Meropenem versus Ceftazidime-Avibactam versus Ceftazidime-Avibactam with Aztreonam as empiric, first-line treatment of high-risk febrile neutropenia: first report of the CAMerA Trial, an open-labelled, randomized-controlled trial.

Abstract

Abstract Introduction: Infections due to extended spectrum beta-lactam (ESBL) positive, carbapenemase producing enterobacteriaceae (CPE) and NDM1 resistance Enterobacteriaceae have significantly increased internationally and may account for up to 70% of infections in some geographies. Parallelly, high colistin resistance rates have also been reported. We are reporting the initial results of the first randomized-controlled trial addressing this issue of antibiotic resistant Gram-negative bacteremia (GNB). Objectives: The objective of the study was to assess the efficacy of first-line Ceftazidime–Avibactam with or without Aztreonam in high-risk FN, versus meropenem. Methodology: Adult patients with high-risk FN were randomized to Meropenem, Ceftazidime-Avibactum or Ceftazidime-Avibactum with Aztreonam as the first line antibiotic regimen. Results: Compared to meropenem, there was a trend towards reduced antibiotic failure, as defined by breakthrough fever within 7 days, with ceftazidime-avibactam, with or without aztreonam, although this wasn’t statistically significant, (p value = 0.076). Besides this, antibiotic failure was significantly associated with blood culture positivity (p= 0.015). Also, the presence of lung infiltrates was significantly associated with transfer to ICU (p=0.001). Conclusion: In high-risk FN, there was a trend to a higher incidence of antibiotic failure with first-line therapy with meropenem, compared to ceftazidime-avibactam with or without aztreonam, (p value = 0.076).