Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem-resistant Gram-negative bacilli infection

• Published in: BMC infectious diseases Vol. 23; no. 1; pp. 1 - 709
• Main Authors: Zheng, Zihao, Shao, Ziqiang, Lu, Lihai, Tang, Siyu, Shi, Kai, Gong, Fangxiao, Liu, Jingquan
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 20.10.2023; BioMed Central; BMC
• Subjects: Antibiotics; Bacteria; Bacterial infections; Bacterial pneumonia; Carbapenem-resistant Gram-negative bacilli; Carbapenems; Care and treatment; Caspofungin; Ceftazidime; Ceftazidime/avibactam; China; Colistin; Combination therapy; Data analysis; Diarrhea; Dosage and administration; Drug resistance; Drug resistance in microorganisms; Drug therapy; Electronic health records; Electronic medical records; Enrollments; Evaluation; Gram-negative bacilli; Health aspects; Hospitals; Imipenem; Infections; Inflammation; Klebsiella; Management; Medical records; Medical research; Medicine, Experimental; Microorganisms; Mortality; Pathogens; Patient safety; Patients; Pneumonia; Public health; Respiratory tract; Respiratory tract infection; Sepsis; Statistical analysis; Therapy; Urogenital system; Ventilators; China; United States > US; Europe
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08715-w

The rapid global emergence and spread of carbapenem-resistant Gram-negative bacilli (CR-GNB) is recognized as a major public health concern, and there are currently few effective treatments for CR-GNB infection. The aim of this study was to investigate the clinical characteristics and outcomes of patients with CR-GNB infections treated with ceftazidime/avibactam (CAZ/AVI) combined with colistin from October 2019 to February 2023 in China. A total of 31 patients with CR-GNB infections were retrospectively identified using the electronic medical record system of Zhejiang Provincial People's Hospital. Thirty-one patients were treated with CAZ/AVI combined with colistin. Respiratory tract infections (87%) were most common. The common drug-resistant bacteria encompass Klebsiella pneumonia (54.8%), Acinetobacter baumannii (29.0%), and Pseudomonas aeruginosa (16.1%). The 30-day mortality rate was 29.0%, and the 7-day microbial clearance rate was 64.5%. The inflammatory marker CRP changes, but not PCT and WBC, were statistically significant on days 7 and 14 after combination therapy. There were seven patients developing acute renal injury (AKI) after combination therapy and treating with continuous renal replacement therapy (CRRT). Two patients developed diarrhea. The combination of CAZ/AVI and colistin has potential efficacy in patients with CR-GNB infection, but more studies are needed to determine whether it can reduce 30-day mortality rates and increase 7-day microbial clearance. At the same time, the adverse reactions of combination therapy should not be ignored.