Efficacy of ceftazidime-avibactam in the treatment of carbapenem-resistant Klebsiella pneumoniae infections: Focus on solid organ transplantation recipients

• Published in: International journal of antimicrobial agents Vol. 63; no. 5; p. 107152
• Main Authors: Hu, Juan, Zha, Lei, Yu, Yong-Wei, Su, Qun, Fang, Xue-Ling, Ji, Jin-Ru, Shen, Ping, Chen, Yun-Bo, Zheng, Xia, Xiao, Yong-Hong
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2024
• Subjects: Carbapenem-resistance; Ceftazidime-avibactam; Retrospective cohort study; Severe infection; Solid organ transplantation; Severe infection; Solid organ transplantation; Ceftazidime-avibactam; Carbapenem-resistance; Retrospective cohort study
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2024.107152

•CAZ-AVI therapy is associated with a lower 30-day and 90-day mortality rate than those receiving other antibiotic regimens.•CAZ-AVI therapy is associated with a higher clinical improvement and microbiological cure rate than those receiving other antibiotic regimens.•The CAZ-AVI therapy is a promising option for treating infections in patients with or without SOT. Ceftazidime-avibactam (CAZ-AVI) is a new option to treat KPC- and OXA-48 carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. However, clinical evidence is limited regarding its use in treating CRKP infections, especially in solid organ transplantation (SOT) recipients. In this study, we assessed the efficacy of CAZ-AVI in treating CRKP infections in both the general population and the SOT recipients in comparison with other antibiotic regimens. This is a single-centre retrospective cohort study of patients admitted between January 1, 2018 and June 30, 2021 with the diagnosis of CRKP infections receiving either CAZ-AVI or other regimens ≥ 72 hours and clinical outcomes were analysed. Of 200 patients with CRKP infections, 67 received CAZ-AVI, 133 received other regimens, and 50 were SOT recipients. In the SOT cohort, 30 patients received CAZ-AVI, and 20 received other regimens. The overall 30-day mortality was 38% in the SOT cohort. Compared with patients receiving other regimens, CAZ-AVI therapy resulted in lower 30-day mortality (23.3% vs. 60%, P = 0.014) and 90-day mortality (35.7% vs. 86.7%, P = 0.003), higher clinical cure (93.3% vs. 40%, P < 0.001) and microbiological clearance. Similar promising results of CAZ-AVI were also shown in the whole population cohort. Moreover, clinical outcomes of SOT recipients receiving CAZ-AVI were not inferior to those without SOT. CAZ-AVI therapy was associated with better clinical outcomes in CRKP infections in both the general population and SOT recipients. Considering the limitations of the present study, well-conducted RCTs are still warranted to confirm these findings.