Ceftazidime-avibactam-based combination therapy for hospital-acquired central nervous system infections caused by carbapenem-resistant Klebsiella pneumoniae

Xiaoyu Zhao; Shirong Li; Yixin Zhang; Jue Wang; Chuning Wang; Xiaohua Qin; Fupin Hu; Minggui Wang

doi:10.1016/j.ijantimicag.2023.106777

Ceftazidime-avibactam-based combination therapy for hospital-acquired central nervous system infections caused by carbapenem-resistant Klebsiella pneumoniae

Int J Antimicrob Agents. 2023 May;61(5):106777. doi: 10.1016/j.ijantimicag.2023.106777. Epub 2023 Mar 9.

Authors

Xiaoyu Zhao¹, Shirong Li², Yixin Zhang¹, Jue Wang¹, Chuning Wang¹, Xiaohua Qin¹, Fupin Hu¹, Minggui Wang³

Affiliations

¹ Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission, Shanghai, China; Institute of Microbes and Infections, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China.
³ Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission, Shanghai, China; Institute of Microbes and Infections, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: mgwang@fudan.edu.cn.

PMID: 36905946
DOI: 10.1016/j.ijantimicag.2023.106777

Abstract

Objectives: Klebsiella pneumoniae (K. pneumoniae) is one of the most common bacteria in the hospital-acquired central nervous system (CNS) infections. Central nervous system infections caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with significant mortality rates and high hospital costs due to limited antibiotic treatment options. This retrospective study aimed to evaluate the clinical efficacy of ceftazidime-avibactam (CZA) for the treatment of CNS infections caused by CRKP.

Methods: Twenty-one patients with hospital-acquired CNS infections caused by CRKP who received treatment with CZA for ≥ 72 hours were enrolled. The primary outcome was to assess the clinical and microbiology efficacy of CZA for the treatment of CNS infections caused by CRKP.

Results: A high burden of comorbidity was discovered in 20 of 21 patients (95.2%). Most patients had a history of craniocerebral surgery and 17 (81.0%) of the patients were in the intensive care unit with a median APACHE II score of 16 (IQR 9-20) and SOFA score of 6 (IQR 3-7). Eighteen cases were treated by CZA-based combination therapies, while the remaining three cases were treated with CZA alone. At the end of the treatment, the overall clinical efficacy was 76.2% (16 of 21) with a bacterial clearance rate of 81.0% (17 of 21) and all-cause mortality of 23.8% (five of 21).

Conclusion: This study showed that CZA-based combination therapy is an effective treatment option for CNS infections caused by CRKP.

Keywords: Carbapenem-resistant Klebsiella pneumoniae; Ceftazidime-avibactam; Central nervous system infection; Clinical efficacy.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Azabicyclo Compounds / therapeutic use
Carbapenem-Resistant Enterobacteriaceae*
Carbapenems / therapeutic use
Ceftazidime / therapeutic use
Central Nervous System Infections* / drug therapy
Drug Combinations
Hospitals
Humans
Klebsiella Infections* / microbiology
Klebsiella pneumoniae
Microbial Sensitivity Tests
Retrospective Studies

Substances

avibactam, ceftazidime drug combination
Ceftazidime
Anti-Bacterial Agents
Azabicyclo Compounds
Drug Combinations
Carbapenems