Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin
ABSTRACT Although polymyxins are a suboptimal option for difficult-to-treat resistant infections, they are still preferred as the first-line treatment, especially in low- and middle-income countries. This study assesses the efficacy of ceftazidime-avibactam (CAZ-AVI) following polymyxin B failure in...
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American Society for Microbiology
2025-01-01
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| Series: | Microbiology Spectrum |
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| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.01770-24 |
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| author | Jingli Lu Yani Ma Zhe Cao Baoling Zhu Luna Fan Haiyang Meng |
| author_facet | Jingli Lu Yani Ma Zhe Cao Baoling Zhu Luna Fan Haiyang Meng |
| author_sort | Jingli Lu |
| collection | DOAJ |
| description | ABSTRACT Although polymyxins are a suboptimal option for difficult-to-treat resistant infections, they are still preferred as the first-line treatment, especially in low- and middle-income countries. This study assesses the efficacy of ceftazidime-avibactam (CAZ-AVI) following polymyxin B failure in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. We retrospectively reviewed cases of infections caused by CRKP in adults who received CAZ-AVI as salvage therapy. Clinical features and outcomes were described, and a logistic regression model was used to assess the risk factors associated with in-hospital crude mortality. One hundred and six patients were included in this study. The median age was 56 years. The most common infectious sites were lung. The patients received CAZ-AVI as salvage therapy for a median duration of 9 days following initial treatment with polymyxin B (median, 12.5 days). Also, 91 (85.8%) patients received CAZ-AVI combination therapy, and 34 (32.1%) patients received CAZ-AVI in combination with polymyxin B. The rate of in-hospital crude mortality was 25.5% (27/106), with the highest rate observed in patients treated with regimens containing polymyxin B (41.2%; 14/34). Therapeutic response was observed in 81 (76.4%) patients, with microbiological eradication achieved in 77.1% (74/96) of cases. Multivariable analysis identified that the length of intensive care unit stays, the sequential organ failure assessment (SOFA) score at CAZ-AVI withdrawal, and regimens containing polymyxin B were independently associated with in-hospital mortality, whereas the duration of CAZ-AVI treatment was independently associated with survival. CAZ-AVI salvage therapy demonstrated improved survival outcomes in patients who experienced failure with polymyxin B therapy.IMPORTANCEFor patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, published experience with salvage therapy is limited after the failure of polymyxin-based initial therapy. Here, we found that ceftazidime-avibactam salvage therapy for patients with CRKP infections offers benefit in mortality. |
| format | Article |
| id | doaj-art-4495363f39c34c21b931f4b827a33426 |
| institution | Kabale University |
| issn | 2165-0497 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | American Society for Microbiology |
| record_format | Article |
| series | Microbiology Spectrum |
| spelling | doaj-art-4495363f39c34c21b931f4b827a334262025-01-07T14:05:19ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972025-01-0113110.1128/spectrum.01770-24Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxinJingli Lu0Yani Ma1Zhe Cao2Baoling Zhu3Luna Fan4Haiyang Meng5Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Kunming Medical University, Kunming, ChinaDepartment of Pharmacy, Zhenping People’s Hospital, Zhenping, ChinaDepartment of Pharmacy, Xiangcheng Hospital of Chinese Medicine, Xiangcheng, ChinaDepartment of Pharmacy, Huanghe Science and Technology College Affiliated Hospital, Zhengzhou, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaABSTRACT Although polymyxins are a suboptimal option for difficult-to-treat resistant infections, they are still preferred as the first-line treatment, especially in low- and middle-income countries. This study assesses the efficacy of ceftazidime-avibactam (CAZ-AVI) following polymyxin B failure in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. We retrospectively reviewed cases of infections caused by CRKP in adults who received CAZ-AVI as salvage therapy. Clinical features and outcomes were described, and a logistic regression model was used to assess the risk factors associated with in-hospital crude mortality. One hundred and six patients were included in this study. The median age was 56 years. The most common infectious sites were lung. The patients received CAZ-AVI as salvage therapy for a median duration of 9 days following initial treatment with polymyxin B (median, 12.5 days). Also, 91 (85.8%) patients received CAZ-AVI combination therapy, and 34 (32.1%) patients received CAZ-AVI in combination with polymyxin B. The rate of in-hospital crude mortality was 25.5% (27/106), with the highest rate observed in patients treated with regimens containing polymyxin B (41.2%; 14/34). Therapeutic response was observed in 81 (76.4%) patients, with microbiological eradication achieved in 77.1% (74/96) of cases. Multivariable analysis identified that the length of intensive care unit stays, the sequential organ failure assessment (SOFA) score at CAZ-AVI withdrawal, and regimens containing polymyxin B were independently associated with in-hospital mortality, whereas the duration of CAZ-AVI treatment was independently associated with survival. CAZ-AVI salvage therapy demonstrated improved survival outcomes in patients who experienced failure with polymyxin B therapy.IMPORTANCEFor patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, published experience with salvage therapy is limited after the failure of polymyxin-based initial therapy. Here, we found that ceftazidime-avibactam salvage therapy for patients with CRKP infections offers benefit in mortality.https://journals.asm.org/doi/10.1128/spectrum.01770-24ceftazidime-avibactampolymyxin Bcarbapenem-resistant Enterobacteriaceaesalvage therapy |
| spellingShingle | Jingli Lu Yani Ma Zhe Cao Baoling Zhu Luna Fan Haiyang Meng Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin Microbiology Spectrum ceftazidime-avibactam polymyxin B carbapenem-resistant Enterobacteriaceae salvage therapy |
| title | Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin |
| title_full | Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin |
| title_fullStr | Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin |
| title_full_unstemmed | Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin |
| title_short | Efficacy of ceftazidime-avibactam with or without polymyxin for carbapenem-resistant Klebsiella pneumoniae infections after initial treatment with polymyxin |
| title_sort | efficacy of ceftazidime avibactam with or without polymyxin for carbapenem resistant klebsiella pneumoniae infections after initial treatment with polymyxin |
| topic | ceftazidime-avibactam polymyxin B carbapenem-resistant Enterobacteriaceae salvage therapy |
| url | https://journals.asm.org/doi/10.1128/spectrum.01770-24 |
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