University of Queensland, Faculty of Medicine, UQ Center for Clinical Research, Brisbane, Australia.
Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Antimicrob Agents Chemother. 2020 Dec 16;65(1). doi: 10.1128/AAC.01052-20.
Carbapenem-sparing regimens are needed for the treatment of infections caused by extended-spectrum-β-lactamase (ESBL)- and AmpC-producing members of the We sought to compare the clinical efficacy of ceftazidime/avibactam and carbapenems against ESBL- and AmpC-producing species. A systematic review and meta-analysis of randomized controlled trials comparing ceftazidime/avibactam with carbapenems for the treatment of ESBL- and AmpC-producing was conducted. Five randomized controlled trials (RCTs) with ESBL- and AmpC-specific outcome data were compiled. Of the 246 patients infected with an ESBL-producing microorganism in the ceftazidime/avibactam arm, 224 (91%) had a clinical response at test of cure (TOC), versus 240 of 271 (89%) patients in the carbapenem arm (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.97 to 1.08; = 0.45; = 0%). Clinical response rates for AmpC producers in the ceftazidime/avibactam and carbapenem arms were 32/40 (80%) and 37/42 (88%), respectively (RR, 0.91; 95% CI, 0.76 to 1.10; = 0.35; = 0%). Microbiological response and mortality rates were not reported specifically for ESBL/AmpC producers. Ceftazidime/avibactam may be a carbapenem-sparing option for the treatment of mild to moderate complicated urinary tract and intra-abdominal infections caused by ESBL-producing species, and the data are too limited to provide any conclusive recommendations for the AmpC producers. Care should be taken before extrapolating this to severe infections, given that the representation of this population in the reviewed studies was negligible. Ceftazidime/avibactam is a costly drug active against carbapenem-resistant microorganisms and should be used judiciously to preserve its activity against them.
碳青霉烯节约方案用于治疗产超广谱β-内酰胺酶（ESBL）和产 AmpC 酶的 我们旨在比较头孢他啶/阿维巴坦和碳青霉烯类药物治疗产 ESBL 和产 AmpC 的 种的临床疗效。对比较头孢他啶/阿维巴坦与碳青霉烯类药物治疗产 ESBL 和产 AmpC 的 种的随机对照试验进行了系统评价和荟萃分析。编译了五篇具有 ESBL 和 AmpC 特异性结局数据的随机对照试验。在头孢他啶/阿维巴坦组中，246 例感染产 ESBL 微生物的患者中，224 例（91%）在治愈测试（TOC）时具有临床反应，而在碳青霉烯组中，271 例（89%）患者中有 240 例（风险比[RR]，1.02；95%置信区间[CI]，0.97 至 1.08； = 0.45； = 0%）。头孢他啶/阿维巴坦组和碳青霉烯组产 AmpC 患者的临床反应率分别为 32/40（80%）和 37/42（88%）（RR，0.91；95%CI，0.76 至 1.10； = 0.35； = 0%）。未专门报告 ESBL/AmpC 产者的微生物学反应和死亡率。头孢他啶/阿维巴坦可能是治疗产 ESBL 微生物引起的轻度至中度复杂尿路感染和腹腔内感染的碳青霉烯节约选择，鉴于纳入研究中该人群的代表性微不足道，因此尚无任何结论性建议。鉴于该药物对碳青霉烯类耐药微生物具有活性且价格昂贵，在将其推广用于严重感染时应谨慎，以保持其对这些微生物的活性。
