比较头孢他啶/阿维巴坦与多粘菌素B治疗耐碳青霉烯类微生物感染的疗效：一项倾向评分匹配的回顾性队列研究。
Comparing ceftazidime/avibactam and polymyxin B for treating carbapenem-resistant organisms infections: A propensity score-matched retrospective cohort study.
作者信息
Liu Chunmei, Leng Bing, Xie Maoyu, Jiang Shuangyan, Guan Xiaoyan, Xu Jiahui, Guo Yuqing, Jiang Jinjiao, Zeng Juan
机构信息
Department of Clinical Laboratory, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, PR China.
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, PR China.
出版信息
Int J Antimicrob Agents. 2025 Mar;65(3):107418. doi: 10.1016/j.ijantimicag.2024.107418. Epub 2024 Dec 20.
BACKGROUND AND AIM
There are limited comparative studies of ceftazidime/avibactam (CAZ/AVI) vs. polymyxin B (PMB) for carbapenem-resistant organisms (CRO) infections. The aim of this study was to compare the efficacy and safety of CAZ/AVI and PMB in treating CRO infections.
METHODS
This single-centre, retrospective cohort study with propensity score-matching (PSM) involved adult patients with CRO infections. Patients who received the CAZ/AVI-based regimen were included in the cohort group; those prescribed with the PMB-based regimen were included in the control group. The primary outcome was 28-day all-cause mortality.
RESULTS
Among 298 eligible patients, 96 patients in each group were included in the PSM cohort. The CAZ/AVI group showed no improvement in 28-day or 14-day all-cause mortality, nor in 14-day clinical response, compared to the PMB group. However, the CAZ/AVI-based regimen was associated with higher 14-day clinical response rates than the PMB-based regimen in subgroups with carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections and monotherapy. The CAZ/AVI group achieved greater CRO eradication than the PMB group (crude odds ratio [OR], 1.658; 95% confidence interval [CI], 1.108-2.480; P = 0.014; adjusted OR, 1.718; 95% CI, 1.055-2.798; P = 0.030). This advantage in CRO eradication with CAZ/AVI was consistent in most subgroups, including septic shock, bloodstream infection and lower respiratory tract infection. The CAZ/AVI and PMB groups had comparable nephrotoxicity (crude OR, 0.577; 95% CI, 0.306-1.089; P = 0.090; adjusted OR, 0.741; 95% CI, 0.361-1.521; P = 0.414).
CONCLUSION
CAZ/AVI-based and PMB-based regimens demonstrated similar clinical efficacy and nephrotoxicity in treating CRO infections. However, CAZ/AVI was superior to PMB in CRO eradication and treating CRPA infections. CAZ/AVI monotherapy was more effective than PMB monotherapy for CRO infections.
TRIAL REGISTRATION
ChiCTR2300078790 prospectively registered on 19 Dec 2023 (https://www.chictr.org.cn).
背景与目的
针对碳青霉烯类耐药菌（CRO）感染，头孢他啶/阿维巴坦（CAZ/AVI）与多粘菌素B（PMB）的比较研究有限。本研究旨在比较CAZ/AVI和PMB治疗CRO感染的疗效和安全性。
方法
本单中心、倾向评分匹配（PSM）的回顾性队列研究纳入了患有CRO感染的成年患者。接受基于CAZ/AVI方案治疗的患者纳入队列组；接受基于PMB方案治疗的患者纳入对照组。主要结局为28天全因死亡率。
结果
在298例符合条件的患者中，每组96例患者被纳入PSM队列。与PMB组相比，CAZ/AVI组在28天或14天全因死亡率以及14天临床反应方面均无改善。然而，在碳青霉烯类耐药铜绿假单胞菌（CRPA）感染和单药治疗的亚组中，基于CAZ/AVI的方案比基于PMB的方案具有更高的14天临床反应率。CAZ/AVI组在根除CRO方面比PMB组更有效（粗比值比[OR]，1.658；95%置信区间[CI]，1.108 - 2.480；P = 0.014；调整后OR，1.718；95% CI，1.055 - 2.798；P = 0.030）。CAZ/AVI在根除CRO方面的这一优势在大多数亚组中是一致的，包括感染性休克、血流感染和下呼吸道感染。CAZ/AVI组和PMB组的肾毒性相当（粗OR，0.577；95% CI，0.306 - 1.089；P = 0.090；调整后OR，0.741；95% CI，0.
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