头孢他啶-阿维巴坦治疗耐碳青霉烯类以外的多重耐药革兰阴性菌感染的临床经验
Clinical Experience with Ceftazidime-Avibactam for the Treatment of Infections due to Multidrug-Resistant Gram-Negative Bacteria Other than Carbapenem-Resistant .
作者信息
Vena Antonio, Giacobbe Daniele Roberto, Castaldo Nadia, Cattelan Annamaria, Mussini Cristina, Luzzati Roberto, Rosa Francesco Giuseppe De, Del Puente Filippo, Mastroianni Claudio Maria, Cascio Antonio, Carbonara Sergio, Capone Alessandro, Boni Silvia, Sepulcri Chiara, Meschiari Marianna, Raumer Francesca, Oliva Alessandra, Corcione Silvia, Bassetti Matteo
机构信息
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy.
Hospital Policlinico San Martino-IRCCS, Genoa 16132, Italy.
出版信息
Antibiotics (Basel). 2020 Feb 9;9(2):71. doi: 10.3390/antibiotics9020071.
BACKGROUND
Experience in real clinical practice with ceftazidime-avibactam for the treatment of serious infections due to gram-negative bacteria (GNB) other than carbapenem-resistant (CRE) is very limited.
METHODS
We carried out a retrospective multicenter study of patients hospitalized in 13 Italian hospitals who received ≤72 h of ceftazidime-avibactam for GNB other than CRE to assess the rates of clinical success, resistance development, and occurrence of adverse events.
RESULTS
Ceftazidime-avibactam was used to treat 41 patients with GNB infections other than CRE. Median age was 62 years and 68% of them were male. The main causative agents were (33/41; 80.5%) and extended spectrum beta lactamase (ESBL)-producing (4/41, 9.8%). Four patients had polymicrobial infections. All strains were susceptible to ceftazidime-avibactam. The most common primary infection was nosocomial pneumonia ( = 20; 48.8%), primary bacteremia ( = 7; 17.1%), intra-abdominal infection ( = 4; 9.8%), and bone infection ( = 4; 9.8%). Ceftazidime-avibactam was mainly administered as a combination treatment ( = 33; 80.5%) and the median length of therapy was 13 days. Clinical success at the end of the follow-up period was 90.5%, and the only risk factor for treatment failure at multivariate analysis was receiving continuous renal replacement therapy during ceftazidime-avibactam. There was no association between clinical failures and type of primary infection, microbiological isolates, and monotherapy with ceftazidime-avibactam. Only one patient experienced recurrent infection 5 days after the end of treatment. Development of resistance to ceftazidime-avibactam was not detected in any case during the whole follow-up period. No adverse events related to ceftazidime-avibactam were observed in the study population.
CONCLUSIONS
Ceftazidime-avibactam may be a valuable therapeutic option for serious infections due to GNB other than CRE.
背景
头孢他啶-阿维巴坦在实际临床实践中用于治疗耐碳青霉烯类革兰氏阴性菌（GNB）以外的严重感染的经验非常有限。
方法
我们对意大利13家医院收治的接受≤72小时头孢他啶-阿维巴坦治疗耐碳青霉烯类革兰氏阴性菌以外的革兰氏阴性菌患者进行了一项回顾性多中心研究，以评估临床成功率、耐药性发展及不良事件的发生率。
结果
头孢他啶-阿维巴坦用于治疗41例耐碳青霉烯类革兰氏阴性菌以外的革兰氏阴性菌感染患者。中位年龄为62岁，其中68%为男性。主要病原体为[具体病原体未给出]（33/41；80.5%）和产超广谱β-内酰胺酶（ESBL）的[具体病原体未给出]（4/41，9.8%）。4例患者为混合微生物感染。所有菌株对头孢他啶-阿维巴坦敏感。最常见的原发性感染为医院获得性肺炎（20例；48.8%）、原发性菌血症（7例；17.1%）、腹腔内感染（4例；9.8%）和骨感染（4例；9.8%）。头孢他啶-阿维巴坦主要作为联合治疗给药（33例；80.5%），中位治疗时长为13天。随访期末的临床成功率为90.5%，多因素分析中治疗失败的唯一危险因素是在使用头孢他啶-阿维巴坦期间接受持续肾脏替代治疗。临床失败与原发性感染类型、微生物分离株及头孢他啶-阿维巴坦单药治疗之间无关联。仅1例患者在治疗结束后5天出现复发性感染。在整个随访期间未检测到对头孢他啶-阿维巴坦的耐药性发展。在研究人群中未观察到与头孢他啶-阿维巴坦相关的不良事件。
结论
头孢他啶-阿维巴坦可能是治疗耐碳青霉烯类革兰氏阴性菌以外的革兰氏阴性菌严重感染的一种有价值的治疗选择。
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