Abstract
Complicated infections from multidrug-resistant Gram-negative bacteria (MDR-GNB) represent a serious problem presenting many challenges. Resistance to many classes of antibiotics reduces the probability of an adequate empirical treatment, with unfavorable consequences, increasing morbidity and mortality. Readily available patient medical history and updated information about the local microbiological epidemiology remain critical for defining the baseline risk of MDR-GNB infections and guiding empirical treatment choices, with the aim of avoiding both undertreatment and overtreatment. There are few literature data that report real-life experiences in the use of ceftolozane/tazobactam and ceftazidime/avibactam, with particular reference to microbiological cure. Some studies reported experiences for the treatment of MDR-GNB infections in patients with hematological malignancies or specifically in Pseudomonas aeruginosa infections. We report our clinical single-center experience regarding the real-life use of ceftolozane/tazobactam and ceftazidime/avibactam to treat serious and complicated infections due to MDR-GNB and carbapenem-resistant Enterobacterales (CRE), with particular regard given to intra-abdominal and urinary tract infections and sepsis.
Highlights
Ceftazidime/avibactam has recently been approved for the treatment of complicated intraabdominal infections, complicated urinary tract infections, and hospital-acquired and ventilator-associated bacterial pneumonia (HABP and VABP)
A total of 241 microbiological isolates obtained from 122 consecutive patients treated with ≥72 h of ceftolozane/tazobactam for Gram-negative bacteria (GNB) infections were included in the study
Healthcare-associated infections from GNB are very frequent, and those caused by MDR, XDR, and PDR microorganisms are increasing
Summary
Infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) are difficult to treat, representing an actual serious health emergency, in patients who often have comorbidities.These difficult infections are responsible for high direct costs consequent to the use of new antimicrobial drugs and the indirect costs of prolonged hospitalization and healthcare-related expenditure [1,2].The increase in infections by Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and extended-spectrum β-lactamase-producing (ESBL) or carbapenem-resistant Enterobacterales (CRE) have hindered the treatment of these infections, with a consequent increase in morbidity and mortality [3,4,5,6,7].The link between an increased consumption of carbapenems, considered as last-resort antibiotics for the treatment of infections due to MDR Gram-negative bacteria, and the emergence of carbapenemases-producing Enterobacterales (CPE) other than CRE is well-demonstrated [8,9].The need for new and effective anti-CRE therapies, together with an adequate infection source control practice, is urgent. Infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB) are difficult to treat, representing an actual serious health emergency, in patients who often have comorbidities. These difficult infections are responsible for high direct costs consequent to the use of new antimicrobial drugs and the indirect costs of prolonged hospitalization and healthcare-related expenditure [1,2]. The link between an increased consumption of carbapenems, considered as last-resort antibiotics for the treatment of infections due to MDR Gram-negative bacteria, and the emergence of carbapenemases-producing Enterobacterales (CPE) other than CRE is well-demonstrated [8,9]. Unlike most β-lactamase inhibitors, avibactam is a novel synthetic non-β-lactam (diazabicyclooctane)/β-lactamase inhibitor that inhibits a wide range of β-lactamases, including Ambler Class A (GEM, SHV, CTX-M, and KPC), Class C (AmpC), and some Class D (OXA-48) β-lactamases [11], expanding the activity spectrum of ceftazidime to MDR
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