Alqahtani Hajar, Alghamdi Ahlam, Alobaidallah Nouf, Alfayez Amal, Almousa Rawan, Albagli Rawan, Shamas Nour, Farahat Fayssal, Mahmoud Ebrahim, Bosaeed Mohammad, Abanamy Reem
Department of Pharmaceutical Care, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
JAC Antimicrob Resist. 2022 Oct 11;4(5):dlac104. doi: 10.1093/jacamr/dlac104. eCollection 2022 Oct.
Carbapenem-resistant Enterobacterales (CRE) is an urgent public health threat of significant global concern. Few observational studies have evaluated the clinical outcomes for treatment of CRE harbouring OXA-48 or NDM genes with ceftazidime/avibactam. Previous findings showed lower 30 day mortality with ceftazidime/avibactam ranges between 8.3% and 22%.
This single-centre retrospective cohort study included adult patients aged ≥18 years admitted to King Abdulaziz Medical City (KAMC) who had received ceftazidime/avibactam for at least 72 h for infections caused by CRE with genes encoding for carbapenemase production (CP-CRE).
A total of 211 patients, mostly male (57%), having CP-CRE infections treated with ceftazidime/avibactam were included, with an average age of 62 years. More than 50% of patients were critically ill, for which 46% received invasive ventilation and 36% were on inotropes. The most frequent infectious disease was hospital/ventilator-acquired pneumonia with being the most frequent causative pathogen. The majority of isolates harboured OXA-48 (81%), followed by NDM ± OXA-48 (19%). The overall clinical cure and 30 day mortality was 78% and 21% respectively (stratified per gene: 79% and 21.6% for OXA-48 and 75% and 17.5% for NDM ± OXA-48).
This was the largest study that evaluated clinical outcomes associate with CP-CRE harbouring OXA-48 gene infections treated with ceftazidime/avibactam. Clinical cure and 30 day mortality were consistent with those of previous studies. Findings suggested that combination therapy with ceftazidime/avibactam had no direct impact on clinical outcomes for CP-CRE with OXA-48.
耐碳青霉烯类肠杆菌科细菌（CRE）是一个引起全球重大关注的紧迫公共卫生威胁。很少有观察性研究评估用头孢他啶/阿维巴坦治疗携带OXA-48或NDM基因的CRE的临床结局。先前的研究结果显示，头孢他啶/阿维巴坦治疗的30天死亡率较低，在8.3%至22%之间。
这项单中心回顾性队列研究纳入了年龄≥18岁、入住阿卜杜勒阿齐兹国王医疗城（KAMC）、因产碳青霉烯酶的CRE（CP-CRE）感染接受头孢他啶/阿维巴坦治疗至少72小时的成年患者。
共纳入211例接受头孢他啶/阿维巴坦治疗CP-CRE感染的患者，大多数为男性（57%），平均年龄62岁。超过50%的患者病情危重，其中46%接受有创通气，36%使用血管活性药物。最常见的传染病是医院/呼吸机获得性肺炎，最常见的致病病原体是[此处原文缺失相关内容]。大多数分离株携带OXA-48（81%），其次是NDM±OXA-48（19%）。总体临床治愈率和30天死亡率分别为78%和21%（按基因分层：OXA-48为79%和21.6%，NDM±OXA-48为75%和17.5%）。
这是评估用头孢他啶/阿维巴坦治疗携带OXA-48基因的CP-CRE感染相关临床结局的最大规模研究。临床治愈率和30天死亡率与先前研究一致。研究结果表明，头孢他啶/阿维巴坦联合治疗对携带OXA-48的CP-CRE的临床结局没有直接影响。
