Abstract
Background: Ceftazidime/avibactam is a new cephalosporin/beta-lactamase inhibitor combination approved in 2015 by the FDA for the treatment of complicated intra-abdominal and urinary tract infection, hospital-acquired pneumoniae and Gram-negative infections with limited treatment options. Methods: In this retrospective study, we evaluate the efficacy of ceftazidime/avibactam treatment in 81 patients with Gram-negative infection treated in our center from January 2018 to December 2019. The outcome evaluated was 30-days survival or relapse of infection after the first positive blood culture. Results: the majority of patients were 56 male (69%), with median age of 67. Charlson’s Comorbidity Index was >3 in 58 patients. In total, 46% of the patients were admitted into the medical unit, 41% in the ICU, and 14% in the surgical ward. Of the patients, 78% had nosocomial infections, and 22% had healthcare-related infections. The clinical failure rate was 35%: 13 patients died within 30 days from the onset of infection. The outcome was influenced by the clinical condition of the patients: solid organ transplantation (p = 0.003) emerged as an independent predictor of mortality; non-survival patients most frequently had pneumonia (p = 0.009) or mechanical ventilation (p = 0.049). Conclusion: Ceftazidime–avibactam showed high efficacy in infections caused by MDR Gram-negative pathogens with limited therapeutic options.
Highlights
In 2017, the WHO published a list of antibiotic-resistant priority pathogens, a catalogue of 12 species of bacteria that pose the greatest threat to human health: the list is divided in 3 categories according to the urgency of the need for new antibiotics.The critical priority category includes multidrug-resistant Gram-negative bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, and various Enterobacteriaceae), especially E. coli and K. pneumoniae which are the most involved species in blood stream infections (BSIs) and a cause of concern due to the wide antibiotic resistance patterns [1,2].Combination therapy seems to be more successful than monotherapy for the treatment of MDR Gram-negative infections and could reduce the insurgence of antibiotic resistance
Ceftazidime–avibactam showed high efficacy in infections caused by MDR Gram-negative pathogens with limited therapeutic options
According to other data described in the literature [10,12,13], our study demonstrated that mechanical ventilation and pneumonia were correlated with higher 30-day mortality
Summary
In 2017, the WHO published a list of antibiotic-resistant priority pathogens, a catalogue of 12 species of bacteria that pose the greatest threat to human health: the list is divided in 3 categories (critical, high and medium priority) according to the urgency of the need for new antibiotics.The critical priority category includes multidrug-resistant Gram-negative bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, and various Enterobacteriaceae), especially E. coli and K. pneumoniae which are the most involved species in blood stream infections (BSIs) and a cause of concern due to the wide antibiotic resistance patterns [1,2].Combination therapy seems to be more successful than monotherapy for the treatment of MDR Gram-negative infections (i.e., colistin–polimixin B or tigecycline in combination with a carbapenem) and could reduce the insurgence of antibiotic resistance. The critical priority category includes multidrug-resistant Gram-negative bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, and various Enterobacteriaceae), especially E. coli and K. pneumoniae which are the most involved species in blood stream infections (BSIs) and a cause of concern due to the wide antibiotic resistance patterns [1,2]. New therapeutic options include the β-lactam–β-lactamase inhibitor combination ceftazidime–avibactam (CZA), used in monotherapy or combination with aztreonam [3]. Ceftazidime/avibactam is a new cephalosporin/beta-lactamase inhibitor combination approved in 2015 by the FDA for the treatment of complicated intra-abdominal and urinary tract infection, hospital-acquired pneumoniae and Gram-negative infections with limited treatment options. Methods: In this retrospective study, we evaluate the efficacy of ceftazidime/avibactam treatment in 81 patients with Gram-negative infection treated in our center from January 2018 to December 2019. Conclusion: Ceftazidime–avibactam showed high efficacy in infections caused by MDR Gram-negative pathogens with limited therapeutic options
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