头孢他啶-阿维巴坦用于儿童疑似或确诊耐碳青霉烯类微生物感染的回顾性研究。
Use of Ceftazidime-Avibactam for Suspected or Confirmed Carbapenem-Resistant Organisms in Children: A Retrospective Study.
作者信息
Meng Haiyang, Zhao Yongmei, An Qi, Zhu Baoling, Cao Zhe, Lu Jingli
机构信息
Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People's Republic of China.
出版信息
Infect Drug Resist. 2023 Sep 5;16:5815-5824. doi: 10.2147/IDR.S426326. eCollection 2023.
BACKGROUND
The incidence of carbapenem-resistant organism (CRO) infections is increasing in children. However, pediatric-specific treatment strategies present unique challenges. Ceftazidime/avibactam is a β-lactam/β-lactamase inhibitor combination, showing adequate efficiency against CRO isolates. However, clinical data on the efficacy of ceftazidime/avibactam in children are still lacking.
METHODS
This was a retrospective study of children (aged <18 years) infected with confirmed or suspected carbapenem-resistant pathogens and treated with ceftazidime-avibactam at the First Affiliated Hospital of Zhengzhou University between 2020 and 2022.
RESULTS
We identified 38 children aged 14 (5.0-16.3) years; 20 (52.6%) had hematologic malignancies. 25 children with confirmed CRO infections were administered ceftazidime-avibactam as targeted therapy. The median treatment was 10 (6.0-16.5) days. Among them, 24 had infections caused by carbapenem-resistant Enterobacterales (CRE) (18 carbapenem-resistant and six carbapenem-resistant species) and one with carbapenem-resistant strains. The source of infection was the bloodstream in 60.0% of the cases (15/25). The clinical response rate was 84.0% (21/25), and 30-day mortality rate was 20% (5/25). 13 children were administered ceftazidime-avibactam as empiric therapy for suspected infections. The median treatment was 8 (6.0-13.0) days. No deaths occurred and clinical response was achieved in 12 of the 13 patients (92.3%) who empirically treated with ceftazidime-avibactam.
CONCLUSION
Ceftazidime-avibactam is important for improving survival, and clinical response in children with infections caused by CRO.
背景
耐碳青霉烯类病原体（CRO）感染在儿童中的发病率正在上升。然而，针对儿科的治疗策略存在独特的挑战。头孢他啶/阿维巴坦是一种β-内酰胺/β-内酰胺酶抑制剂组合，对CRO分离株显示出足够的疗效。然而，关于头孢他啶/阿维巴坦在儿童中疗效的临床数据仍然缺乏。
方法
这是一项对2020年至2022年期间在郑州大学第一附属医院感染确诊或疑似耐碳青霉烯类病原体并接受头孢他啶-阿维巴坦治疗的18岁以下儿童进行的回顾性研究。
结果
我们确定了38名年龄为14（5.0 - 16.3）岁的儿童；20名（52.6%）患有血液系统恶性肿瘤。25名确诊CRO感染的儿童接受了头孢他啶-阿维巴坦作为靶向治疗。中位治疗时间为10（6.0 - 16.5）天。其中，24名由耐碳青霉烯类肠杆菌科细菌（CRE）引起感染（18种耐碳青霉烯类和6种耐碳青霉烯类菌种），1名由耐碳青霉烯类菌株引起感染。60.0%的病例（15/25）感染源为血流。临床缓解率为84.0%（21/25），30天死亡率为20%（5/25）。13名儿童接受了头孢他啶-阿维巴坦作为疑似感染的经验性治疗。中位治疗时间为8（6.0 - 13.0）天。在接受头孢他啶-阿维巴坦经验性治疗的13名患者中，无死亡发生，12名（92.3%）实现了临床缓解。
结论
头孢他啶-阿维巴坦对于提高CRO感染儿童的生存率和临床缓解率很重要。
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