Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia.

BACKGROUND

Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP bacteremia.

METHODS

Patients with CZA-susceptible CRKP bacteremia who received CZA for a minimum of 5 days at our hospital from February 2020 to September 2023 were enrolled. The resistance mechanisms of the CRKP isolates were determined. Cox regression analysis was used to analyze the factors associated with 28-day mortality, and logistic regression was used to study 14-day clinical failure.

RESULTS

A total of 135 adults who received CZA for CRKP bacteremia were identified. Among the CRKP isolates, 85 (63.0 %) were KPC-2 producers and 17 (12.6 %) were OXA-48 producers. Monotherapy with CZA was identified in 98 cases (72.5 %). The 28-day mortality rate was 28.1 %, and the 14-day clinical failure rate was 41.5 %. In multivariate analysis, 28-day mortality was positively associated with older age, malignancy, and INCREMENT score ≥8. Charlson comorbidity index and the SOFA score were independent predictors of 14-day clinical failure. Among patients with SOFA score >6, malignancy was an independent risk factor for 28-day mortality, and early initiation of CZA therapy within 4 days was a protective factor against 28-day mortality.

CONCLUSION

Older age, malignancy, and INCREMENT score ≥8 are predictors for mortality in CZA-susceptible CRKP bacteremia treated with CZA. Early treatment with CZA is associated with survival in patients with high disease severity.