头孢他啶-阿维巴坦的药物流行病学：210 家美国医院的回顾性队列分析。
Pharmacoepidemiology of Ceftazidime-Avibactam Use: A Retrospective Cohort Analysis of 210 US Hospitals.
机构信息
Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
US Public Health Service Commissioned Corps, Rockville, Maryland, USA.
出版信息
Clin Infect Dis. 2021 Feb 16;72(4):611-621. doi: 10.1093/cid/ciaa061.
BACKGROUND
Ceftazidime-avibactam has in vitro activity against some carbapenem-resistant gram-negative infections (GNIs), and therefore may be a useful alternative to more toxic antibiotics such as colistin. Understanding ceftazidime-avibactam uptake and usage patterns would inform hospital formularies, stewardship, and antibiotic development.
METHODS
A retrospective cohort study assessed inpatient encounters in the Vizient database. Ceftazidime-avibactam and colistin administrations were categorized into presumed empiric (3 consecutive days of therapy or less with qualifying exclusions) versus targeted therapy (≥4 consecutive days of therapy) for presumed carbapenem-resistant GNIs. Quarterly percentage change (QPC) using modified Poisson regression and relative change in frequency of targeted ceftazidime-avibactam to colistin encounters was calculated. Factors associated with preferentially receiving targeted ceftazidime-avibactam versus colistin were identified using generalized estimating equations.
RESULTS
Between 2015 quarter (q) 1 and 2017q4, ceftazidime-avibactam was administered 21 215 times across 1901 encounters. Inpatient prescriptions for ceftazidime-avibactam increased from 0.44/10 000 hospitalizations in 2015q1 to 7.7/10 000 in 2017q4 (QPC, +11%; 95% CI, 10-13%; P < .01), while conversely colistin prescriptions decreased quarterly by 5% (95% CI, 4-6%; P < .01). Ceftazidime-avibactam therapy was categorized as empiric 25% of the time, targeted 65% of the time, and indeterminate 10% of the time. Patients with chronic kidney disease were twice as likely to receive targeted ceftazidime-avibactam versus colistin (RR, 2.02; 95% CI, 1.82-2.25), whereas those on dialysis were less likely to receive ceftazidime-avibactam than colistin (RR, 0.71; 95% CI, .61-.83).
CONCLUSIONS
Since approval in 2015, ceftazidime-avibactam use has grown for presumed carbapenem-resistant GNIs, while colistin has correspondingly declined. Renal function drove the choice between ceftazidime-avibactam and colistin as targeted therapy.
背景
头孢他啶-阿维巴坦对一些耐碳青霉烯类革兰氏阴性菌感染（GNIs）具有体外活性，因此可能是多粘菌素等毒性更大的抗生素的有用替代品。了解头孢他啶-阿维巴坦的摄取和使用模式将为医院处方、管理和抗生素开发提供信息。
方法
一项回顾性队列研究评估了 Vizient 数据库中的住院患者。头孢他啶-阿维巴坦和多粘菌素的给药分为经验性治疗（3 天或更短的连续治疗，有资格排除）与目标治疗（≥4 天的连续治疗），用于疑似耐碳青霉烯类 GNIs。使用修正泊松回归计算每季度百分比变化（QPC）和目标治疗头孢他啶-阿维巴坦与多粘菌素治疗的频率相对变化。使用广义估计方程确定优先接受目标治疗头孢他啶-阿维巴坦与多粘菌素的相关因素。
结果
在 2015 年第 1 季度至 2017 年第 4 季度期间，1901 例患者中有 21215 次接受了头孢他啶-阿维巴坦治疗。住院患者的头孢他啶-阿维巴坦处方从 2015 年第 1 季度的每 10000 例住院患者 0.44 例增加到 2017 年第 4 季度的 7.7 例（QPC，+11%；95%CI，10-13%；P<.01），而多粘菌素处方则呈季度递减趋势，降幅为 5%（95%CI，4-6%；P<.01）。头孢他啶-阿维巴坦治疗被归类为经验性治疗的比例为 25%，目标治疗的比例为 65%，不确定的比例为 10%。患有慢性肾脏病的患者接受目标治疗头孢他啶-阿维巴坦的可能性是接受多粘菌素的两倍（RR，2.02；95%CI，1.82-2.25），而接受透析治疗的患者接受头孢他啶-阿维巴坦治疗的可能性低于多粘菌素（RR，0.71；95%CI，0.61-0.83）。
结论
自 2015 年批准以来，头孢他啶-阿维巴坦的使用量一直在增加，用于治疗疑似耐碳青霉烯类 GNIs，而多粘菌素的使用量则相应减少。肾功能是头孢他啶-阿维巴坦和多粘菌素作为目标治疗选择的决定因素。
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