Khoshdel Nahal, Noursalehigarakani Melina, Seghatoleslami Zahra Sadat, Hadavand Fahimeh, Eghbal Elaheh, Nasiri Mohammad Javad, Simula Elena, Ahmed Parnian, Sechi Leonardo Antonio
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
Department of Infectious Diseases, Islamic Azad University, Tehran Medical Branch, Tehran, Islamic Republic of Iran.
Eur J Clin Microbiol Infect Dis. 2025 Apr;44(4):767-778. doi: 10.1007/s10096-025-05044-5. Epub 2025 Jan 22.
Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections.
We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success.
A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02).
This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.
头孢他啶-阿维巴坦（CAZ-AVI）已成为治疗革兰氏阴性菌感染的一种有前景的选择，尤其是由对头孢他啶不敏感（NS）病原体引起的感染。本系统评价和荟萃分析旨在评估CAZ-AVI在这些具有挑战性的感染中的疗效和安全性。
我们系统检索了EMBASE、Cochrane CENTRAL和PubMed/Medline数据库，以获取截至2024年9月15日发表的研究。纳入评估CAZ-AVI治疗革兰氏阴性菌感染的随机对照试验（RCT）。进行荟萃分析以计算临床和微生物学成功的合并比值比（OR）。
通过数据库检索共识别出146项研究，最终纳入17项研究。在针对革兰氏阴性病原体的疗效研究中，与对照药物相比，CAZ-AVI的临床成功率无显著差异（合并OR：0.90，p = 0.22），微生物学成功率有非显著性增加（合并OR：1.20，p = 0.41）。相比之下，对于对头孢他啶不敏感的病原体，六项研究报告临床治愈率无显著差异（合并OR：0.77，p = 0.24），而四项研究表明微生物学治愈率有非显著性增加（合并OR：1.83，p < 0.02）。结论：本研究表明，CAZ-AVI是治疗革兰氏阴性菌感染（包括对头孢他啶不敏感的病原体）的可行选择。虽然它对这些耐药病原体显示出有前景的活性，但在总体分析中其临床和微生物学成功率与其他抗生素相当。然而，CAZ-AVI在管理耐药感染方面可能具有优势。这些发现强调了在治疗指南中考虑CAZ-AVI的必要性，并强调了抗生素管理计划对于优化其使用和预防耐药性的重要性。持续监测耐药模式和患者结局对于确保其长期疗效至关重要。
