Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia
Few studies have evaluated the efficacy of ceftazidime–avibactam (CA) for <i>Klebsiella pneumoniae</i> carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Microorganisms |
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| Online Access: | https://www.mdpi.com/2076-2607/12/1/195 |
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| author | Fabián Herrera Diego Torres Ana Laborde Rosana Jordán Noelia Mañez Lorena Berruezo Sandra Lambert Nadia Suchowiercha Patricia Costantini Andrea Nenna María Laura Pereyra José Benso María Luz González Ibañez María José Eusebio Laura Barcán Nadia Baldoni Lucas Tula Inés Roccia Rossi Martín Luck Vanesa Soto Verónica Fernández Alberto Ángel Carena |
| author_facet | Fabián Herrera Diego Torres Ana Laborde Rosana Jordán Noelia Mañez Lorena Berruezo Sandra Lambert Nadia Suchowiercha Patricia Costantini Andrea Nenna María Laura Pereyra José Benso María Luz González Ibañez María José Eusebio Laura Barcán Nadia Baldoni Lucas Tula Inés Roccia Rossi Martín Luck Vanesa Soto Verónica Fernández Alberto Ángel Carena |
| author_sort | Fabián Herrera |
| collection | DOAJ |
| description | Few studies have evaluated the efficacy of ceftazidime–avibactam (CA) for <i>Klebsiella pneumoniae</i> 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). <i>Klebsiella</i> spp. (60.9%) and <i>Escherichia coli</i> (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 (<i>p</i> < 0.001). Thirty-day overall mortality in G1 vs. G2 vs. G3 was 22.2% vs. 53.8% vs. 11.9%, respectively (<i>p</i> < 0.001), and infection-related mortality was 5.5% vs. 51.9% vs. 7.7% (<i>p</i> < 0.001). The independent risk factors for mortality were Pitt score > 4: OR 3.63, 95% CI, 1.18–11.14 (<i>p</i> = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58–30.33 (<i>p</i> = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01–0.08 (<i>p</i> < 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. |
| first_indexed | 2024-03-08T09:49:40Z |
| format | Article |
| id | doaj.art-6416323d68d54a47b647356dafe13b89 |
| institution | Directory Open Access Journal |
| issn | 2076-2607 |
| language | English |
| last_indexed | 2024-03-08T09:49:40Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Microorganisms |
| spelling | doaj.art-6416323d68d54a47b647356dafe13b892024-01-29T14:06:56ZengMDPI AGMicroorganisms2076-26072024-01-0112119510.3390/microorganisms12010195Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales BacteremiaFabián Herrera0Diego Torres1Ana Laborde2Rosana Jordán3Noelia Mañez4Lorena Berruezo5Sandra Lambert6Nadia Suchowiercha7Patricia Costantini8Andrea Nenna9María Laura Pereyra10José Benso11María Luz González Ibañez12María José Eusebio13Laura Barcán14Nadia Baldoni15Lucas Tula16Inés Roccia Rossi17Martín Luck18Vanesa Soto19Verónica Fernández20Alberto Ángel Carena21Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaFundación para Combatir la Leucemia, Buenos Aires C1114, ArgentinaInfectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, ArgentinaInfectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, ArgentinaInfectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, ArgentinaInfectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, ArgentinaInfectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, ArgentinaInfectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, ArgentinaInfectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, ArgentinaInfectious Diseases Service, Hospital Universitario Austral, Buenos Aires B1629, ArgentinaInfectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, ArgentinaFundación para Combatir la Leucemia, Buenos Aires C1114, ArgentinaInfectious Diseases Service, Hospital Británico de Buenos Aires, Buenos Aires C1280, ArgentinaInfectious Diseases Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, ArgentinaInfectious Diseases Service, Hospital HIGA Rodolfo Rossi, La Plata B1902, ArgentinaInfectious Diseases Service, Hospital El Cruce, Buenos Aires B1888, ArgentinaInfectious Diseases Service, Hospital HIGA Gral. San Martín, La Plata B1900, ArgentinaInfectious Diseases Service, Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, ArgentinaInfectious Diseases Service, Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, ArgentinaInfectious Diseases Section, Internal Medicine Department, Hospital Italiano de San Justo, Buenos Aires C1198, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaFew studies have evaluated the efficacy of ceftazidime–avibactam (CA) for <i>Klebsiella pneumoniae</i> 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). <i>Klebsiella</i> spp. (60.9%) and <i>Escherichia coli</i> (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 (<i>p</i> < 0.001). Thirty-day overall mortality in G1 vs. G2 vs. G3 was 22.2% vs. 53.8% vs. 11.9%, respectively (<i>p</i> < 0.001), and infection-related mortality was 5.5% vs. 51.9% vs. 7.7% (<i>p</i> < 0.001). The independent risk factors for mortality were Pitt score > 4: OR 3.63, 95% CI, 1.18–11.14 (<i>p</i> = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58–30.33 (<i>p</i> = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01–0.08 (<i>p</i> < 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.https://www.mdpi.com/2076-2607/12/1/195ceftazidime–avibactamKPC-producingbacteremianeutropenia |
| spellingShingle | Fabián Herrera Diego Torres Ana Laborde Rosana Jordán Noelia Mañez Lorena Berruezo Sandra Lambert Nadia Suchowiercha Patricia Costantini Andrea Nenna María Laura Pereyra José Benso María Luz González Ibañez María José Eusebio Laura Barcán Nadia Baldoni Lucas Tula Inés Roccia Rossi Martín Luck Vanesa Soto Verónica Fernández Alberto Ángel Carena Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia Microorganisms ceftazidime–avibactam KPC-producing bacteremia neutropenia |
| title | Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia |
| title_full | Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia |
| title_fullStr | Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia |
| title_full_unstemmed | Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia |
| title_short | Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia |
| title_sort | ceftazidime avibactam improves outcomes in high risk neutropenic patients with i klebsiella pneumoniae i carbapenemase producing enterobacterales bacteremia |
| topic | ceftazidime–avibactam KPC-producing bacteremia neutropenia |
| url | https://www.mdpi.com/2076-2607/12/1/195 |
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