Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study
Objectives: Limited data on clinical and microbiological efficacy, patient mortality, and other associated factors are available for ceftazidime/avibactam (CAZ/AVI)-based regimens for carbapenem-resistant Gram-negative bacteria (CR-GNB). This study aimed to assess these issues retrospectively using...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-06-01
|
| Series: | Journal of Infection and Public Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S187603412300134X |
| _version_ | 1797829557280047104 |
|---|---|
| author | Hai-Hui Zhuang Ying Chen Qin Hu Wen-Ming Long Xiao-Li Wu Qin Wang Tian-Tian Xu Qiang Qu Yi-Ping Liu Yi-Wen Xiao Jian Qu |
| author_facet | Hai-Hui Zhuang Ying Chen Qin Hu Wen-Ming Long Xiao-Li Wu Qin Wang Tian-Tian Xu Qiang Qu Yi-Ping Liu Yi-Wen Xiao Jian Qu |
| author_sort | Hai-Hui Zhuang |
| collection | DOAJ |
| description | Objectives: Limited data on clinical and microbiological efficacy, patient mortality, and other associated factors are available for ceftazidime/avibactam (CAZ/AVI)-based regimens for carbapenem-resistant Gram-negative bacteria (CR-GNB). This study aimed to assess these issues retrospectively using multicenter data. Methods: This multicenter study included CR-GNB infected patients treated with CAZ/AVI-based regimens for more than three days. Patient characteristics, bacterial culture reports, drug-sensitivity test results, and antibiotic use, including CAZ/AVI use, were extracted from the patient's clinical records. The clinical and microbiological efficacy of the combined drug regimen and patient mortality were evaluated according to corresponding definitions. Univariate and multivariate logistic regressions were performed to explore the efficacy and mortality-related factors. Results: A total of 183 patients with CR-GNB infection were considered for the analysis according to the inclusion and exclusion criteria. After the treatment of CAZ/AVI-based regimens, the clinical efficacy was 75.4 %. The 7-day microbial efficacy and clearance rate after treatment were 43.7 % and 66.0 %, respectively. Moreover, 30-day all-cause and in-hospital mortality were 11.5 % and 14.2 %, respectively. Harboring renal dysfunction (creatinine clearance rate (CCR) of<20 mL/min), cardiovascular diseases, and digestive system diseases were independent risk factors for poor clinical efficacy of CAZ/AVI-based regimens. Bloodstream infection (BSI), patients with the adjusted doses of CAZ/AVI, and CAZ/AVI co-administration with carbapenem were independently associated factors of bacterial clearance by CAZ/AVI-based regimens. Age, total hospital stays, use of mechanical ventilation, and cumulative CAZ/AVI dose were independent factors associated with all-cause mortality. Conclusion: CAZ/AVI was an effective drug in treating CR-GNB infection. CAZ/AVI that is mostly excreted by the kidney and is accumulated in renal impairment should be renally adjusted. Renal dysfunction and the adjusted dose of CAZ/AVI were associated with efficacy. Clinicians should individualize CAZ/AVI regimen and dose by the level of renal function to achieve optimal efficacy and survival. The efficacy of CAZ/AVI in the treatment of CR-GNB infection, as well as the implementation of individualized precision drug administration of CAZ/AVI according to patients’ different infection sites, renal function, bacterial types, bacterial resistance mechanisms, blood concentration monitoring and other conditions need to be further studied in multicenter. |
| first_indexed | 2024-04-09T13:22:05Z |
| format | Article |
| id | doaj.art-74ba3a9cf19e4d7c86377fad7c9a878d |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-04-09T13:22:05Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-74ba3a9cf19e4d7c86377fad7c9a878d2023-05-11T04:23:41ZengElsevierJournal of Infection and Public Health1876-03412023-06-01166938947Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational studyHai-Hui Zhuang0Ying Chen1Qin Hu2Wen-Ming Long3Xiao-Li Wu4Qin Wang5Tian-Tian Xu6Qiang Qu7Yi-Ping Liu8Yi-Wen Xiao9Jian Qu10Department of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, ChinaDepartment of Pharmacy, Wuhan University, Renmin Hospital, Wuhan 430060, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410078, China; Institute of Hospital Management, Central South University, Changsha 410078, ChinaDepartment of Pharmacy, Jingzhou District, Second People’s Hospital of Huaihua City, Huaihua 418400, ChinaDepartment of Pharmacy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, ChinaDepartment of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang 330006, ChinaDepartment of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang 330006, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha 410078, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410078, China; Institute of Hospital Management, Central South University, Changsha 410078, ChinaDepartment of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, ChinaDepartment of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, ChinaDepartment of Pharmacy, the Second Xiangya Hospital, Central South University, Central South University, Changsha 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha 410011, China; Hunan key laboratory of the research and development of novel pharmaceutical preparations, Changsha Medical University, Changsha 410219, China; Corresponding author at: Department of Pharmacy, the Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, China.Objectives: Limited data on clinical and microbiological efficacy, patient mortality, and other associated factors are available for ceftazidime/avibactam (CAZ/AVI)-based regimens for carbapenem-resistant Gram-negative bacteria (CR-GNB). This study aimed to assess these issues retrospectively using multicenter data. Methods: This multicenter study included CR-GNB infected patients treated with CAZ/AVI-based regimens for more than three days. Patient characteristics, bacterial culture reports, drug-sensitivity test results, and antibiotic use, including CAZ/AVI use, were extracted from the patient's clinical records. The clinical and microbiological efficacy of the combined drug regimen and patient mortality were evaluated according to corresponding definitions. Univariate and multivariate logistic regressions were performed to explore the efficacy and mortality-related factors. Results: A total of 183 patients with CR-GNB infection were considered for the analysis according to the inclusion and exclusion criteria. After the treatment of CAZ/AVI-based regimens, the clinical efficacy was 75.4 %. The 7-day microbial efficacy and clearance rate after treatment were 43.7 % and 66.0 %, respectively. Moreover, 30-day all-cause and in-hospital mortality were 11.5 % and 14.2 %, respectively. Harboring renal dysfunction (creatinine clearance rate (CCR) of<20 mL/min), cardiovascular diseases, and digestive system diseases were independent risk factors for poor clinical efficacy of CAZ/AVI-based regimens. Bloodstream infection (BSI), patients with the adjusted doses of CAZ/AVI, and CAZ/AVI co-administration with carbapenem were independently associated factors of bacterial clearance by CAZ/AVI-based regimens. Age, total hospital stays, use of mechanical ventilation, and cumulative CAZ/AVI dose were independent factors associated with all-cause mortality. Conclusion: CAZ/AVI was an effective drug in treating CR-GNB infection. CAZ/AVI that is mostly excreted by the kidney and is accumulated in renal impairment should be renally adjusted. Renal dysfunction and the adjusted dose of CAZ/AVI were associated with efficacy. Clinicians should individualize CAZ/AVI regimen and dose by the level of renal function to achieve optimal efficacy and survival. The efficacy of CAZ/AVI in the treatment of CR-GNB infection, as well as the implementation of individualized precision drug administration of CAZ/AVI according to patients’ different infection sites, renal function, bacterial types, bacterial resistance mechanisms, blood concentration monitoring and other conditions need to be further studied in multicenter.http://www.sciencedirect.com/science/article/pii/S187603412300134XCeftazidime/avibactamCarbapenem-resistant Gram-negative bacteriaClinical efficacyBacterial eliminationMortality |
| spellingShingle | Hai-Hui Zhuang Ying Chen Qin Hu Wen-Ming Long Xiao-Li Wu Qin Wang Tian-Tian Xu Qiang Qu Yi-Ping Liu Yi-Wen Xiao Jian Qu Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study Journal of Infection and Public Health Ceftazidime/avibactam Carbapenem-resistant Gram-negative bacteria Clinical efficacy Bacterial elimination Mortality |
| title | Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study |
| title_full | Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study |
| title_fullStr | Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study |
| title_full_unstemmed | Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study |
| title_short | Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study |
| title_sort | efficacy and mortality of ceftazidime avibactam based regimens in carbapenem resistant gram negative bacteria infections a retrospective multicenter observational study |
| topic | Ceftazidime/avibactam Carbapenem-resistant Gram-negative bacteria Clinical efficacy Bacterial elimination Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S187603412300134X |
| work_keys_str_mv | AT haihuizhuang efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT yingchen efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT qinhu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT wenminglong efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT xiaoliwu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT qinwang efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT tiantianxu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT qiangqu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT yipingliu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT yiwenxiao efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy AT jianqu efficacyandmortalityofceftazidimeavibactambasedregimensincarbapenemresistantgramnegativebacteriainfectionsaretrospectivemulticenterobservationalstudy |