Efficacy of Ceftazidime-avibactam Plus Aztreonam in Patients With Bloodstream Infections Caused by Metallo-ß-lactamase-Producing Enterobacterales.
Clin Infect Dis
; 72(11): 1871-1878, 2021 06 01.
Article
em En
| MEDLINE
| ID: mdl-32427286
ABSTRACT
BACKGROUND:
In vitro data support the use of combination of aztreonam (ATM) with ceftazidime-avibactam (CAZ-AVI), but clinical studies are lacking. The aim of our study was to compare the outcome of patients with bloodstream infections (BSIs) due to metallo-ß-lactamase (MBL)-producing Enterobacterales treated either with CAZ-AVI plus ATM or other active antibiotics (OAAs).METHODS:
This was a prospective observational study including patients admitted to 3 hospitals in Italy and Greece. The primary outcome measure was 30-day all-cause mortality. Secondary outcomes were clinical failure at day 14 and length of stay after BSI diagnosis. Cox regression analysis including a propensity score (PS) for receiving CAZ-AVI + ATM was performed to evaluate primary and secondary outcomes. A PS-based matched analysis was also performed.RESULTS:
We enrolled 102 patients with BSI; 82 had infections caused by NDM-producing (79 Klebsiella pneumoniae and 3 Escherichia coli) and 20 by VIM-producing (14 K. pneumoniae, 5 Enterobacter species, 1 Morganella morganii) strains. The 30-day mortality rate was 19.2% in the CAZ-AVI + ATM group vs 44% in the OAA group (Pâ =â .007). The PS-adjusted analysis showed that the use of CAZ-AVI + ATM was associated with lower 30-day mortality (hazard ratio [HR], 0.37 [95% confidence interval {CI}, .13-.74]; Pâ =â .01), lower clinical failure at day 14 (HR, 0.30 [95% CI, .14-.65]; Pâ =â .002), and shorter length of stay (subdistributional HR, 0.49 [95% CI, .30-.82]; Pâ =â .007). The PS-matched analysis confirmed these findings.CONCLUSIONS:
The CAZ-AVI + ATM combination offers a therapeutic advantage compared to OAAs for patients with BSI due to MBL-producing Enterobacterales. Further studies are warranted.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Aztreonam
/
Sepse
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article