Araujo da Silva André Ricardo, Quijada Rafael
Faculty of Medicine, Universidade Federal Fluminense, Niterói 24220-900, Brazil.
Prontobaby Group, Rio de Janeiro 20540-100, Brazil.
Children (Basel). 2024 May 29;11(6):664. doi: 10.3390/children11060664.
Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant gram-negative bacteria (CRB). Our aim was to describe the use of CAZ-AVI in children admitted to pediatric intensive care units (PICUs), with suspected or proven CRB infections.
A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included.
CAZ-AVI was used in 37 patients. The median age was 28 months (range 1-215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1-138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1-22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%.
Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.
头孢他啶-阿维巴坦（CAZ-AVI）是可用于治疗耐碳青霉烯革兰氏阴性菌（CRB）感染的新型抗生素之一。我们的目的是描述CAZ-AVI在疑似或确诊CRB感染的儿科重症监护病房（PICU）住院儿童中的使用情况。
2020年1月至2024年1月期间，在巴西里约热内卢的两个PICU进行了一项回顾性描述性研究。纳入接受CAZ-AVI治疗超过24小时的0至18岁儿童。
37例患者使用了CAZ-AVI。中位年龄为28个月（范围1-215个月），17例（45.9%）为男性。从患者入院到首次开具CAZ-AVI处方的中位时间为39.9天（范围1-138天）。34例（91.9%）儿童入院时至少有一种合并症，91.9%在开具CAZ-AVI处方前至少使用过一种侵入性装置，89.2%之前接受过碳青霉烯类治疗；15例（40.5%）在使用CAZ-AVI之前发生过医疗相关感染（HAI）。CAZ-AVI的平均使用时间为11天（范围1-22天）。在处方前24小时内或处方当天，12例（32.4%）患者的培养物中分离出革兰氏阴性菌。5例患者的培养物中确诊为CRB，其中4例（80%）在治疗7天后微生物清除得到证实。30天死亡率为37.8%。
几乎所有使用CAZ-AVI的患者都是患有多种合并症且之前使用过碳青霉烯类的重症儿童。在确诊的CRB感染中，7天内的微生物清除率较高。
