Department of Pharmacy, Atrium Health, Charlotte, North Carolina, USA
Department of Pharmacy, Atrium Health, Charlotte, North Carolina, USA.
Antimicrob Agents Chemother. 2020 Apr 21;64(5). doi: 10.1128/AAC.02313-19.
The comparative efficacy of ceftazidime-avibactam and meropenem-vaborbactam for treatment of carbapenem-resistant (CRE) infections remains unknown. This was a multicenter, retrospective cohort study of adults with CRE infections who received ceftazidime-avibactam or meropenem-vaborbactam for ≥72 hours from February 2015 to October 2018. Patients with a localized urinary tract infection and repeat study drug exposures after the first episode were excluded. The primary endpoint was clinical success compared between treatment groups. Secondary endpoints included 30- and 90-day mortality, adverse events (AE), 90-day CRE infection recurrence, and development of resistance in patients with recurrent infection. A subgroup analysis was completed comparing patients who received ceftazidime-avibactam monotherapy, ceftazidime-avibactam combination therapy, and meropenem-vaborbactam monotherapy. A total of 131 patients were included (ceftazidime-avibactam, = 105; meropenem-vaborbactam, = 26), 40% of whom had bacteremia. No significant difference in clinical success was observed between groups (62% versus 69%; = 0.49). Patients in the ceftazidime-avibactam arm received combination therapy more often than patients in the meropenem-vaborbactam arm (61% versus 15%; < 0.01). No difference in 30- and 90-day mortality resulted, and rates of AE were similar between groups. In patients with recurrent infection, development of resistance occurred in three patients that received ceftazidime-avibactam monotherapy and in no patients in the meropenem-vaborbactam arm. Clinical success was similar between patients receiving ceftazidime-avibactam and meropenem-vaborbactam for treatment of CRE infections, despite ceftazidime-avibactam being used more often as a combination therapy. Development of resistance was more common with ceftazidime-avibactam monotherapy.
头孢他啶-阿维巴坦与美罗培南-维巴坦治疗碳青霉烯类耐药 （CRE） 感染的疗效比较尚不清楚。这是一项多中心、回顾性队列研究，纳入了 2015 年 2 月至 2018 年 10 月期间接受头孢他啶-阿维巴坦或美罗培南-维巴坦治疗且治疗时间≥72 小时的 CRE 感染成人患者。排除了局部尿路感染和首次发作后重复使用研究药物的患者。主要终点为治疗组间临床疗效的比较。次要终点包括 30 天和 90 天死亡率、不良事件（AE）、90 天 CRE 感染复发以及复发性感染患者的耐药性发展。完成了一项亚组分析，比较了接受头孢他啶-阿维巴坦单药治疗、头孢他啶-阿维巴坦联合治疗和美罗培南-维巴坦单药治疗的患者。共纳入 131 例患者（头孢他啶-阿维巴坦组，105 例；美罗培南-维巴坦组，26 例），其中 40%合并菌血症。两组间临床疗效无显著差异（62% vs. 69%； = 0.49）。头孢他啶-阿维巴坦组患者接受联合治疗的比例高于美罗培南-维巴坦组（61% vs. 15%； < 0.01）。两组 30 天和 90 天死亡率无差异，AE 发生率相似。在复发性感染患者中，接受头孢他啶-阿维巴坦单药治疗的 3 例患者出现耐药，而接受美罗培南-维巴坦治疗的患者无耐药。接受头孢他啶-阿维巴坦和美罗培南-维巴坦治疗 CRE 感染的患者临床疗效相似，尽管头孢他啶-阿维巴坦更常作为联合治疗使用。头孢他啶-阿维巴坦单药治疗耐药更为常见。
