Jorgensen Sarah C J, Trinh Trang D, Zasowski Evan J, Lagnf Abdalhamid M, Bhatia Sahil, Melvin Sarah M, Steed Molly E, Simon Samuel P, Estrada Sandra J, Morrisette Taylor, Claeys Kimberly C, Rosenberg Joshua R, Davis Susan L, Rybak Michael J
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California, USA.
Open Forum Infect Dis. 2019 Dec 6;6(12):ofz522. doi: 10.1093/ofid/ofz522. eCollection 2019 Dec.
We conducted this study to describe the clinical characteristics, microbiology, and outcomes of patients treated with ceftazidime-avibactam (CZA) for a range of multidrug-resistant Gram-negative (MDR-GN) infections.
This is a multicenter, retrospective cohort study conducted at 6 medical centers in the United States between 2015 and 2019. Adult patients who received CZA (≥72 hours) were eligible. The primary outcome was clinical failure defined as a composite of 30-day all-cause mortality, 30-day microbiological failure, and/or failure to resolve or improve signs or symptoms of infection on CZA.
In total, data from 203 patients were evaluated. Carbapenem-resistant Enterobacteriaceae (CRE) and spp were isolated from 117 (57.6%) and 63 (31.0%) culture specimens, respectively. The most common infection sources were respiratory (37.4%), urinary (19.7%), and intra-abdominal (18.7%). Blood cultures were positive in 22 (10.8%) patients. Clinical failure, 30-day mortality, and 30-day recurrence occurred in 59 (29.1%), 35 (17.2%), and 12 (5.9%) patients, respectively. On therapy, CZA resistance developed in 1 of 62 patients with repeat testing. Primary bacteremia or respiratory tract infection and higher SOFA score were positively associated with clinical failure (adjusted odds ratio [aOR] = 2.270, 95% confidence interval [CI] = 1.115-4.620 and aOR = 1.234, 95% CI = 1.118-1.362, respectively). Receipt of CZA within 48 hours of infection onset was protective (aOR, 0.409; 95% CI, 0.180-0.930). Seventeen (8.4%) patients experienced a potential drug-related adverse effect (10 acute kidney injury, 3 infection, 2 rash, and 1 each gastrointestinal intolerance and neutropenia).
Ceftazidime-avibactam is being used to treat a range of MDR-GN infections including spp as well as CRE.
我们开展这项研究以描述接受头孢他啶-阿维巴坦（CZA）治疗多种耐多药革兰阴性菌（MDR-GN）感染患者的临床特征、微生物学情况及治疗结果。
这是一项于2015年至2019年在美国6个医学中心进行的多中心回顾性队列研究。接受CZA治疗（≥72小时）的成年患者符合条件。主要结局为临床失败，定义为30天全因死亡率、30天微生物学失败和/或CZA治疗后感染体征或症状未缓解或改善的综合情况。
总共评估了203例患者的数据。分别从117份（57.6%）和63份（31.0%）培养标本中分离出耐碳青霉烯类肠杆菌科细菌（CRE）和 菌。最常见的感染源为呼吸道（37.4%）、泌尿系统（19.7%）和腹腔内（18.7%）。22例（10.8%）患者血培养阳性。59例（29.1%）、35例（17.2%）和12例（5.9%）患者分别出现临床失败、30天死亡率和30天复发。在治疗过程中，62例接受重复检测的患者中有1例出现CZA耐药。原发性菌血症或呼吸道感染以及较高的序贯器官衰竭评估（SOFA）评分与临床失败呈正相关（校正比值比[aOR]=2.270，95%置信区间[CI]=1.115 - 4.620；aOR = 1.234，95%CI = 1.118 - 1.362）。感染发作后48小时内接受CZA治疗具有保护作用（aOR，0.409；95%CI，0.180 - 0.930）。17例（8.4%）患者出现潜在的药物相关不良反应（10例急性肾损伤、3例 感染、2例皮疹以及各1例胃肠道不耐受和中性粒细胞减少）。
头孢他啶-阿维巴坦正用于治疗包括 菌以及CRE在内的多种MDR-GN感染。
