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Abu Jaber AMR, Basgut B, Hawan AA, Al Shehri AA, AlKahtani SA, Ahmed NJ, Abdi A. The Clinical Efficacy of Adding Ceftazidime/Avibactam to Standard Therapy in Treating Infections Caused by Carbapenem-Resistant Klebsiella pneumonia with blaOXA-48-like Genes. Antibiotics (Basel) 2024; 13:265. [PMID: 38534700 DOI: 10.3390/antibiotics13030265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Ceftazidime/avibactam (CAZ-AVI) is FDA-approved for managing infections caused by resistant gram-negative bacilli, particularly infections via carbapenem-resistant Enterobacterales pathogens. The clinical data are still limited, particularly those in Saudi Arabia. The present study is a retrospective cohort study that was carried out at the Armed Forces Hospital in the southern region of Saudi Arabia to compare the clinical and microbiological outcomes for CAZ-AVI-treated patients as monotherapy and as an add-on to standard therapy for carbapenem-resistant Klebsiella pneumonia (CRKP) OXA-48 infections to those treated with standard drugs. The study included CRKP OXA-48-like infected patients who were administered antibiotics for more than seven days from 1 August 2018 to May 2023. Patients' baseline characteristics and demography were extracted from the clinical records, and their clinical/microbiology efficiencies were assessed as per the corresponding definitions. Univariate and multivariate logistic regressions were conducted to identify the potential independent variable for CAZ-AVI efficiency. A total of 114 patient files were included for the evaluation. Among these patients, 64 used CAZ-AVI combined with standard therapy and were included in the intervention group, and 50 of them used standard therapy and were included in the comparative group. Following analysis, CAZ-AVI's clinical success was 42.2% (p = 0.028), while the intervention versus comparative groups showed decreased 30-day all-cause mortality (50.0% versus 70.0%; p = 0.036) and infection recurrence (7.8% versus 24.0%; p = 0.019), as well as substantially increased rates of microbial eradication (68.8% versus 42.0%; p = 0.007). CAZ-AVI add-on therapy rather than monotherapy showed statistically significant favored clinical and microbial outcomes over the standard therapy. Furthermore, sex (female %), ICU admission, and fever were negatively associated with patients' 30-day all-cause mortality, serving as independent negative factors. Only fever, CRP bio levels, inotropes, and ICU admissions were significant predictors influencing the CAZ-AVI's clinical efficiency. The duration of CAZ-AVI therapy positively influenced CAZ-AVI's microbial eradication, while both WBC counts and fever experiences were negative predictors. This study shows the effective usage of CAZ-AVI against CRKP OXA-48-like infections. The influencing independent variables depicted here should recommend that clinicians individualize the CAZ-AVI dose based on co-existing risk factors to achieve optimal survival and efficacy. Prospective multicenter and randomized control studies are recommended, with individualized CAZ-AVI precision administration implemented based on patients' characteristics.
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Affiliation(s)
- Al Maamon R Abu Jaber
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia 99138, Northern Cyprus TR-10 Mersin, Turkey
| | - Bilgen Basgut
- Department of Pharmacology, Faculty of Pharmacy, Baskent University, Ankara 06790, Turkey
| | - Ali Abdullah Hawan
- The Armed Forces Hospitals Southern Region AFHSR, Khamis Mushait 62413, Saudi Arabia
| | - Ali Amer Al Shehri
- The Armed Forces Hospitals Southern Region AFHSR, Khamis Mushait 62413, Saudi Arabia
| | | | - Nehad J Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Abdikarim Abdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Near East University, Nicosia 99138, Northern Cyprus TR-10 Mersin, Turkey
- Department of Clinical Pharmacy, Faculty of Pharmacy, Yeditepe University, İstanbul 34755, Turkey
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Mackow NA, van Duin D. Reviewing novel treatment options for carbapenem-resistant Enterobacterales. Expert Rev Anti Infect Ther 2024; 22:71-85. [PMID: 38183224 DOI: 10.1080/14787210.2024.2303028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Carbapenem resistant Enterobacterales (CRE) are a major threat to global health and hospital-onset CRE infections have risen during the COVID-19 pandemic. Novel antimicrobials are now available for the treatment of CRE infections. There remains an urgent need for new antimicrobials for CRE, especially for those producing metallo-β-lactamases. AREAS COVERED This article discusses previously published research supporting currently available novel antimicrobials for the treatment of CRE infections. Newer compounds currently being evaluated in clinical trials are covered. A literature search was conducted in PubMed over all available dates for relevant published papers and conference abstracts with the search terms, 'CRE,' 'carbapenem-resistant Enterobacterales,' 'β-lactam-β-lactamase inhibitor,' 'KPC,' 'NDM,' 'metallo-β-lactamase,' 'ceftazidime-avibactam,' 'meropenem-vaborbactam,' 'imipenem-cilastatin-relebactam,' 'cefiderocol,' 'eravacycline,' 'plazomicin,' 'taniborbactam,' 'zidebactam,' and 'nacubactam.' EXPERT OPINION Novel antimicrobials for CRE infections have been developed, most notably the β-lactam-β-lactamase inhibitor combinations, though treatment options for infections with metallo-β-lactamase producing Enterobacterales remain few and have limitations. Development of antibiotics with activity against metallo-β-lactamase producing Enterobacterales is eagerly awaited, and there are promising new compounds in clinical trials. Finally, more clinical research is needed to optimize and individualize treatment approaches, which will help guide antimicrobial stewardship initiatives aimed at reducing the spread of CRE and development of further resistance.
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Affiliation(s)
- Natalie A Mackow
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Xu J, Luo C, Huang L, Xiao X, Liu L, Yang Z. Clinical Efficacy and Safety Evaluation of Ceftazidime-Avibactam in the Treatment of Klebsiella pneumoniae Infection: A Retrospective Analysis from a Hospital in China. Infect Drug Resist 2023; 16:7227-7237. [PMID: 38023408 PMCID: PMC10656859 DOI: 10.2147/idr.s435882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ceftazidime-avibactam (CAZ-AVI) is a new cephalosporin/β-lactamase inhibitor combination that received clinical approval in China in 2019. This study aims to investigate the efficacy and safety of CAZ-AVI in the treatment of Klebsiella pneumoniae (KP) infection in a hospital, and differences in efficacy among various infection sites and between monotherapy and combination therapy, providing valuable insights for its further application. Methods Patients who used CAZ-AVI between January 2019 and April 2023 were identified through the hospital information system. Demographic information, details of the infection site, KP strain's drug sensitivity report, treatment duration, combination therapies, adverse drug reactions (ADR), and 28-day survival were recorded. Clinical and microbiological efficacies were analyzed using SPSS 23.0 software to compare different infection sites and combination therapies. Results The overall effective clinical response (CR) rate of CAZ-AVI against KP infection was 62.13%, with a favorable microbial response (MR) rate was 65.68% and a 28-day survival rate was 63.91%. No significant difference occurred in effective CR and 28-day survival rate among different infection sites (P = 0.709 and 0.862, respectively). The favorable MR rate for abdominal infections was slightly lower than that for other sites of infection (P = 0.021). No significant differences in effective CR, favorable MR, and 28-day survival between monotherapy and combination therapy were present (P values were 0.649, 0.123, and 0.280, respectively). The incidence of ADR was 1.78%, including increased creatinine, elevated transaminase, hematuria, and thrombocytopenia. Conclusion CAZ-AVI demonstrates good clinical efficacy and safety in the treatment of KP infections. The clinical efficacy of CAZ-AVI was similar across different infection sites, and combination therapy did not show an advantage over monotherapy. Further studies are warranted. It should be noted that CAZ-AVI may induce thrombocytopenia and hematuria.
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Affiliation(s)
- Jia Xu
- Department of Clinical Pharmacy, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
| | - Chengjia Luo
- Department of Clinical Pharmacy, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
| | - Liang Huang
- Department of Rehabilitation, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
| | - Xi Xiao
- Department of Clinical Laboratory, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
| | - Ling Liu
- Department of Clinical Pharmacy, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
| | - Zhiling Yang
- Department of Clinical Pharmacy, Hunan Provincial People’s Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, 410016, People’s Republic of China
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Giovagnorio F, De Vito A, Madeddu G, Parisi SG, Geremia N. Resistance in Pseudomonas aeruginosa: A Narrative Review of Antibiogram Interpretation and Emerging Treatments. Antibiotics (Basel) 2023; 12:1621. [PMID: 37998823 PMCID: PMC10669487 DOI: 10.3390/antibiotics12111621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Pseudomonas aeruginosa is a ubiquitous Gram-negative bacterium renowned for its resilience and adaptability across diverse environments, including clinical settings, where it emerges as a formidable pathogen. Notorious for causing nosocomial infections, P. aeruginosa presents a significant challenge due to its intrinsic and acquired resistance mechanisms. This comprehensive review aims to delve into the intricate resistance mechanisms employed by P. aeruginosa and to discern how these mechanisms can be inferred by analyzing sensitivity patterns displayed in antibiograms, emphasizing the complexities encountered in clinical management. Traditional monotherapies are increasingly overshadowed by the emergence of multidrug-resistant strains, necessitating a paradigm shift towards innovative combination therapies and the exploration of novel antibiotics. The review accentuates the critical role of accurate antibiogram interpretation in guiding judicious antibiotic use, optimizing therapeutic outcomes, and mitigating the propagation of antibiotic resistance. Misinterpretations, it cautions, can inadvertently foster resistance, jeopardizing patient health and amplifying global antibiotic resistance challenges. This paper advocates for enhanced clinician proficiency in interpreting antibiograms, facilitating informed and strategic antibiotic deployment, thereby improving patient prognosis and contributing to global antibiotic stewardship efforts.
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Affiliation(s)
- Federico Giovagnorio
- Department of Molecular Medicine, University of Padua, 35121 Padua, Italy; (F.G.); (S.G.P.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | | | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale “dell’Angelo”, 30174 Venice, Italy
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile “S.S. Giovanni e Paolo”, 30122 Venice, Italy
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Torres A, Wible M, Tawadrous M, Irani P, Stone GG, Quintana A, Debabov D, Burroughs M, Bradford PA, Kollef M. Efficacy and safety of ceftazidime/avibactam in patients with infections caused by β-lactamase-producing Gram-negative pathogens: a pooled analysis from the Phase 3 clinical trial programme. J Antimicrob Chemother 2023; 78:2672-2682. [PMID: 37700689 PMCID: PMC11157139 DOI: 10.1093/jac/dkad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES This post hoc pooled analysis evaluated clinical and microbiological outcomes and safety in patients with infections caused by β-lactamase-producing Gram-negative pathogens across five Phase 3, randomized, controlled, multicentre trials of ceftazidime/avibactam in adults with complicated intra-abdominal infection (cIAI), complicated urinary tract infection (cUTI)/pyelonephritis and nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP). METHODS In each trial, RECLAIM/RECLAIM 3 (cIAI), REPRISE (cIAI/cUTI), RECAPTURE (cUTI) and REPROVE (NP, including VAP) patients were randomized 1:1 to IV ceftazidime/avibactam (plus metronidazole for patients with cIAI) or comparators (carbapenems in >97% patients) for 5-21 days. Clinical and microbiological responses at the test-of-cure visit were assessed for patients with ESBLs, and/or plasmidic and/or overexpression of chromosomal AmpC, and/or serine carbapenemases without MBLs identified in baseline Gram-negative isolates by phenotypic screening and molecular characterization in the pooled microbiological modified ITT (mMITT) population. RESULTS In total, 813 patients (ceftazidime/avibactam, n = 389; comparator, n = 424) had ≥1 β-lactamase-producing baseline pathogen identified, amongst whom 792 patients (ceftazidime/avibactam, n = 379; comparator, n = 413) had no MBLs. The most frequent β-lactamase-producing pathogens across treatment groups were Escherichia coli (n = 381), Klebsiella pneumoniae (n = 261) and Pseudomonas aeruginosa (n = 53). Clinical cure rates in the pooled non-MBL β-lactamase-producing mMITT population were 88.1% (334/379) for ceftazidime/avibactam and 88.1% (364/413) for comparators; favourable microbiological response rates were 76.5% (290/379) and 68.8% (284/413), respectively. The safety profile of ceftazidime/avibactam was consistent with previous observations. CONCLUSIONS This analysis provides supportive evidence of the efficacy and safety of ceftazidime/avibactam in patients with infections caused by ESBLs, AmpC and serine carbapenemase-producing Gram-negative pathogens. TRIAL REGISTRATION NCT01499290; NCT01726023; NCT01644643; NCT01595438/NCT01599806; NCT01808092.
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Affiliation(s)
- Antoni Torres
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | | | | | - Paurus Irani
- Hospital Business Unit, Pfizer, Tadworth, Surrey, UK
| | | | | | - Dmitri Debabov
- Non-clinical Development Microbiology, AbbVie, Irvine, CA, USA
| | | | | | - Marin Kollef
- Division of Pulmonary & Critical Care Medicine, Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, MO, USA
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Zheng Z, Shao Z, Lu L, Tang S, Shi K, Gong F, Liu J. Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem-resistant Gram-negative bacilli infection. BMC Infect Dis 2023; 23:709. [PMID: 37864200 PMCID: PMC10589954 DOI: 10.1186/s12879-023-08715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The rapid global emergence and spread of carbapenem-resistant Gram-negative bacilli (CR-GNB) is recognized as a major public health concern, and there are currently few effective treatments for CR-GNB infection. The aim of this study was to investigate the clinical characteristics and outcomes of patients with CR-GNB infections treated with ceftazidime/avibactam (CAZ/AVI) combined with colistin from October 2019 to February 2023 in China. METHODS A total of 31 patients with CR-GNB infections were retrospectively identified using the electronic medical record system of Zhejiang Provincial People's Hospital. RESULTS Thirty-one patients were treated with CAZ/AVI combined with colistin. Respiratory tract infections (87%) were most common. The common drug-resistant bacteria encompass Klebsiella pneumonia (54.8%), Acinetobacter baumannii (29.0%), and Pseudomonas aeruginosa (16.1%). The 30-day mortality rate was 29.0%, and the 7-day microbial clearance rate was 64.5%. The inflammatory marker CRP changes, but not PCT and WBC, were statistically significant on days 7 and 14 after combination therapy. There were seven patients developing acute renal injury (AKI) after combination therapy and treating with continuous renal replacement therapy (CRRT). Two patients developed diarrhea. CONCLUSION The combination of CAZ/AVI and colistin has potential efficacy in patients with CR-GNB infection, but more studies are needed to determine whether it can reduce 30-day mortality rates and increase 7-day microbial clearance. At the same time, the adverse reactions of combination therapy should not be ignored.
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Affiliation(s)
- Zihao Zheng
- Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Ziqiang Shao
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Lihai Lu
- Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Siyu Tang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Kai Shi
- Department of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, Zhejiang Province, China
| | - Fangxiao Gong
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Jingquan Liu
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China.
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Waters J, Shorr AF. Bloodstream Infection and Gram-Negative Resistance: The Role for Newer Antibiotics. Antibiotics (Basel) 2023; 12:977. [PMID: 37370296 DOI: 10.3390/antibiotics12060977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Gram-negative resistance remains a major challenge. Rates of in vitro resistance to commonly utilized antibiotics have skyrocketed over the last decade. Clinicians now encounter multidrug-resistant organisms routinely. Fortunately, newer agents, such as ceftazidime-avibactam, ceftolozone-tazobactam, meropenem-vaborbactam, and cefiderocol, have been developed and are now available for use against these pathogens. Clinical trials with these novel therapies have focused on multiple infection types ranging from complicated urinary tract infections to nosocomial pneumonia. Nonetheless, there remains little information about the efficacy of these drugs for bacteremia. To better appreciate the types and limitations of the evidence supporting the role for these unique molecules in bloodstream infection, one requires an appreciation of the initial clinical trials supporting the regulatory approval of these antibiotics. Furthermore, physicians must understand the subsequent case series and reports specifically focusing on outcomes for patients with bacteremia treated with these drugs. Despite the limitations of the data and reports relating to treatment for bacteremia with these antibiotics, each agent appears to be efficacious and can provide good outcomes in bloodstream infections due to resistant pathogens.
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Affiliation(s)
- Jessica Waters
- Division of Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA
| | - Andrew F Shorr
- Division of Pulmonary and Critical Care Medicine, Medstar Washington Hospital Center, Washington, DC 20010, USA
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Zhuang HH, Chen Y, Hu Q, Long WM, Wu XL, Wang Q, Xu TT, Qu Q, Liu YP, Xiao YW, Qu J. Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study. J Infect Public Health 2023; 16:938-947. [PMID: 37087853 DOI: 10.1016/j.jiph.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES Limited data on clinical and microbiological efficacy, patient mortality, and other associated factors are available for ceftazidime/avibactam (CAZ/AVI)-based regimens for carbapenem-resistant Gram-negative bacteria (CR-GNB). This study aimed to assess these issues retrospectively using multicenter data. METHODS This multicenter study included CR-GNB infected patients treated with CAZ/AVI-based regimens for more than three days. Patient characteristics, bacterial culture reports, drug-sensitivity test results, and antibiotic use, including CAZ/AVI use, were extracted from the patient's clinical records. The clinical and microbiological efficacy of the combined drug regimen and patient mortality were evaluated according to corresponding definitions. Univariate and multivariate logistic regressions were performed to explore the efficacy and mortality-related factors. RESULTS A total of 183 patients with CR-GNB infection were considered for the analysis according to the inclusion and exclusion criteria. After the treatment of CAZ/AVI-based regimens, the clinical efficacy was 75.4 %. The 7-day microbial efficacy and clearance rate after treatment were 43.7 % and 66.0 %, respectively. Moreover, 30-day all-cause and in-hospital mortality were 11.5 % and 14.2 %, respectively. Harboring renal dysfunction (creatinine clearance rate (CCR) of<20 mL/min), cardiovascular diseases, and digestive system diseases were independent risk factors for poor clinical efficacy of CAZ/AVI-based regimens. Bloodstream infection (BSI), patients with the adjusted doses of CAZ/AVI, and CAZ/AVI co-administration with carbapenem were independently associated factors of bacterial clearance by CAZ/AVI-based regimens. Age, total hospital stays, use of mechanical ventilation, and cumulative CAZ/AVI dose were independent factors associated with all-cause mortality. CONCLUSION CAZ/AVI was an effective drug in treating CR-GNB infection. CAZ/AVI that is mostly excreted by the kidney and is accumulated in renal impairment should be renally adjusted. Renal dysfunction and the adjusted dose of CAZ/AVI were associated with efficacy. Clinicians should individualize CAZ/AVI regimen and dose by the level of renal function to achieve optimal efficacy and survival. The efficacy of CAZ/AVI in the treatment of CR-GNB infection, as well as the implementation of individualized precision drug administration of CAZ/AVI according to patients' different infection sites, renal function, bacterial types, bacterial resistance mechanisms, blood concentration monitoring and other conditions need to be further studied in multicenter.
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Affiliation(s)
- Hai-Hui Zhuang
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
| | - Ying Chen
- Department of Pharmacy, Wuhan University, Renmin Hospital, Wuhan 430060, China
| | - Qin Hu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410078, China; Institute of Hospital Management, Central South University, Changsha 410078, China
| | - Wen-Ming Long
- Department of Pharmacy, Jingzhou District, Second People's Hospital of Huaihua City, Huaihua 418400, China
| | - Xiao-Li Wu
- Department of Pharmacy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Qin Wang
- Department of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Tian-Tian Xu
- Department of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410078, China; Institute of Hospital Management, Central South University, Changsha 410078, China
| | - Yi-Ping Liu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
| | - Yi-Wen Xiao
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
| | - Jian Qu
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China; Hunan key laboratory of the research and development of novel pharmaceutical preparations, Changsha Medical University, Changsha 410219, China.
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Soriano A, Montravers P, Bassetti M, Klyasova G, Daikos G, Irani P, Stone G, Chambers R, Peeters P, Shah M, Hulin C, Albuquerque N, Basin E, Gaborit B, Kourbeti I, Menichetti F, Perez-Rodriguez MT, Pletz MW, Sanchez M, Trompa I, Verma A, de Figueiredo MLN, Charbonneau C. The Use and Effectiveness of Ceftazidime-Avibactam in Real-World Clinical Practice: EZTEAM Study. Infect Dis Ther 2023; 12:891-917. [PMID: 36763243 PMCID: PMC9912999 DOI: 10.1007/s40121-023-00762-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Ceftazidime-avibactam has proven activity against multidrug-resistant (MDR) bacteria in clinical trials and real-world studies. This study was conducted to describe the patterns of use of ceftazidime-avibactam (including indications and associated antibiotics), and the effectiveness and safety of ceftazidime-avibactam in real-world clinical practice. METHODS This non-interventional medical chart review study was conducted in 11 countries across the European and Latin American (LATAM) regions. Consecutive patients treated in clinical practice with at least one dose of ceftazidime-avibactam for an approved indication per country label since 01 January 2018 (or launch date in the country if posterior) were enrolled. Effectiveness analyses were conducted in patients treated with ceftazidime-avibactam for at least 72 h. RESULTS Of the 569 eligible patients enrolled, 516 (90.7%) were treated for at least 72 h (354 patients from Europe and 162 patients from LATAM); 390 patients (75.7%) had switched from another antibiotic line for Gram-negative coverage. Infection sources were intra-abdominal, urinary, respiratory, bloodstream infections, and other infections (approximately 20% each). K. pneumoniae was the most common microorganism identified in the latest microbiological evaluation before starting ceftazidime-avibactam (59.3%). Two-thirds of microorganisms tested for susceptibility were MDR, of which 89.3% were carbapenem-resistant. The common MDR mechanisms for K. pneumoniae were carbapenemase (33.9%), oxacillinase 48 (25.2%), extended-spectrum beta-lactamase (21.5%), or metallo-beta-lactamase (14.2%) production. Without prior patient exposure, 17 isolates (mostly K. pneumoniae) were resistant to ceftazidime-avibactam. Treatment success was achieved in 77.3% of patients overall (88.3% among patients with urinary infection), regardless of first or second treatment line. In-hospital mortality rate was 23.1%. Adverse events were reported for six of the 569 patients enrolled. CONCLUSION This study provides important real-world evidence on treatment patterns, effectiveness, and safety of ceftazidime-avibactam in clinical practice through its recruitment in the European and LATAM regions. Ceftazidime-avibactam is one of the antibiotics to consider for treatment of MDR bacteria. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03923426.
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Affiliation(s)
- Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, Helios Building, Villarroel 170, Barcelona, Spain
| | - Philippe Montravers
- Department of Anaesthesiology and Surgical Critical Care Unit, CHU Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université de Paris-Cité, Paris, France
| | - Matteo Bassetti
- Clinica Malattie Infettive, San Martino IST- IRCCS, Ospedale Policlinico, Genoa, Italy
| | - Galina Klyasova
- National Medical Research Center for Hematology, Moscow, Russian Federation
| | | | | | | | | | | | - Mitesh Shah
- IQVIA Real-World Solutions, Bengaluru, India
| | | | | | - Efim Basin
- Regional Clinical Hospital #1, Krasnodar, Russia
| | - Benjamin Gaborit
- Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 413, INSERM, Nantes, France
| | | | | | | | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Marisa Sanchez
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Anita Verma
- Kings College Hospital NHS Foundation Trust, London, UK
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Swaminathan S, Routray A, Mane A. Early and Appropriate Use of Ceftazidime-Avibactam in the Management of Multidrug-Resistant Gram-Negative Bacterial Infections in the Indian Scenario. Cureus 2022; 14:e28283. [PMID: 36072213 PMCID: PMC9440350 DOI: 10.7759/cureus.28283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
The increasing prevalence of antibiotic-resistant pathogens exerts a substantial burden on the healthcare infrastructure worldwide. The World Health Organization (WHO) has declared that multidrug-resistant (MDR) Gram-negative pathogens, especially, carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii, and Pseudomonas aeruginosa as the topmost priority while developing newer antimicrobials. The increasing prevalence of infectious diseases caused by MDR Gram-negative bacteria also poses a challenge when choosing the empiric antimicrobial therapy for seriously ill hospitalized patients. The infections caused by MDR Gram-negative organisms ultimately result in increased mortality, morbidity, prolonged hospital stay, and increased cost of management. To tackle these challenges, newer antimicrobials like ceftazidime-avibactam were explored. The article also discusses the in vitro activity and therapeutic efficacy of ceftazidime-avibactam along with its pharmacokinetic properties and the role it will play in the management of MDR Gram-negative organisms in the Indian setting. Several studies have highlighted the role of early and appropriate antibiotic use in the reduction of mortality in patients with Gram-negative infections. Timely initiation of appropriate antibiotic therapy for serious infections leads to favorable clinical outcomes. Early and appropriate use of ceftazidime-avibactam while treating MDR Gram-negative infections has been associated with improved clinical outcomes. The aim of this review is to highlight the efficacy of ceftazidime-avibactam in the treatment of MDR Gram-negative infections. We have also summarized the information on outcomes achieved by early and appropriate use of ceftazidime-avibactam.
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11
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Di Pietrantonio M, Brescini L, Candi J, Gianluca M, Pallotta F, Mazzanti S, Mantini P, Candelaresi B, Olivieri S, Ginevri F, Cesaretti G, Castelletti S, Cocci E, Polo RG, Cerutti E, Simonetti O, Cirioni O, Tavio M, Giacometti A, Barchiesi F. Ceftazidime-Avibactam for the Treatment of Multidrug-Resistant Pathogens: A Retrospective, Single Center Study. Antibiotics (Basel) 2022; 11:antibiotics11030321. [PMID: 35326784 PMCID: PMC8944595 DOI: 10.3390/antibiotics11030321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/07/2022] Open
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.
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Affiliation(s)
- Maria Di Pietrantonio
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
| | - Lucia Brescini
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
- Correspondence: ; Tel.: +39-071-596-3502
| | - Jennifer Candi
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Morroni Gianluca
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
| | - Francesco Pallotta
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Sara Mazzanti
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
| | - Paolo Mantini
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Bianca Candelaresi
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Silvia Olivieri
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Francesco Ginevri
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Giulia Cesaretti
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Faculty of Medicine, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60126 Ancona, Torrette, Italy;
| | - Sefora Castelletti
- Infectious Diseases, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (S.C.); (M.T.)
| | - Emanuele Cocci
- Hospital Pharmacy, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (E.C.); (R.G.P.)
| | - Rosaria G. Polo
- Hospital Pharmacy, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (E.C.); (R.G.P.)
| | - Elisabetta Cerutti
- Anesthesia and Transplant Surgical Intensive Care Unit, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy;
| | - Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Torrete, Italy;
| | - Oscar Cirioni
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
| | - Marcello Tavio
- Infectious Diseases, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (S.C.); (M.T.)
| | - Andrea Giacometti
- Infectious Diseases Clinic, Ospedali Riuniti Umberto I, Via Conca 71, 60126 Ancona, Torrette, Italy; (M.D.P.); (F.P.); (S.M.); (P.M.); (B.C.); (S.O.); (F.G.); (G.C.); (O.C.); (A.G.)
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Via Tronto 10/a, 60020 Ancona, Torrette, Italy; (M.G.); (F.B.)
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61122 Pesaro, Pesaro and Urbino, Italy
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12
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Daikos GL, da Cunha CA, Rossolini GM, Stone GG, Baillon-Plot N, Tawadrous M, Irani P. Review of Ceftazidime-Avibactam for the Treatment of Infections Caused by Pseudomonas aeruginosa. Antibiotics (Basel) 2021; 10:antibiotics10091126. [PMID: 34572708 PMCID: PMC8467554 DOI: 10.3390/antibiotics10091126] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/12/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that causes a range of serious infections that are often challenging to treat, as this pathogen can express multiple resistance mechanisms, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes. Ceftazidime–avibactam is a combination antimicrobial agent comprising ceftazidime, a third-generation semisynthetic cephalosporin, and avibactam, a novel non-β-lactam β-lactamase inhibitor. This review explores the potential role of ceftazidime–avibactam for the treatment of P. aeruginosa infections. Ceftazidime–avibactam has good in vitro activity against P. aeruginosa relative to comparator β-lactam agents and fluoroquinolones, comparable to amikacin and ceftolozane–tazobactam. In Phase 3 clinical trials, ceftazidime–avibactam has generally demonstrated similar clinical and microbiological outcomes to comparators in patients with complicated intra-abdominal infections, complicated urinary tract infections or hospital-acquired/ventilator-associated pneumonia caused by P. aeruginosa. Although real-world data are limited, favourable outcomes with ceftazidime–avibactam treatment have been reported in some patients with MDR and XDR P. aeruginosa infections. Thus, ceftazidime–avibactam may have a potentially important role in the management of serious and complicated P. aeruginosa infections, including those caused by MDR and XDR strains.
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Affiliation(s)
- George L. Daikos
- Department of Medicine, National and Kapodistrian University of Athens, 115-27 Athens, Greece
- Correspondence: ; Tel.: +30-210-804-9218
| | | | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, I-50134 Florence, Italy;
- Clinical Microbiology and Virology Unit, Careggi University Hospital, I-50134 Florence, Italy
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