Zhang Lingchun, Ma Yani, Zhao Chenglong, Zhao Shujuan, Zhao Lulu, Yang Yuxin, Wang Yuhan, Meng Haiyang, Sun Jun
Department of Pharmacy, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, People's Republic of China.
Department of Pharmacy, the First Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China.
Infect Drug Resist. 2024 Jan 25;17:239-248. doi: 10.2147/IDR.S445243. eCollection 2024.
Carbapenem-Resistant (CRKP) is a significant public health threat, because it is associated with substantial morbidity and mortality. However, the risk factors associated with treatment failure of ceftazidime-avibactam (CAZ-AVI) and the need for CAZ-AVI-based combination remain unclear.
We conducted a retrospective study of critically ill patients (age: > 18 years) diagnosed with CRKP infections and treated with CAZ-AVI for at least 24 h between June 2020 and December 2022 at Henan Provincial People's Hospital.
This study included a total of 103 patients who received CAZ-AVI. Of these, 91 (88.3%) patients received the standard dosage of 2.5 g every q8h, while only 20 (19.4%) received monotherapy. The Kaplan-Meier curves showed that the all-cause 30-day mortality was significantly higher among patients who experienced septic shock than those who did not. There was no significant difference in mortality between monotherapy and combination therapy. Dose reduction of CAZ-AVI was associated with a significantly increased mortality rate. Independent risk factors for the 30-day mortality included higher APACHE II score (HR: 1.084, 95% CI: 1.024-1.147, p = 0.005) and lower lymphocyte count (HR: 0.247, 95% CI: 0.093-0.655, p = 0.005). Conversely, a combination therapy regimen containing carbapenems was associated with lower mortality (HR: 0.273, 95% CI: 0.086-0.869, p = 0.028).
Our study suggests that CAZ-AVI provides clinical benefits in terms of survival and clinical response in critically ill patients with CRKP infection. A higher APACHE II score and lower lymphocyte count were associated with 30-day mortality, while the combination therapy regimen containing carbapenems was the only protective factor. CAZ-AVI dose reduction was associated with an increased mortality rate. Futher large-scale studies are needed to validate these findings.
耐碳青霉烯类肺炎克雷伯菌（CRKP）是对公众健康的重大威胁，因为它与高发病率和死亡率相关。然而，与头孢他啶-阿维巴坦（CAZ-AVI）治疗失败相关的危险因素以及基于CAZ-AVI联合治疗的必要性仍不明确。
我们对2020年6月至2022年12月期间在河南省人民医院诊断为CRKP感染并接受CAZ-AVI治疗至少24小时的重症患者（年龄>18岁）进行了一项回顾性研究。
本研究共纳入103例接受CAZ-AVI治疗的患者。其中，91例（88.3%）患者接受每8小时2.5g的标准剂量，而仅20例（19.4%）接受单药治疗。Kaplan-Meier曲线显示，发生感染性休克的患者全因30天死亡率显著高于未发生感染性休克的患者。单药治疗和联合治疗的死亡率无显著差异。CAZ-AVI剂量减少与死亡率显著增加相关。30天死亡率的独立危险因素包括较高的急性生理与慢性健康状况评分系统II（APACHE II）评分（HR：1.084，95%CI：1.024-1.147，p = 0.005）和较低的淋巴细胞计数（HR：0.247，95%CI：0.093-0.655，p = 0.005）。相反，含碳青霉烯类的联合治疗方案与较低的死亡率相关（HR：0.273，95%CI：0.086-0.869，p = 0.028）。
我们的研究表明，CAZ-AVI在CRKP感染的重症患者的生存和临床反应方面具有临床益处。较高的APACHE II评分和较低的淋巴细胞计数与30天死亡率相关，而含碳青霉烯类的联合治疗方案是唯一的保护因素。CAZ-AVI剂量减少与死亡率增加相关。需要进一步的大规模研究来验证这些发现。
