Ceftazidime-Avibactam Use for Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Infections: A Retrospective Observational Multicenter Study-Reference-Cited by-同舟云学术

Ceftazidime-Avibactam Use for Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Infections: A Retrospective Observational Multicenter Study

Published:2021-02-22 Issue:9 Volume:73 Page:1664-1676
ISSN:1058-4838
Container-title:Clinical Infectious Diseases
language:en
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Author:

Tumbarello Mario¹²³,Raffaelli Francesca¹,Giannella Maddalena⁴,Mantengoli Elisabetta⁵,Mularoni Alessandra⁶,Venditti Mario⁷,De Rosa Francesco Giuseppe⁸,Sarmati Loredana⁹,Bassetti Matteo¹⁰¹¹,Brindicci Gaetano¹²,Rossi Marianna¹³,Luzzati Roberto¹⁴,Grossi Paolo Antonio¹⁵,Corona Alberto¹⁶,Capone Alessandro¹⁷,Falcone Marco¹⁸,Mussini Cristina¹⁹,Trecarichi Enrico Maria²⁰,Cascio Antonio²¹,Guffanti Elena²²,Russo Alessandro²³,De Pascale Gennaro²⁴,Tascini Carlo²⁵,Gentile Ivan²⁶,Losito Angela Raffaella¹,Bussini Linda⁴,Corti Giampaolo⁵²⁷,Ceccarelli Giancarlo⁷,Corcione Silvia⁸²⁸,Compagno Mirko²⁹,Giacobbe Daniele Roberto¹⁰¹¹,Saracino Annalisa¹²,Fantoni Massimo¹²,Antinori Spinello³⁰,Peghin Maddalena³¹,Bonfanti Paolo¹³³²,Oliva Alessandra⁷,De Gasperi Andrea²²,Tiseo Giusy¹⁸,Rovelli Cristina¹⁵,Meschiari Marianna³³,Shbaklo Nour⁸,Spanu Teresa¹³⁴,Cauda Roberto¹²,Viale Pierluigi⁴

Affiliation:

1. Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy

2. Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy

3. Department of Medical Biotechnologies, University of Siena, Siena, Italy

4. Department of Medical and Surgical Sciences, University of Bologna, IRCCS Pol. S. Orsola Bologna, Italy

5. SOD Malattie Infettive e Tropicali Azienda Ospedaliero Universitaria Careggi, Florence, Italy

6. ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy

7. Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Rome, Italy

8. Department of Medical Sciences, University of Turin, Turin, Italy

9. Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy

10. Infectious Diseases Unit, Ospedale Policlinico San Martino–IRCCS, Genova, Italy

11. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

12. Operative Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Bari, Italy

13. UOC Malattie Infettive, Ospedale San Gerardo, Genoa, Italy

14. Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy

15. Clinica di Malattie Infettive e Tropicali, Università degli Studi dell’Insubria–ASST-Sette Laghi, Varese, Italy

16. SC Anestesia e Rianimazione, ASST Fatebenefratelli Sacco, Polo Universitario, Milan, Italy

17. Infezioni Sistemiche ed Immunodepresso, National Institute for Infectious Disease L Spallanzani, Rome, Italy

18. Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

19. Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy

20. Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy

21. Infectious and Tropical Diseases Unit– Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G D’Alessandro,” University of Palermo, Palermo, Italy

22. Anestesia Rianimazione 2, ASST GOM Niguarda, Milan, Italy

23. Internal Medicine Unit, Policlinico Casilino, Rome, Italy

24. Dipartimento di Scienza dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy

25. Malattie Infettive ad Indirizzo neurologico Ospedale Cotugno, Naples, Italy

26. Dipartimento di Medicina Clinica e Chirurgia–Sezione di Malattie Infettive, Università di Napoli “Federico II,” Naples, Italy

27. Dipartimento Medicina Sperimentale e Clinica Università di Firenze, Florence, Italy

28. Tufts University School of Medicine, Boston, MA, USA

29. Clinical Infectious Diseases, Tor Vergata University, Rome, Italy

30. Dipartimento di Scienze Biomediche e Cliniche L Sacco Università degli Studi di Milano Polo Universitario, Milan, Italy

31. Clinica Malattie Infettive, Dipartimento di Area Medica Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy

32. Dipartimento di Medicina e Chirurgia, Università Milano Bicocca, Milan, Italy

33. Clinica delle Malattie Infettive, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Italy

34. Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy

Abstract

Abstract Background A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae. Methods We retrospectively analyzed observational data on use and outcomes of CAZ-AVI therapy for infections caused by Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens versus CAZ-AVI monotherapy. Results The cohort comprised 577 adults with bloodstream infections (n = 391) or nonbacteremic infections involving mainly the urinary tract, lower respiratory tract, and intra-abdominal structures. All received treatment with CAZ-AVI alone (n = 165) or with ≥1 other active antimicrobials (n = 412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs 25.0%, P = .79). In multivariate analysis, mortality was positively associated with presence at infection onset of septic shock (P = .002), neutropenia (P < .001), or an INCREMENT score ≥8 (P = .01); with lower respiratory tract infection (LRTI) (P = .04); and with CAZ-AVI dose adjustment for renal function (P = .01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P = .006). All associations remained significant after propensity score adjustment. Conclusions CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug’s seemingly more limited efficacy in LRTIs and potential survival benefits of prolonging CAZ-AVI infusions to ≥3 hours.

Funder

Università Cattolica del Sacro Cuore

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Link

http://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciab176/38027825/ciab176.pdf

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