头孢他啶-阿维巴坦治疗耐碳青霉烯类肺炎克雷伯菌感染：头孢他啶-阿维巴坦治疗耐碳青霉烯类肺炎克雷伯菌感染。

Ceftazidime-avibactam in the treatment of infections from carbapenem-resistant Klebsiella pneumoniae: Ceftazidime-avibactam against CR-KP infections.

作者信息

Gu Jie, Xu Jie, Zuo Ting-Ting, Chen Yan-Bin

机构信息

Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, 899#, Pinghai Road, Suzhou, Jiangsu Province, 215000, China.

Center for Clinical Laboratory, The First Affiliated Hospital of Soochow University, 899#, Pinghai Road, Suzhou, Jiangsu Province, 215000, China.

出版信息

J Glob Antimicrob Resist. 2021 Sep;26:20-25. doi: 10.1016/j.jgar.2021.04.022. Epub 2021 May 18.

DOI:10.1016/j.jgar.2021.04.022

PMID:34020072

Abstract

OBJECTIVES

Clinical experience with ceftazidime-avibactam (CAZ-AVI) for the treatment of carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections is not well evaluated. The aim of this study was to assess its efficacy in a single-centre cohort of patients infected with CR-KP.

METHODS

We conducted a retrospective observational study of consecutive patients treated for >72 h with CAZ-AVI or other active antibiotics (OAAs) for CR-KP infections. The primary outcome was 30-d mortality. The secondary outcomes were 14-d clinical failure and 14-d microbiological failure. Multivariate regression and propensity score matching were used to evaluate the relationship between CAZ-AVI treatment and outcomes.

RESULTS

Ninety infections caused by CR-KP were documented in our study. Forty-two patients were treated with CAZ-AVI and 48 with OAAs. The crude 30-d mortality (8/42 vs. 22/48, P=0.007), 14-d clinical failure (14/42 vs. 24/48, P=0.046) and 14-d microbiological failure (11/42 vs. 15/48, P=0.034) were significantly lower in patients with CAZ-AVI treatment. The Kaplan-Meier survival curves of 30-d mortality confirmed the findings (logrank=0.004). In the multivariable models, the odds ratio (OR) of 30-d mortality (OR 0.23 95% CI 0.10-0.51, P<0.000), 14-d clinical failure (OR 0.37, 95% CI 0.14-0.95, P=0.039) and 14-d microbiological failure (OR 0.17, 95% CI 0.08-0.93, P=0.038) remain consistently significant. In the subgroup analysis, CAZ-AVI was associated with decreased 30-d mortality in the positive blood culture (OR 0.23, 95% CI 0.08-0.63, P=0.004), septic shock (OR 0.23, 95% CI 0.07-0.78, P=0.019), SOFA score (>5, OR 0.13, 95% CI 0.04-0.36, P<0.000), mechanical ventilation (OR 0.13, 95% CI 0.04-0.36, p<0.000) and Charlson comorbidity index (>3, OR 0.15, 95% CI 0.04-0.55, P=0.004). After propensity score matching, 29 cases from each group were well matched. The 30-d mortality remained significantly lower in the CAZ-AVI group (6/29 vs. 13/29, P=0.05).

CONCLUSION

CAZ-AVI may be a more valuable therapeutic option for severe CR-KP infections than for mild cases and further randomized controlled trials are needed to evaluate the efficacy.

摘要

目的

头孢他啶-阿维巴坦（CAZ-AVI）治疗耐碳青霉烯类肺炎克雷伯菌（CR-KP）感染的临床经验尚未得到充分评估。本研究的目的是评估其在单中心CR-KP感染患者队列中的疗效。

方法

我们对连续接受CAZ-AVI或其他活性抗生素（OAAs）治疗>72小时的CR-KP感染患者进行了回顾性观察研究。主要结局是30天死亡率。次要结局是14天临床失败和14天微生物学失败。采用多变量回归和倾向评分匹配来评估CAZ-AVI治疗与结局之间的关系。

结果

本研究记录了90例由CR-KP引起的感染。42例患者接受CAZ-AVI治疗，48例接受OAAs治疗。接受CAZ-AVI治疗的患者，其30天粗死亡率（8/42对22/48，P=0.007）、14天临床失败率（14/42对24/48，P=0.046）和14天微生物学失败率（11/42对15/48，P=0.034）显著更低。30天死亡率的Kaplan-Meier生存曲线证实了这一结果（对数秩检验=0.004）。在多变量模型中，30天死亡率的比值比（OR）（OR 0.23，95%CI 0.10-0.51，P<0.000）、14天临床失败率（OR 0.37，95%CI 0.14-0.95，P=0.039）和14天微生物学失败率（OR 0.17，95%CI 0.08-0.93，P=0.038）仍然具有显著意义。在亚组分析中，CAZ-AVI与血培养阳性患者30天死亡率降低相关（OR 0.23，95%CI 0.08-0.63，P=0.004）、感染性休克（OR 0.23，95%CI 0.07-0.78，P=0.019）、序贯器官衰竭评估（SOFA）评分（>5，OR 0.13，95%CI 0.04-0.36，P<0.000）、机械通气（OR 0.13，95%CI 0.04-0.36，P<0.000）和Charlson合并症指数（>3，OR 0.15，95%CI 0.04-0.55，P=0.004）。倾向评分匹配后，每组29例病例匹配良好。CAZ-AVI组的30天死亡率仍然显著更低（6/29对13/29，P=0.05）。