Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms
Por:
Temkin, E, Torre-Cisneros, J, Beovic, B, Benito, N, Giannella, M, Gilarranz, R, Jeremiah, C, Loeches, B, Machuca, I, Jimenez-Martin, MJ, Martinez, JA, Mora-Rillo, M, Navas, E, Osthoff, M, Pozo, JC, Ramos, JCR, Rodriguez, M, Sanchez-Garcia, M, Viale, P, Wolff, M, Carmeli, Y
Publicada:
1 feb 2017
Resumen:
Ceftazidime-avibactam (CAZ-AVI) is a recently approved beta-lactam-beta-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.
Filiaciones:
Temkin, E:
Tel Aviv Sourasky Med Ctr, Dept Epidemiol & Prevent Med, Tel Aviv, Israel
Torre-Cisneros, J:
Hosp Univ Reina Sofia, Dept Infect Dis, Cordoba, Spain
Univ Cordoba, Inst Maimonides Invest Biomed, Cordoba, Spain
Beovic, B:
Univ Med Ctr Ljubljana, Dept Infect Dis, Ljubljana, Slovenia
Benito, N:
Hosp Santa Creu & Sant Pau, Dept Med, Infect Dis Unit, Barcelona, Spain
Univ Autonoma Barcelona, Inst Invest Biomed St Pau, Barcelona, Spain
Giannella, M:
Univ Bologna, S Orsola Malpighi Hosp, Dept Med & Surg Sci, Infect Dis Unit, Bologna, Italy
Gilarranz, R:
Hosp Univ Gran Canaria Doctor Negrin, Dept Clin Microbiol, Las Palmas Gran Canaria, Spain
Jeremiah, C:
St Vincents Hosp, Dept Infect Dis, Melbourne, Vic, Australia
Loeches, B:
Hosp Univ La Paz IdiPAZ, Infect Dis Unit, Madrid, Spain
Machuca, I:
Hosp Univ Reina Sofia, Dept Infect Dis, Cordoba, Spain
Univ Cordoba, Inst Maimonides Invest Biomed, Cordoba, Spain
Jimenez-Martin, MJ:
Hosp Clin San Carlos, Crit Care Dept, Madrid, Spain
Martinez, JA:
Univ Barcelona, IDIBAPS, Hosp Clin, Dept Infect Dis, Barcelona, Spain
Mora-Rillo, M:
Hosp Univ La Paz IdiPAZ, Infect Dis Unit, Madrid, Spain
Navas, E:
Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain
Osthoff, M:
Univ Basel Hosp, Div Infect Dis & Hosp Epidemiol, Basel, Switzerland
Pozo, JC:
Hosp Univ Reina Sofia, Dept Crit Care Med, Cordoba, Spain
Ramos, JCR:
Hosp Univ La Paz IdiPAZ, Infect Dis Unit, Madrid, Spain
Rodriguez, M:
Hosp Univ Reina Sofia, Dept Crit Care Med, Cordoba, Spain
Sanchez-Garcia, M:
Hosp Clin San Carlos, Crit Care Dept, Madrid, Spain
Viale, P:
Alma Mater Studiorum Univ Bologna, Dept Med Surg Sci, Bologna, Italy
Wolff, M:
Ctr Hosp Univ Bichat Claude Bernard, AP HP, Paris, France
Univ Paris Diderot, Paris, France
Carmeli, Y:
Tel Aviv Sourasky Med Ctr, Dept Epidemiol & Prevent Med, Tel Aviv, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Green Published, Bronze
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