Pfäfflin Frieder, Theloe Anja, Stegemann Miriam Songa, Leistner Rasmus, Sander Leif Erik, Kurth Florian, Achterberg Stephan
Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Antimicrobial Stewardship, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Antibiotics (Basel). 2025 Jul 31;14(8):773. doi: 10.3390/antibiotics14080773.
: The World Health Organization has declared carbapenem-resistant organisms a research and development priority. Although ceftazidime-avibactam was approved around a decade ago, there is still a lack of prospective data on the treatment of resistant pathogens with this agent. : We conducted a prospective, observational, single-center, investigator-initiated study of patients treated with ceftazidime-avibactam for infections caused by carbapenem-resistant organisms. The primary outcome was clinical cure 14 days after the initiation of ceftazidime-avibactam treatment. Secondary outcomes, which were assessed on day 30, included microbiological failure, development of resistance, all-cause mortality, and length of stay in the intensive care unit. : A total of 50 patients were included in the study. At baseline, the median Charlson Comorbidity Index and Sequential Organ Failure Assessment Score were 5.5 and 7. Approximately three-quarters of the patients were treated in an intensive care unit and had undergone mechanical ventilation within the previous 7 days prior to the commencement of ceftazidime-avibactam treatment. Half of the patients were diagnosed with nosocomial pneumonia. Most infections were caused by (48%) and (28%). Clinical cure at day 14 was achieved in 59% of patients. Four deaths (9%) and two cases of microbiological failure (4%) were observed. The median length of stay in the intensive care unit was 14 days. There was no emergence of resistance to ceftazidime-avibactam. : Our study contributes to the growing body of evidence supporting the effectiveness of ceftazidime-avibactam in treating infections caused by carbapenem-resistant organisms. In this cohort of critically ill patients, our results in terms of both clinical success and survival are in the upper range compared to those from mainly retrospective and some prospective studies. Although the benefits of ceftazidime-avibactam have been demonstrated in this and other studies, it must be prescribed cautiously to ensure it remains effective.
世界卫生组织已将耐碳青霉烯类微生物列为研发重点。尽管头孢他啶-阿维巴坦大约在十年前就已获批，但关于用该药物治疗耐药病原体仍缺乏前瞻性数据。
我们开展了一项前瞻性、观察性、单中心、由研究者发起的研究，纳入了接受头孢他啶-阿维巴坦治疗耐碳青霉烯类微生物所致感染的患者。主要结局是头孢他啶-阿维巴坦治疗开始14天后的临床治愈情况。在第30天评估的次要结局包括微生物学治疗失败、耐药性产生、全因死亡率以及重症监护病房住院时间。
该研究共纳入50例患者。基线时，查尔森合并症指数中位数和序贯器官衰竭评估评分分别为5.5和7。约四分之三的患者在重症监护病房接受治疗，且在头孢他啶-阿维巴坦治疗开始前7天内接受过机械通气。一半患者被诊断为医院获得性肺炎。大多数感染由[具体病原体1]（48%）和[具体病原体2]（28%）引起。14天时59%的患者实现临床治愈。观察到4例死亡（9%）和2例微生物学治疗失败（4%）。重症监护病房住院时间中位数为14天。未出现对头孢他啶-阿维巴坦的耐药情况。
我们的研究为支持头孢他啶-阿维巴坦治疗耐碳青霉烯类微生物所致感染有效性的证据不断增加做出了贡献。在这组重症患者中，我们在临床成功和生存方面取得的结果与主要为回顾性研究以及一些前瞻性研究的结果相比处于较高水平。尽管在本研究及其他研究中已证明了头孢他啶-阿维巴坦的益处，但必须谨慎处方以确保其持续有效。
