Background: Ceftazidime-avibactam (CAZ-AVI) has been approved in Europe for the treatment of complicated intra-abdominal and urinary tract infections, as well as hospital-acquired pneumonia, and for gram-negative infections with limited treatment options. CAZ-AVI displays in vitro activity against Klebsiella pneumoniae carbapenemase (KPC) enzyme producers, but clinical trial data on its efficacy in this setting are lacking. Methods: We retrospectively reviewed 138 cases of infections caused by KPC-producing K. pneumoniae (KPC-Kp) in adults who received CAZ-AVI in compassionate-use programs in Italy. Case features and outcomes were analyzed, and survival was then specifically explored in the large subcohort whose infections were bacteremic. Results: The 138 patients started CAZ-AVI salvage therapy after a first-line treatment (median, 7 days) with other antimicrobials. CAZ-AVI was administered with at least 1 other active antibiotic in 109 (78.9%) cases. Thirty days after infection onset, 47 (34.1%) of the 138 patients had died. Thirty-day mortality among the 104 patients with bacteremic KPC-Kp infections was significantly lower than that of a matched cohort whose KPC-Kp bacteremia had been treated with drugs other than CAZ-AVI (36.5% vs 55.8%, P = .005). Multivariate analysis of the 208 cases of KPC-Kp bacteremia identified septic shock, neutropenia, Charlson comorbidity index ≥3, and recent mechanical ventilation as independent predictors of mortality, whereas receipt of CAZ-AVI was the sole independent predictor of survival. Conclusions: CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia.
Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae / M. Tumbarello, E.M. Trecarichi, A. Corona, F.G. De Rosa, M. Bassetti, C. Mussini, F. Menichetti, C. Viscoli, C. Campoli, M. Venditti, A. De Gasperi, A. Mularoni, C. Tascini, G. Parruti, C. Pallotto, S. Sica, E. Concia, R. Cultrera, G. De Pascale, A. Capone, S. Antinori, S. Corcione, E. Righi, A.R. Losito, M. Digaetano, F. Amadori, D.R. Giacobbe, G. Ceccarelli, E. Mazza, F. Raffaelli, T. Spanu, R. Cauda, P. Viale. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 68:3(2019), pp. 355-364.
|Titolo:||Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae|
|Parole Chiave:||Microbiology (medical); Infectious Diseases|
|Settore Scientifico Disciplinare:||Settore MED/17 - Malattie Infettive|
|Data di pubblicazione:||2019|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/cid/ciy492|
|Appare nelle tipologie:||01 - Articolo su periodico|