Περίληψη:
Background: Infections caused by KPC-producing Klebsiella pneumoniae (Kp) are associated with high mortality. Therefore, new treatment options are urgently required. Objectives: To assess the outcomes and predictors of mortality in patients with KPC-or OXA-48-Kp infections treated with ceftazidime/avibactam with an emphasis on KPC-Kp bloodstream infections (BSIs). Methods: A multicentre prospective observational study was conducted between January 2018 and March 2019. Patients with KPC-or OXA-48-Kp infections treated with ceftazidime/avibactam were included in the analysis. The subgroup of patients with KPC-Kp BSIs treated with ceftazidime/avibactam was matched by propensity score with a cohort of patients whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam with in vitro activity. Results: One hundred and forty-seven patients were identified; 140 were infected with KPC producers and 7 with OXA-48 producers. For targeted therapy, 68 (46.3%) patients received monotherapy with ceftazidime/avibactam and 79 (53.7%) patients received ceftazidime/avibactam in combination with at least another active agent. The 14 and 28 day mortality rates were 9% and 20%, respectively. The 28 day mortality among the 71 patients with KPC-Kp BSIs treated with ceftazidime/avibactam was significantly lower than that observed in the 71 matched patients, whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam (18.3% versus 40.8%; P = 0.005). In the Cox proportional hazards model, ultimately fatal disease, rapidly fatal disease and Charlson comorbidity index ≥2 were independent predictors of death, whereas treatment with ceftazidime/avibactam-containing regimens was the only independent predictor of survival. Conclusions: Ceftazidime/avibactam appears to be an effective treatment against serious infections caused by KPC-Kp. © 2021 The Author(s).
Συγγραφείς:
Karaiskos, I., ikaraiskos@hygeia.gr
Daikos, G.L.
Gkoufa, A.
Adamis, G.
Stefos, A.
Symbardi, S.
Chrysos, G.
Filiou, E.
Basoulis, D.
Mouloudi, E.
Galani, L.
Akinosoglou, K.
Arvaniti, K.
Masgala, A.
Petraki, M.
Papadimitriou, E.
Galani, I.
Poulakou, G.
Routsi, C.
Giamarellou, H.
Λέξεις-κλειδιά:
amikacin; aminoglycoside; avibactam plus ceftazidime; carbapenemase; cephalosporin derivative; ciprofloxacin; colistin; cotrimoxazole; creatinine; fosfomycin; gentamicin; meropenem; penicillin derivative; tigecycline; antiinfective agent; avibactam; azabicyclo derivative; bacterial protein; beta lactamase; carbapenemase; ceftazidime, abdominal infection; adult; antibiotic therapy; Article; bacterium identification; bloodstream infection; carbapenemase producing Enterobacteriaceae; catheter infection; cause of death; Charlson Comorbidity Index; clinical assessment; clinical evaluation; cohort analysis; controlled study; drug efficacy; fatality; female; human; in vitro study; Klebsiella pneumoniae infection; loading drug dose; major clinical study; male; molecularly targeted therapy; monotherapy; mortality rate; multicenter study; observational study; outcome assessment; personal experience; propensity score; prospective study; sepsis; septic shock; single drug dose; skin infection; survival rate; therapy effect; urinary tract infection; drug combination; Klebsiella infection; Klebsiella pneumoniae; microbial sensitivity test; register, Anti-Bacterial Agents; Azabicyclo Compounds; Bacterial Proteins; beta-Lactamases; Ceftazidime; Drug Combinations; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Registries
