Dumlu Rıdvan, Şahin Meyha, Derin Okan, Gül Özlem, Başgönül Sedef, Zengin Rehile, Arabacı Çiğdem, Şimşek Funda, Gençer Serap, Kocagöz Ayşe Sesin, Mert Ali
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, 34214 Istanbul, Turkey.
Epidemiology Doctorate Program, Graduate School of Health Sciences, Istanbul Medipol University, 34815 Istanbul, Turkey.
Antibiotics (Basel). 2024 Oct 18;13(10):990. doi: 10.3390/antibiotics13100990.
: Ceftazidime-avibactam (CAZ-AVI) is recommended as first-line treatment for Oxacillinase-48 (OXA-48) β-Lactamase-producing carbapenem-resistant Enterobacterales (CRE) infections, while polymyxin-based combination therapies (PBCTs) are used as a last resort when CAZ-AVI is unavailable. Research comparing the effectiveness of CAZ-AVI and PBCT in CRE blood stream infections (CRE-BSIs) is limited, mostly focusing on carbapenemase (KPC)-producing isolates. In Turkey, OXA-48 is endemic and OXA-48-Like is common. Therefore, our study aimed to compare the impact of these treatments on 30-day mortality in patients with CRE-BSIs in endemic regions. : Retrospective data from January 2019 to May 2023 were collected from four tertiary healthcare centers in Istanbul. Demographic, clinical, and outcome data of ICU patients treated with CAZ-AVI monotherapy or PBCT for CRE-BSIs were analyzed. The effect on 30-day survival was evaluated using Cox regression analysis post propensity score matching (PSM). : Out of 151 patients, 44.4% (: 67) received CAZ-AVI and 55.6% (: 84) received PBCT. All-cause mortality rates were 20% (: 13) with CAZ-AVI and 36.9% (: 31) with PBCT. Cox regression analysis post PSM indicated CAZ-AVI monotherapy significantly reduced the mortality risk compared to PBCT (HR: 0.16, 95%CI: 0.07-0.37, < 0.001), while age increased the risk (HR: 1.02 per year, 95% CI 1.0-1.04, : 0.01). : In OXA-48-predominant areas, CAZ-AVI demonstrated significantly lower mortality in patients with CRE-BSIs compared to PBCT. The results were attributed to the pharmacokinetic and pharmacodynamic disadvantages of polymyxins compared to CAZ-AVI, and the impact of age-related physical conditions. Therefore, CAZ-AVI should be the preferred treatment for CRE-BSIs in OXA-48-endemic regions.
头孢他啶-阿维巴坦（CAZ-AVI）被推荐作为产奥克西西林酶-48（OXA-48）β-内酰胺酶的耐碳青霉烯类肠杆菌科细菌（CRE）感染的一线治疗药物，而当无法获得CAZ-AVI时，基于多粘菌素的联合疗法（PBCTs）被用作最后手段。比较CAZ-AVI和PBCT在CRE血流感染（CRE-BSIs）中的有效性的研究有限，主要集中在产碳青霉烯酶（KPC）的分离株上。在土耳其，OXA-48是地方性流行的，且OXA-48样菌株很常见。因此，我们的研究旨在比较这些治疗方法对地方性流行地区CRE-BSIs患者30天死亡率的影响。：从伊斯坦布尔的四个三级医疗中心收集了2019年1月至2023年5月的回顾性数据。分析了接受CAZ-AVI单药治疗或PBCT治疗CRE-BSIs的ICU患者的人口统计学、临床和结局数据。使用倾向得分匹配（PSM）后的Cox回归分析评估对30天生存的影响。：在151名患者中，44.4%（n = 67）接受了CAZ-AVI治疗，55.6%（n = 84）接受了PBCT治疗。CAZ-AVI治疗组的全因死亡率为20%（n = 13），PBCT治疗组为36.9%（n = 31）。PSM后的Cox回归分析表明，与PBCT相比，CAZ-AVI单药治疗显著降低了死亡风险（HR：0.16，95%CI：0.07 - 0.37，P < 0.001），而年龄增加了风险（HR：每年1.02，95%CI 1.0 - 1.04，P = 0.01）。：在以OXA-48为主的地区，与PBCT相比，CAZ-AVI在CRE-BSIs患者中显示出显著更低的死亡率。结果归因于与CAZ-AVI相比多粘菌素的药代动力学和药效学劣势，以及与年龄相关的身体状况的影响。因此，在OXA-48地方性流行地区，CAZ-AVI应是CRE-BSIs的首选治疗药物。
