Infectious Diseases Unit-Internal Medicine Department, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Hospital Álvaro Cunqueiro Bloque técnico, Estrada Clara Campoamor 341, Vigo (Pontevedra), Spain.
J Antimicrob Chemother. 2018 Nov 1;73(11):3170-3175. doi: 10.1093/jac/dky295.
Experience in real clinical practice with ceftazidime/avibactam is limited, and there are even fewer data on infections due to OXA-48-producing Enterobacteriaceae.
We designed an observational study of a prospectively collected cohort of adult patients receiving ceftazidime/avibactam in our centre. Only the first treatment course of each patient was analysed. Efficacy and safety were evaluated as 14 and 30 day mortality, recurrence rate at 90 days, resistance development and occurrence of adverse effects.
Fifty-seven patients were treated with ceftazidime/avibactam. The median age was 64 years (range 26-86), 77% were male and the median Charlson index was 3. The most frequent sources of infection were intra-abdominal (28%), followed by respiratory (26%) and urinary (25%). Thirty-one (54%) patients had a severe infection (defined as presence of sepsis or septic shock). Most patients received ceftazidime/avibactam as monotherapy (81%) and the median duration of treatment was 13 days. Mortality at 14 days was 14%. In multivariate analysis, the only mortality risk factor was INCREMENT-CPE score >7 (HR 11.7, 95% CI 4.2-20.6). There was no association between mortality and monotherapy with ceftazidime/avibactam. The recurrence rate at 90 days was 10%. Ceftazidime/avibactam resistance was not detected in any case and only two patients developed adverse events related to treatment.
Ceftazidime/avibactam shows promising results, even in monotherapy, for the treatment of patients with severe infections due to OXA-48-producing Enterobacteriaceae and limited therapeutic options. The emergence of resistance to ceftazidime/avibactam was not observed.
在真实临床实践中，头孢他啶/阿维巴坦的经验有限，而关于产 OXA-48 肠杆菌科细菌感染的数据则更少。
我们设计了一项前瞻性收集的成人患者队列观察研究，这些患者在我们中心接受头孢他啶/阿维巴坦治疗。仅分析每位患者的第一个疗程。疗效和安全性评估为 14 天和 30 天死亡率、90 天内复发率、耐药性发展和不良反应发生情况。
57 例患者接受头孢他啶/阿维巴坦治疗。中位年龄为 64 岁（范围 26-86 岁），77%为男性，中位 Charlson 指数为 3。最常见的感染源是腹腔内（28%），其次是呼吸道（26%）和泌尿道（25%）。31 例（54%）患者患有严重感染（定义为存在败血症或感染性休克）。大多数患者接受头孢他啶/阿维巴坦单药治疗（81%），治疗中位时间为 13 天。14 天死亡率为 14%。多变量分析中，唯一的死亡风险因素是 INCREMENT-CPE 评分>7（HR 11.7，95%CI 4.2-20.6）。头孢他啶/阿维巴坦单药治疗与死亡率之间无关联。90 天复发率为 10%。未发现头孢他啶/阿维巴坦耐药，仅有 2 例患者发生与治疗相关的不良反应。
头孢他啶/阿维巴坦即使在单药治疗中，对于治疗产 OXA-48 肠杆菌科细菌和治疗选择有限的严重感染患者，也显示出良好的疗效。未观察到头孢他啶/阿维巴坦耐药的出现。
