학술논문
Ceftazidime-Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia.
Document Type
Academic Journal
Author
Herrera F; Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina.; Torres D; Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina.; Laborde A; Fundación para Combatir la Leucemia, Buenos Aires C1114, Argentina.; Jordán R; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina.; Mañez N; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina.; Berruezo L; Infectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina.; Lambert S; Infectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, Argentina.; Suchowiercha N; Infectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, Argentina.; Costantini P; Infectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina.; Nenna A; Infectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina.; Pereyra ML; Infectious Diseases Service, Hospital Universitario Austral, Buenos Aires B1629, Argentina.; Benso J; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, Argentina.; González Ibañez ML; Fundación para Combatir la Leucemia, Buenos Aires C1114, Argentina.; Eusebio MJ; Infectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina.; Barcán L; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina.; Baldoni N; Infectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina.; Tula L; Infectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, Argentina.; Roccia Rossi I; Infectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, Argentina.; Luck M; Infectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina.; Soto V; Infectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina.; Fernández V; Infectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, Argentina.; Carena AÁ; Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina.
Source
Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101625893 Publication Model: Electronic Cited Medium: Print ISSN: 2076-2607 (Print) Linking ISSN: 20762607 NLM ISO Abbreviation: Microorganisms Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2076-2607
Abstract
Few studies have evaluated the efficacy of ceftazidime-avibactam (CA) for Klebsiella pneumoniae carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients with multi-drug resistant Enterobacterales bacteremia. They were compared according to the resistance mechanism and definitive treatment provided: KPC-CPE treated with CA (G1), KPC-CPE treated with other antibiotics (G2), and patients with ESBL-producing Enterobacterales bacteremia who received appropriate definitive therapy (G3). Thirty-day mortality was evaluated using a logistic regression model, and survival was analyzed with Kaplan-Meier curves. A total of 238 patients were included: 18 (G1), 52 (G2), and 168 (G3). Klebsiella spp. (60.9%) and Escherichia coli (26.4%) were the Enterobacterales most frequently isolated, and 71% of the bacteremias had a clinical source. The resistance profile between G1 and G2 was colistin 35.3% vs. 36.5%, amikacin 16.7% vs. 40.4%, and tigeclycline 11.1% vs. 19.2%. The antibiotics prescribed in combination with G2 were carbapenems, colistin, amikacin, fosfomycin, tigecycline, and fluoroquinolones. Seven-day clinical response in G1 vs. G2 vs. G3 was 94.4% vs. 42.3% vs. 82.7%, respectively ( p < 0.001). Thirty-day overall mortality in G1 vs. G2 vs. G3 was 22.2% vs. 53.8% vs. 11.9%, respectively ( p < 0.001), and infection-related mortality was 5.5% vs. 51.9% vs. 7.7% ( p < 0.001). The independent risk factors for mortality were Pitt score > 4: OR 3.63, 95% CI, 1.18-11.14 ( p = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58-30.33 ( p = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01-0.08 ( p < 0.001). High-risk neutropenic patients with KPC-CPE treated with CA had an outcome similar to those treated for ESBL-producing Enterobacterales, with higher 7-day clinical response and lower overall and infection-related mortality than those treated with other antibiotics. In view of these data, CA may be considered the preferred therapeutic option for KPC-PEB in high-risk neutropenic patients.