Lin Jing, Zhang Li, Zhou Menglan, Tian Xiaotong, Chen Jialong, Lu Minya, Liu Zhengyin
Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Infect Dis Ther. 2023 Aug;12(8):2165-2177. doi: 10.1007/s40121-023-00852-8. Epub 2023 Sep 1.
This study aimed to evaluate the different efficacies between monotherapy and combination therapy with ceftazidime/avibactam (CAZ/AVI) in treating carbapenem-resistant Klebsiella pneumoniae (CRKP) infection.
We retrospectively analyzed observational multicenter data from 38 hospitals in China. Multivariate regression analysis was used to explore the association between combination therapy with CAZ/AVI and in-hospital mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to validate our findings.
A total of 132 eligible patients were divided into CAZ/AVI combination therapy (n = 43) and monotherapy (n = 89) cohorts. Multivariate logistic regression showed that there was no statistically significant relationship between combination therapy and a lower risk of in-hospital mortality [odds ratio (OR) 0.907, 95% confidence interval (CI) 0.329-2.498, p = 0.850]. In the subgroup of critical patients who were in the intensive care unit (ICU) (OR 0.943, 95% CI 0.221-4.033, p = 0.937) or with sequential organ failure assessment (SOFA) ≥ 3 (OR 0.733, 95% CI 0.191-2.808, p = 0.650), CAZ/AVI combination therapy was not a lower risk factor for in-hospital mortality. Moreover, in the subgroup of patients using CAZ/AVI plus tigecycline (accounting for 46.5% in the combination therapy) compared with CAZ/AVI monotherapy, there was no statistical difference between the two groups in in-hospital mortality, nor in the subgroup of patients with CRKP-associated pneumonia.
Combination therapy (or CAZ/AVI combined with tigecycline) and monotherapy with CAZ/AVI had similar prognoses in patients with only CRKP infection (or CRKP-associated pneumonia), as well as in critically ill patients. Larger randomized controlled trials are warranted to confirm these findings.
本研究旨在评估头孢他啶/阿维巴坦（CAZ/AVI）单药治疗与联合治疗在治疗耐碳青霉烯类肺炎克雷伯菌（CRKP）感染方面的不同疗效。
我们回顾性分析了来自中国38家医院的观察性多中心数据。采用多变量回归分析探讨CAZ/AVI联合治疗与院内死亡率之间的关联。进行倾向评分匹配（PSM）和治疗权重逆概率（IPTW）以验证我们的研究结果。
总共132例符合条件的患者被分为CAZ/AVI联合治疗组（n = 43）和单药治疗组（n = 89）。多变量逻辑回归显示，联合治疗与较低的院内死亡风险之间无统计学显著关系[比值比（OR）0.907，95%置信区间（CI）0.329 - 2.498，p = 0.850]。在重症监护病房（ICU）的重症患者亚组中（OR 0.943，95% CI 0.221 - 4.033，p = 0.937）或序贯器官衰竭评估（SOFA）≥3的患者亚组中（OR 0.733，95% CI 0.191 - 2.808，p = 0.650），CAZ/AVI联合治疗并非较低的院内死亡风险因素。此外，在使用CAZ/AVI加替加环素的患者亚组中（在联合治疗组中占46.5%）与CAZ/AVI单药治疗相比，两组在院内死亡率方面无统计学差异，在CRKP相关肺炎患者亚组中也无差异。
联合治疗（或CAZ/AVI联合替加环素）和CAZ/AVI单药治疗在仅患有CRKP感染（或CRKP相关肺炎）的患者以及重症患者中具有相似的预后。需要更大规模的随机对照试验来证实这些发现。
