Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, "12 de Octubre" University Hospital, Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain.
Am J Transplant. 2023 Jul;23(7):1022-1034. doi: 10.1016/j.ajt.2023.03.011. Epub 2023 Apr 5.
We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.
我们旨在比较头孢他啶-阿维巴坦（CAZ-AVI）与最佳可用治疗（BAT）在碳青霉烯酶产生肺炎克雷伯菌（CPKP-BSI）引起的血流感染的实体器官移植（SOT）受者中的疗效。一项回顾性（2016-2021 年）观察性队列研究在 14 个 INCREMENT-SOT 中心进行（ClinicalTrials.gov 标识符：NCT02852902；特定抗生素和 MIC 值对实体器官移植中 ESBL 或碳青霉烯酶产生肠杆菌科血流感染结局的影响：一项观察性多国研究）。结果为 14 天和 30 天临床成功率（完全缓解归因表现、充分的源控制和阴性随访血培养）和 30 天全因死亡率。构建了多变量逻辑和 Cox 回归分析，以调整接受 CAZ-AVI 的倾向评分。在 210 例 CPKP-BSI 的 SOT 受者中，149 例接受了头孢他啶-阿维巴坦（66/149）或 BAT（83/149）的主动初始治疗。接受 CAZ-AVI 治疗的患者 14 天（80.7% vs 60.6%，P =.011）和 30 天（83.1% vs 60.6%，P =.004）临床成功率更高，30 天死亡率更低（13.25% vs 27.3%，P =.053）。在调整分析中，CAZ-AVI 增加了 14 天（调整后的优势比[aOR]，2.65；95%置信区间[CI]，1.03-6.84；P =.044）和 30 天临床成功率（aOR，3.14；95%CI，1.17-8.40；P =.023）的可能性。相比之下，CAZ-AVI 治疗与 30 天死亡率无关。在 CAZ-AVI 组中，联合治疗与更好的结局无关。总之，CAZ-AVI 可被视为 CPKP-BSI 实体器官移植受者的一线治疗药物。
