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Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms

  • Temkin, Elizabeth Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  • Torre-Cisneros, Julian Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain
  • Beovic, Bojana Department of Infectious Disease, University Medical Center Ljubljana, Ljubljana, Slovenia
  • Benito, Natividad Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
  • Giannella, Maddalena Infectious Diseases Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
  • Gilarranz, Raúl Department of Clinical Microbiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
  • Jeremiah, Cameron Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia
  • Loeches, Belén Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
  • Machuca, Isabel Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain
  • Jiménez-Martín, María José Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain
  • Martínez, José Antonio Department of Infectious Diseases, Hospital Clínic, IDIBAPS, Barcelona University, Barcelona, Spain
  • Mora-Rillo, Marta Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
  • Navas, Enrique Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain
  • Osthoff, Michael Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
  • Pozo, Juan Carlos Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
  • Ramos Ramos, Juan Carlos Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
  • Rodriguez, Marina Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
  • Sánchez-García, Miguel Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain
  • Viale, Pierluigi Department of Medical Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
  • Wolff, Michel Université Paris Diderot, Paris, France
  • Carmeli, Yehuda Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • 2017-1-24
Published in:
  • Antimicrobial Agents and Chemotherapy. - American Society for Microbiology. - 2016, vol. 61, no. 2
Pharmacology (medical)
Pharmacology
Infectious Diseases
English ABSTRACT
Ceftazidime-avibactam (CAZ-AVI) is a recently approved β-lactam–β-lactamase inhibitor combination with the potential to treat serious infections caused by carbapenem-resistant organisms. Few patients with such infections were included in the CAZ-AVI clinical trials, and clinical experience is lacking. We present a case series of patients with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) or Pseudomonas aeruginosa (CRPa) who were treated with CAZ-AVI salvage therapy on a compassionate-use basis. Physicians who had prescribed CAZ-AVI completed a case report form. We used descriptive statistics to summarize patient characteristics and treatment outcomes. We used the Wilcoxon rank sum test and Fisher's exact test to compare patients by treatment outcome. The sample included 36 patients infected with CRE and two with CRPa. The most common infections were intra-abdominal. Physicians categorized 60.5% of patients as having life-threatening infections. All but two patients received other antibiotics before CAZ-AVI, for a median of 13 days. The median duration of CAZ-AVI treatment was 16 days. Twenty-five patients (65.8%) concurrently received other antibiotics to which their pathogen was nonresistant in vitro. Twenty-eight patients (73.7%, 95% confidence interval [CI], 56.9 to 86.6%) experienced clinical and/or microbiological cure. Five patients (20.8%) with documented microbiological cure died, whereas 10 patients (71.4%) with no documented microbiological cure died (P = 0.01). In three-quarters of cases, CAZ-AVI (alone or combined with other antibiotics) cured infections caused by carbapenem-resistant organisms, 95% of which had failed previous therapy. Microbiological cure was associated with improved survival. CAZ-AVI shows promising clinical results for infections for which treatment options are limited.
Language
  • English
Open access status
bronze
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https://sonar.ch/global/documents/2531
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