Almangour Thamer A, Ghonem Leen, Aljabri Ahmad, Alruwaili Alya, Al Musawa Mohammed, Damfu Nader, Almalki Mesfer S, Alattas Majda, Abed Hossam, Naeem Doaa, Almalki Nawaf, Alhifany Abdullah A
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia.
Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Infect Drug Resist. 2022 Jan 23;15:211-221. doi: 10.2147/IDR.S349004. eCollection 2022.
The aim of this study was to compare the safety and effectiveness of ceftazidime-avibactam (CAZ-AVI) to colistin-based regimen in the treatment of infections caused by carbapenem-resistant Enterobacterales (CRE).
This was a retrospective, multicenter, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Main study outcomes included in-hospital mortality, clinical cure at end of treatment, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to assess the independent impact of CAZ-AVI on the clinical outcome.
A total of 230 patients were included in this study: 149 patients received CAZ-AVI and 81 patients received colistin-based regimen. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31-4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.75; 95% CI, 1.28-5.91). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39-1.16) was lower in patients who received CAZ-AVI but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19-0.69) was significantly less common in patients who received CAZ-AVI.
CAZ-AVI is associated with higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treating these infections.
本研究旨在比较头孢他啶-阿维巴坦（CAZ-AVI）与基于黏菌素的治疗方案在治疗耐碳青霉烯类肠杆菌科细菌（CRE）感染方面的安全性和有效性。
这是一项回顾性、多中心、观察性队列研究，研究对象为接受CAZ-AVI或静脉注射黏菌素治疗CRE感染的住院患者。该研究在沙特阿拉伯的5家三级护理医院进行。主要研究结局包括院内死亡率、治疗结束时的临床治愈情况以及急性肾损伤（AKI）。进行单因素分析和多因素逻辑回归模型以评估CAZ-AVI对临床结局的独立影响。
本研究共纳入230例患者：149例患者接受CAZ-AVI治疗，81例患者接受基于黏菌素的治疗方案。接受CAZ-AVI治疗的患者临床治愈率（71%对52%；P = 0.004；OR，2.29；95%CI，1.31 - 4.01）显著更高。在调整两组之间的差异后，CAZ-AVI治疗与临床治愈独立相关（调整后OR，2.75；95%CI，1.28 - 5.91）。接受CAZ-AVI治疗的患者院内死亡率（35%对44%；P = 0.156；OR，0.67；95%CI，0.39 - 1.16）较低，但差异不显著。接受CAZ-AVI治疗的患者AKI发生率（15%对33%；P = 0.002；OR，0.37；95%CI，0.19 - 0.69）显著更低。
与黏菌素相比，CAZ-AVI的临床治愈率更高，AKI发生率更低。我们的研究结果支持在治疗这些感染时优先使用CAZ-AVI而非基于黏菌素的治疗方案。
