Liu Chang-Wei, Chen Qiang, Ding Nan, Hu Li-Fen
Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China.
The Grade 3 Pharmaceutical Chemistry Laboratory of State Administration of Traditional Chinese Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, PR China.
Heliyon. 2024 Aug 3;10(16):e35757. doi: 10.1016/j.heliyon.2024.e35757. eCollection 2024 Aug 30.
This research focused on evaluating the clinical results of patients suffering from pneumonia caused by carbapenem-resistant (CRKP), who received treatment with either ceftazidime-avibactam (CZA) alone or in combination with other antibiotics. From January 2020 to December 2023, we retrospectively analyzed CRKP-related pneumonia patients treated in two Chinese tertiary hospitals. Mortality was measured at 14 and 30 days as the primary outcome. Secondary outcomes included the 14-day microbiological cure rate and the 14-day clinical cure rate. Factors contributing to clinical failure were evaluated via both univariate analysis and multivariate logistic regression. To account for confounding factors, propensity score matching (PSM) was utilized. Among the 195 patients with CRKP infections, 103 (52.8 %) received CZA combination therapy, and 92 (47.2 %) patients received CZA monotherapy. The combination therapy group exhibited superior clinical and microbiological cure rates compared to the monotherapy group, with a 14-day clinical cure rate of 60.1 % vs. 45.7 % ( = 0.042) and a 14-day microbiological cure rate of 72.8 % vs. 58.6 % ( = 0.038), respectively. Combination therapy reduced mortality rates at 14 days (7.8 % vs. 17.4 %, = 0.041), but not at 30 days (14.6 % vs. 25.0 %, = 0.066). Even after using PSM, the group treated with the CZA combination continued to had a lower mortality rate at 14 days (5.9 % vs. 17.6 %, = 0.039). The 14-day clinical cure rate for the combination therapy group was 63.2 %, and the 14-day microbial cure rate was 77.9 %. Both of these statistics were notably greater than those observed in the monotherapy group. Furthermore, the multivariate logistic regression model indicated a significant link between combination therapy and a decrease in clinical failure. Carbapenems were noted to be the most effective class of concomitant agents. Our findings indicate that patients with pneumonia due to CRKP benefit from combination treatment of CZA rather than monotherapy; administering carbapenem in combination with CZA in the early stages could provide considerable survival benefits.
本研究聚焦于评估耐碳青霉烯类肺炎克雷伯菌（CRKP）所致肺炎患者的临床疗效，这些患者接受了单独使用头孢他啶-阿维巴坦（CZA）或联合其他抗生素的治疗。2020年1月至2023年12月，我们回顾性分析了两家中国三级医院治疗的CRKP相关肺炎患者。将14天和30天的死亡率作为主要结局指标。次要结局指标包括14天微生物清除率和14天临床治愈率。通过单因素分析和多因素逻辑回归评估导致临床治疗失败的因素。为了考虑混杂因素，采用了倾向得分匹配（PSM）方法。在195例CRKP感染患者中，103例（52.8%）接受了CZA联合治疗，92例（47.2%）患者接受了CZA单药治疗。联合治疗组在临床和微生物清除率方面均优于单药治疗组，14天临床治愈率分别为60.1%和45.7%（P = 0.042），14天微生物清除率分别为72.8%和58.6%（P = 0.038）。联合治疗降低了14天的死亡率（7.8%对17.4%，P = 0.041），但30天死亡率未降低（14.6%对25.0%，P = 0.066）。即使使用PSM后，CZA联合治疗组在14天时的死亡率仍较低（5.9%对17.6%，P = 0.039）。联合治疗组的14天临床治愈率为63.2%，14天微生物清除率为77.9%。这两个统计数据均显著高于单药治疗组。此外，多因素逻辑回归模型表明联合治疗与临床治疗失败的减少之间存在显著关联。碳青霉烯类被认为是最有效的联合用药类别。我们的研究结果表明，CRKP所致肺炎患者从CZA联合治疗而非单药治疗中获益；早期联合使用碳青霉烯类与CZA可提供显著的生存益处。
