Abstract
BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) represent an important global threat. The aim of this study is to describe the clinical course and outcomes of patients with CRE infections treated with ceftazidime-avibactam (CAZ-AVI) compared to patients treated with other agents.MethodsA retrospective cohort study of patients with established CRE infections from January 2017 until August 2018 was conducted. All patients who received CAZ-AVI and all cultures with carbapenem-resistant isolates were screened. We compared patients who received CAZ-AVI for CRE infections with patients who received other agents.ResultsA total of 38 consecutive patients with CRE infections were identified. Age and baseline comorbidities were similar between the two groups. The median time from admission to isolation of CRE culture was 22.5 days in the CAZ-AVI group and 17 days in the comparative group (P = 0.7). The incidence of CRE bacteremia was similar between the two groups: 7 patients (70%) in the CAZ-AVI group and 15 patients (53.6%) in the comparative group (P = 0.47). The most common type of CRE infections in both groups was hospital acquired pneumonia (HAP). Klebsiella pneumoniae was the predominant pathogen in both groups. A carbapenemase gene was detected in 35 (92%) patients; the OXA-48 gene was the predominant gene identified in 28 (74%) isolates. Eight out of ten patients in the CAZ-AVI group and fifteen out of twenty-eight in the comparative group achieved clinical remission (P = 0.14). After thirty days, all-cause mortality was observed in five patients in the CAZ-AVI group and 16 patients in the comparative group, accounting for 50 and 57% respectively.ConclusionsIn patients with established OXA-48-type CRE infection, CAZ-AVI is a reasonable alternative to standard therapy. These findings need to be confirmed in prospective studies.
Highlights
Carbapenem-resistant Enterobacteriaceae (CRE) represent an important global threat
The comparative group included 28 patients with CRE infections using the same criteria between January 2017 and November 2017 at King Faisal Specialist Hospital and Research Center (KFSHRC)-Jeddah
In summary, our study included a cohort of patients with invasive CRE infections, a majority of whom exhibited OXA-48 genotype, and showed that CAZ-AVI is a promising antibiotic for the treatment of these patients with limited therapeutic options
Summary
Carbapenem-resistant Enterobacteriaceae (CRE) represent an important global threat. The emergence of carbapenem-resistant Enterobacteriaceae (CRE) represents a threat to global public health [1, 2]. Treatment options for CRE infections are very limited. Polymyxins have been used for the treatment of CRE infections; there remain concerns regarding increasing resistance, limited efficacy and toxicity [9,10,11,12]. Novel β-lactam/β-lactamase inhibitor combinations have emerged as new treatment options for CRE infections [12, 13]. These combinations are not active against all carbapenemases [13]. Ceftazidime-avibactam (CAZ-AVI) is a new β-lactam/ β-lactamase inhibitor combination with in vitro activity
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