Labé Pauline, Husain Maya, Parize Perrine, Grimaud Marion, Roy Charlotte, Ratiney Robert, Cohen Jérémie F, Lecuyer Hervé, Toubiana Julie
From the Department of General Pediatrics and Pediatric Infectious Diseases.
Department of Infectious Diseases and Tropical Medicine.
Pediatr Infect Dis J. 2025 Feb 18;44(7):630-636. doi: 10.1097/INF.0000000000004768.
Infections caused by drug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa , are emerging in pediatric hospitals. New ß-lactam/ß-lactamase inhibitor combinations exhibit activity against these pathogens; however, there is limited data regarding their use in pediatric populations.
The study aimed to describe the characteristics of ceftazidime-avibactam (CAZ/AVI) and ceftolozane-tazobactam (C/T) prescriptions in children and assess their appropriateness.
We retrospectively analyzed all CAZ/AVI or C/T prescriptions in children hospitalized in a French tertiary hospital between 2017 and 2022. All clinical, biological, and pharmacological data were collected prospectively as part of the antibiotic monitoring program set up by our antimicrobial stewardship (AMS) team.
In total, 50 CAZ/AVI and 25 C/T prescriptions were recorded, which concerned 21 and 20 patients, respectively. All patients had an underlying chronic condition. Most prescriptions originated from Pediatric Intensive Care Units and the Department of Pediatric Pulmonology and were mainly initiated for respiratory tract infections (n = 41/50, 82% of the CAZ/AVI prescriptions and n = 14/25, 56% of the C/T prescriptions). P. aeruginosa was the primary pathogen in documented infections for both CAZ/AVI and C/T prescriptions (n = 26/48, 54% and n = 16/19, 84%, respectively). Almost all prescriptions of CAZ/AVI and C/T were considered appropriate (n = 47/50, 94% for CAZ/AVI and n = 23/25, 92% for C/T, respectively) by the AMS team. Both CAZ/AVI and C/T treatments were well tolerated and resulted in clinical success in 33 (66%) and 19 (76%) cases, respectively.
Our study suggests that CAZ/AVI and C/T are reasonable treatment options for children infected with Gram-negative pathogens resistant to carbapenems.
耐药革兰氏阴性菌引起的感染，包括耐碳青霉烯类肠杆菌科细菌和铜绿假单胞菌，正在儿科医院中出现。新型β-内酰胺/β-内酰胺酶抑制剂组合对这些病原体具有活性；然而，关于它们在儿科人群中的使用数据有限。
本研究旨在描述儿童使用头孢他啶-阿维巴坦（CAZ/AVI）和头孢洛扎坦-他唑巴坦（C/T）的处方特征，并评估其合理性。
我们回顾性分析了2017年至2022年期间在一家法国三级医院住院的儿童的所有CAZ/AVI或C/T处方。所有临床、生物学和药理学数据均作为我们抗菌药物管理（AMS）团队设立的抗生素监测计划的一部分进行前瞻性收集。
共记录了50份CAZ/AVI处方和25份C/T处方，分别涉及21名和20名患者。所有患者都有潜在的慢性病。大多数处方来自儿科重症监护病房和儿科肺病科，主要用于治疗呼吸道感染（CAZ/AVI处方中有41份，占82%；C/T处方中有14份，占56%）。铜绿假单胞菌是CAZ/AVI和C/T处方记录感染中的主要病原体（分别为26/48，54%和16/19，84%）。AMS团队认为，几乎所有CAZ/AVI和C/T处方都是合适的（CAZ/AVI为47/50，94%；C/T为23/25，92%）。CAZ/AVI和C/T治疗耐受性良好，分别在33例（66%）和19例（76%）病例中取得了临床成功。
我们的研究表明，CAZ/AVI和C/T是治疗耐碳青霉烯类革兰氏阴性病原体感染儿童的合理治疗选择。
