BACKGROUND: A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae (CRE).METHODS: We retrospectively analyzed observational data on the use and outcomes of CAZ-AVI therapy for infections caused by KPC-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 vs. CAZ-AVI monotherapy.RESULTS: The cohort comprised 577 adults with bloodstream infections (BSIs) (n=391) or non-bacteremic infections (nBSIs) involving mainly the urinary tract, lower respiratory tract, intra-abdominal structures. All received treatment with CAZ-AVI alone (n=165) or with one or more other active antimicrobials (n=412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no statistically significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs. 25.0%, P=0.79). In multivariate analysis, mortality was positively associated with the presence at infection onset of septic shock (P=0.002), neutropenia (P <0.001), or an INCREMENT score >8 (P=0.01); with LRTI (P=0.04); and with CAZ-AVI dose adjustment for renal function (P=0.01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P=0.006). 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 the potential survival benefits of prolonging CAZ-AVI infusions to 3 hours or more.
Tumbarello, M., Raffaelli, F., Giannella, M., Mantengoli, E., Mularoni, A., Venditti, M., et al. (2021). Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study. CLINICAL INFECTIOUS DISEASES.
|Citazione:||Tumbarello, M., Raffaelli, F., Giannella, M., Mantengoli, E., Mularoni, A., Venditti, M., et al. (2021). Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study. CLINICAL INFECTIOUS DISEASES.|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||No|
|Titolo:||Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study|
|Autori:||Tumbarello, M; Raffaelli, F; Giannella, M; Mantengoli, E; Mularoni, A; Venditti, M; De Rosa, F; Sarmati, L; Bassetti, M; Brindicci, G; Rossi, M; Luzzati, R; Grossi, P; Corona, A; Capone, A; Falcone, M; Mussini, C; Trecarichi, E; Cascio, A; Guffanti, E; Russo, A; De Pascale, G; Tascini, C; Gentile, I; Losito, A; Bussini, L; Conti, G; Ceccarelli, G; Corcione, S; Compagno, M; Giacobbe, D; Saracino, A; Fantoni, M; Antinori, S; Peghin, M; Bonfanti, P; Oliva, A; De Gasperi, A; Tiseo, G; Rovelli, C; Meschiari, M; Shbaklo, N; Spanu, T; Cauda, R; Viale, P|
|Data di pubblicazione:||2021|
|Rivista:||CLINICAL INFECTIOUS DISEASES|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/cid/ciab176|
|Appare nelle tipologie:||01 - Articolo su rivista|