Ceftazidime-Avibactam Is Superior to Other Treatment Regimens against Carbapenem-Resistant Klebsiella pneumoniae Bacteremia

Ryan K Shields; M Hong Nguyen; Liang Chen; Ellen G Press; Brian A Potoski; Rachel V Marini; Yohei Doi; Barry N Kreiswirth; Cornelius J Clancy

doi:10.1128/AAC.00883-17

Ceftazidime-Avibactam Is Superior to Other Treatment Regimens against Carbapenem-Resistant Klebsiella pneumoniae Bacteremia

Antimicrob Agents Chemother. 2017 Jul 25;61(8):e00883-17. doi: 10.1128/AAC.00883-17. Print 2017 Aug.

Authors

Ryan K Shields^{1

2}, M Hong Nguyen^{3

2}, Liang Chen⁴, Ellen G Press¹, Brian A Potoski^{1

2

5}, Rachel V Marini², Yohei Doi^{1

2}, Barry N Kreiswirth⁴, Cornelius J Clancy^{1

6

7}

Affiliations

¹ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
² Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
³ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA mhn5@pitt.edu.
⁴ Public Health Research Institute Tuberculosis Center, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.
⁵ Department of Pharmacy & Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶ XDR Pathogen Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁷ VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.

Abstract

There are no data comparing outcomes of patients treated with ceftazidime-avibactam versus comparators for carbapenem-resistant Enterobacteriaceae infections. At our center, ceftazidime-avibactam treatment of carbapenem-resistant Klebsiella pneumoniae bacteremia was associated with higher rates of clinical success (P = 0.006) and survival (P = 0.01) than other regimens. Across treatment groups, there were no differences in underlying diseases, severity of illness, source of bacteremia, or strain characteristics (97% produced K. pneumoniae carbapenemase). Aminoglycoside- and colistin-containing regimens were associated with increased rates of nephrotoxicity (P = 0.002).

Keywords: Klebsiella pneumoniae; Klebsiella pneumoniae carbapenemase; bacteremia; carbapenem-resistant Enterobacteriaceae; ceftazidime-avibactam; clinical success.

MeSH terms

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Azabicyclo Compounds / therapeutic use*
Bacteremia / drug therapy*
Bacterial Proteins / metabolism
Carbapenem-Resistant Enterobacteriaceae / drug effects*
Carbapenems / therapeutic use
Ceftazidime / therapeutic use*
Drug Combinations
Drug Resistance, Multiple, Bacterial
Female
Humans
Klebsiella Infections / drug therapy*
Klebsiella Infections / microbiology
Klebsiella pneumoniae / drug effects*
Klebsiella pneumoniae / isolation & purification
Male
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Treatment Outcome
beta-Lactamase Inhibitors / therapeutic use*
beta-Lactamases / metabolism

Substances

Anti-Bacterial Agents
Azabicyclo Compounds
Bacterial Proteins
Carbapenems
Drug Combinations
avibactam, ceftazidime drug combination
beta-Lactamase Inhibitors
Ceftazidime
beta-Lactamases
carbapenemase

Abstract

MeSH terms

Substances

Grants and funding