausea and vomiting, and 7 cases of antibiotic-related diarrhea. CONCLUSION: CZA can be used to treat infections caused by a range of MDR-GNB, including Pseudomonas spp. and CRE.
