PB2285: CLINICAL EXPERIENCE WITH CEFTAZIDIME-AVIBACTAM FOR THE TREATMENT OF BACTEREMIA DUE TO CARBAPENEM-RESISTANT GRAM-NEGATIVE BACTERIA IN HEMATOLOGIC PATIENTS

Abstract

Background: Experience on effectiveness of ceftazidime-avibactam (CAZ-AVI) for bacteremia caused by carbapenem-resistant gram-negative bacteria in hematologic patients is scare. Aims: We conducted this cohort to evaluate the effectiveness and safety of CAZ-AVI for this population, and also, to explore the predictors of clinical outcome. Methods: We performed a retrospective, observational study at a blood diseases hospital in China for patients who received ≥ 72 h of CAZ-AVI for bloodstream infections due to carbapenem-resistant Enterobacteriacea and Pseudomonas aeruginosa between November 2018 and June 2021. Clinical and microbiological characteristics of these patients were collected; clinical and microbiological outcomes, occurrence of adverse effect were assessed. We compared the survival between transplant and nontransplant patients, also between patients who did or did not undergo granulocyte recovery within 14 days. We used Kaplan-Meier survival estimates to generate survival curves. To identify predictors of survival and clinical success, univariate and multivariate analysis was performed. Results: Forty-seven patients were eligible for our study. Forty (85.1%) patients received combination therapy, while seven received CAZ-AVI monotherapy. All patients infected with MBL (metallo-β-lactamase)-CRE (carbapenem-resistant Enterobacteriaceae) (n=23) received combination therapy with aztreonam. The survival at 28 days was 83.0% in 47 patients, and was 91.3% (21/23) in patients with MBL-CRE bacteremia. Clinical success was observed in 35/47 (74.5%) patients. Multivariate analysis revealed the most significant factor of clinical success was the granulocyte recovery within 14 days. Summary/Conclusion: CAZ-AVI-containing regimen is an effective option for the bacteremia due to carbapenem-resistant Gram-negative bacteria among hematologic patients, even in those infected with MBL-CRE bacteremia. Appropriate combination therapy is important after acquiring the information of enzymes and susceptibility to CAZ-AVI in vitro. Granulocyte recovery within 14 days may be a predictor of clinical success.