Ceftazidime-Avibactam for Carbapenem-Resistant Gram-Negative Bacteria Infections: A Real-World Experience in the ICU

Jiaxin Yu; Wei Zuo; Hongwei Fan; Jiayu Wu; Luyao Qiao; Benyu Yang; Wenxi Li; Yang Yang; Bo Zhang

doi:10.2147/IDR.S422545

Ceftazidime-Avibactam for Carbapenem-Resistant Gram-Negative Bacteria Infections: A Real-World Experience in the ICU

Infect Drug Resist. 2023 Sep 14:16:6209-6216. doi: 10.2147/IDR.S422545. eCollection 2023.

Authors

Jiaxin Yu^{1

2}, Wei Zuo^{1

2}, Hongwei Fan^{1

3}, Jiayu Wu^{1

2}, Luyao Qiao^{1

2

4}, Benyu Yang^{1

2

5}, Wenxi Li^{1

2

5}, Yang Yang^#^{1

2}, Bo Zhang^#^{1

2}

Affiliations

¹ Department of Pharmacy, Peking Union Medical College Hospital, Beijing, People's Republic of China.
² State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China.
³ Department of Infectious Medicine, Peking Union Medical College Hospital, Beijing, People's Republic of China.
⁴ Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
⁵ School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Ceftazidime-avibactam (C-A) is a treatment option for carbapenem-resistant gram-negative bacterial (CR-GNB) infections, but little is known regarding its suitability for the intensive care unit (ICU). The current study aimed to analyze use of C-A for critically ill patients, determine independent predictors of clinical outcome and mortality and explore routine dosages for patients in continuous renal replacement therapy (CRRT).

Patients and methods: A single-center, retrospective and observational study was conducted in critically ill patients receiving different C-A-based therapies for CR-GNB infections in a tertiary teaching hospital in Beijing, China. Demographic data, severity of infection, clinical outcomes and mortality were assessed. The primary and secondary outcome of this study was 90-day all-cause mortality and 14-day clinical response, respectively.

Results: A total of 43 patients with CR-GNB infection were enrolled, including 14 (32.6%) patients received C-A monotherapy. C-A monotherapy and combination with other agents did not affect 14-day clinical response or 90-day survival. All-cause mortality at 90-days was 39.5% (17/43). Multivariate Cox analysis showed that concomitant with bloodstream infection was independent risk factors for 90-day mortality and that the time to initiation of C-A and Acute Physiology and Chronic Health Evaluation (APACHE) score was independent predictors of 14-day clinical response. Five CRRT patients who received high-dose C-A therapy (>3.75 g/d) had prolonged survival compared with 5 who received low-dose C-A (<3.75 g/d, p = 0.03).

Conclusion: C-A was an effective therapy for severe CR-GNB infections and clinical response correlated with the time of C-A initiation. A dosage >3.75g/d C-A was associated with prolonged survival of CRRT patients. Randomized controlled trials or multicenter studies are needed to confirm these findings.

Keywords: carbapenem-resistant gram-negative bacteria; ceftazidime-avibactam; infections; intensive care unit; renal replacement therapy.

Grants and funding

This study was supported by the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-059).