Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA.
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.
Int J Antimicrob Agents. 2024 Nov;64(5):107321. doi: 10.1016/j.ijantimicag.2024.107321. Epub 2024 Sep 5.
Ceftazidime/avibactam is one of the preferred treatment options for carbapenem-resistant Enterobacterales (CRE). However, the benefit of combining ceftazidime/avibactam with another antibiotic remains unclear.
To identify variables associated with treatment failure during the use of ceftazidime/avibactam for CRE infections and assess the effect of combining an aminoglycoside with ceftazidime/avibactam.
This was a retrospective cohort study of patients with a positive CRE culture treated with ceftazidime/avibactam between 2015 and 2021 in 134 Veterans Affairs (VA) facilities. The primary outcome was 30-day mortality and the secondary outcome was in-hospital mortality. A subanalysis in patients who received an aminoglycoside was also performed.
A total of 303 patients were included. The overall 30-day and in-hospital mortality rates were 12.5% and 24.1%, respectively. Age (aOR 1.052, 95% CI 1.013-1.093), presence in the ICU (aOR 2.704, 95% CI 1.071-6.830), and receipt of an aminoglycoside prior to initiation of ceftazidime/avibactam (aOR 4.512, 95% CI 1.797-11.327) were independently associated with 30-day mortality. In the subgroup of patients that received an aminoglycoside (n = 77), their use in combination with ceftazidime/avibactam had a 30-day mortality aOR of 0.321 (95% CI, 0.089-1.155).
In veterans treated with ceftazidime/avibactam for CRE infections, increased age, receipt of an empiric aminoglycoside, and presence in the ICU at the time of index culture were associated with higher 30-day mortality. Among patients who received an aminoglycoside, their use in combination with ceftazidime/avibactam trended toward protectiveness of 30-day mortality, suggesting a potential role for this combination to treat CRE infections in patients who are more severely ill.
头孢他啶/阿维巴坦是治疗碳青霉烯类耐药肠杆菌科（CRE）感染的首选治疗方案之一。然而，联合使用头孢他啶/阿维巴坦和另一种抗生素的益处仍不清楚。
确定与使用头孢他啶/阿维巴坦治疗 CRE 感染时治疗失败相关的变量，并评估联合使用氨基糖苷类药物与头孢他啶/阿维巴坦的效果。
这是一项回顾性队列研究，纳入了 2015 年至 2021 年期间在 134 家退伍军人事务部（VA）机构中接受头孢他啶/阿维巴坦治疗的 CRE 阳性培养患者。主要结局为 30 天死亡率，次要结局为住院死亡率。还对接受氨基糖苷类药物的患者进行了亚分析。
共纳入 303 例患者。总的 30 天和住院死亡率分别为 12.5%和 24.1%。年龄（aOR 1.052，95%CI 1.013-1.093）、入住 ICU（aOR 2.704，95%CI 1.071-6.830）和在开始使用头孢他啶/阿维巴坦之前接受氨基糖苷类药物（aOR 4.512，95%CI 1.797-11.327）与 30 天死亡率独立相关。在接受氨基糖苷类药物治疗的患者亚组（n=77）中，联合使用头孢他啶/阿维巴坦治疗的 30 天死亡率的 aOR 为 0.321（95%CI，0.089-1.155）。
在接受头孢他啶/阿维巴坦治疗 CRE 感染的退伍军人中，年龄增加、接受经验性氨基糖苷类药物治疗以及在进行指数培养时入住 ICU 与较高的 30 天死亡率相关。在接受氨基糖苷类药物治疗的患者中，联合使用头孢他啶/阿维巴坦治疗 30 天死亡率呈保护性趋势，这表明该联合方案可能对治疗病情较重的 CRE 感染患者具有潜在作用。
