Campogiani Laura, Vitale Pietro, Lodi Alessandra, Imeneo Alessandra, Fontana Carla, D'Agostini Cartesio, Compagno Mirko, Coppola Luigi, Spalliera Ilaria, Malagnino Vincenzo, Teti Elisabetta, Iannetta Marco, Andreoni Massimo, Sarmati Loredana
Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy.
Department of System Medicine, Tor Vergata University, 00133 Rome, Italy.
Antibiotics (Basel). 2023 Apr 27;12(5):820. doi: 10.3390/antibiotics12050820.
Ceftazidime/avibactam (CAZ-AVI) resistance amongst is worryingly increasing worldwide. The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant (KP) isolates in our University Hospital, with the ultimate goal of evaluating possible risk factors related to the acquisition of resistance. This is a retrospective observational study, including unique (KP) isolates resistant to CAZ-AVI (CAZ-AVI-R) and producing only KPC, collected from July 2019 to August 2021 at Policlinico Tor Vergata, Rome, Italy. The pathogen's list was obtained from the microbiology laboratory; clinical charts of the corresponding patients were reviewed to collect demographic and clinical data. Subjects treated as outpatients or hospitalized for <48 h were excluded. Patients were then divided into two groups: S group, if they had a prior isolate of CAZ-AVI-susceptible KP-KPC, and R group, if the first documented isolate of KP-KPC was resistant to CAZ-AVI. Forty-six unique isolates corresponding to 46 patients were included in the study. The majority of patients (60.9%) were hospitalized in an intensive care unit, 32.6% in internal medicine wards and 6.5% in surgical wards. A total of 15 (32.6%) isolates were collected from rectal swabs, representing a colonization. Amongst clinically relevant infections, pneumonia and urinary tract infections were the most commonly found (5/46, 10.9% each). Half of the patients received CAZ-AVI prior to isolation of the KP-KPC CAZ-AVI-R (23/46). This percentage was significantly higher in patients in the S group compared to patients in the R group (69.3% S group vs. 25% R group, = 0.003). No differences between the two groups were documented in the use of renal replacement therapy or in the infection site. The clinically relevant CAZ-AVI-R KP infections (22/46, 47.8%) were all treated with a combination therapy, 65% including colistin and 55% including CAZ-AVI, with an overall clinical success of 38.1%. Prior use of CAZ-AVI was associated with the emergence of drug resistance.
全球范围内，头孢他啶/阿维巴坦（CAZ-AVI）耐药性正令人担忧地不断增加。本研究的目的是收集并描述我们大学医院中耐CAZ-AVI的肺炎克雷伯菌（KP）分离株的实际数据，最终目标是评估与耐药性获得相关的可能风险因素。这是一项回顾性观察研究，纳入了2019年7月至2021年8月在意大利罗马托尔韦尔加塔综合医院收集的仅产KPC的耐CAZ-AVI（CAZ-AVI-R）的独特肺炎克雷伯菌（KP）分离株。病原体清单来自微生物实验室；查阅了相应患者的临床病历以收集人口统计学和临床数据。排除门诊治疗或住院时间<48小时的患者。然后将患者分为两组：S组，如果他们先前有CAZ-AVI敏感的KP-KPC分离株；R组，如果首次记录的KP-KPC分离株对CAZ-AVI耐药。本研究纳入了与46例患者对应的46株独特分离株。大多数患者（60.9%）在重症监护病房住院，32.6%在内科病房，6.5%在外科病房。总共15株（32.6%）分离株从直肠拭子中收集，代表定植。在临床相关感染中，肺炎和尿路感染最为常见（各占5/46，1）。一半的患者在分离出KP-KPC CAZ-AVI-R之前接受过CAZ-AVI治疗（23/46）。S组患者的这一比例显著高于R组患者（S组为69.3%，R组为25%，P = 0.003）。两组在使用肾脏替代疗法或感染部位方面未记录到差异。临床相关的CAZ-AVI-R KP感染（22/46，47.8%）均采用联合治疗，65%的联合治疗包括黏菌素，55%包括CAZ-AVI，总体临床成功率为38.1%。先前使用CAZ-AVI与耐药性的出现有关。 0.9%）。在分离出KP-KPC CAZ-AVI-R之前，一半的患者接受过CAZ-AVI治疗（23/46）。S组患者的这一比例显著高于R组患者（S组为69.3%，R组为25%，P = 0.003）。两组在使用肾脏替代疗法或感染部位方面未记录到差异。临床相关的CAZ-AVI-R KP感染（22/46，47.8%）均采用联合治疗，65%的联合治疗包括黏菌素，55%包括CAZ-AVI，总体临床成功率为38.1%。先前使用CAZ-AVI与耐药性的出现有关。
