Impact of Antibiotic Therapy with Ceftazidime Avibactam vs. Best Available Therapy in Adult Patients with Bacteremia Caused by Carbapenem-Resistant Enterobacterales
Abstract
:1. Introduction
2. Results
2.1. Sociodemographic Characteristics
2.2. Microbiological Data
2.3. Antimicrobial Therapy and Non-Adjusted Outcomes
2.4. Survival Model and Adjusted Outcomes
2.5. Sensibility Analysis
3. Discussion
4. Materials and Methods
4.1. Study Design and Population
4.2. Study Participants
4.3. Endpoints
4.4. Definitions and Covariations
4.5. Microbiology
4.6. Statistical Analysis
4.7. Ethics
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CRE | Carbapenem-resistant Enterobacterales |
CZA | Ceftazidime/avibactam |
BAT | Best available therapy |
ATM | Aztreonam |
SMD | Standardized mean difference |
SD | Standard deviation |
References
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Original Cohort (N = 169) | Post-IPWT | |||||
---|---|---|---|---|---|---|
CZA (n = 107) | BAT (n = 62) | SMD | CZA | BAT | SMD | |
Male sex, n (%) | 66 (61.7) | 33 (53.2) | 0.172 | 62.3 (59.6) | 36.8 (58.9) | 0.013 |
Age, years; mean (SD) | 53.5 (16.5) | 58.2 (16.7) | 0.285 | 54.7 (16.5) | 53.6 (17.2) | 0.066 |
Charlson score, mean (SD) | 4.0 (2.5) | 4.2 (3.0) | 0.057 | 3.9 (2.4) | 3.7 (2.9) | 0.083 |
Comorbidities, n (%) | ||||||
Acute heart attack | 15 (14.0) | 6 (9.7) | 0.135 | 13.3 (12.7) | 6.6 (10.5) | 0.067 |
COPD | 6 (5.6) | 6 (9.7) | 0.154 | 7.2 (6.9) | 4.5 (7.2) | 0.015 |
Diabetes mellitus | 25 (23.4) | 7 (11.3) | 0.323 | 19.2 (18.3) | 6.6 (10.6) | 0.222 |
Chronic kidney failure | 23 (21.5) | 8 (12.9) | 0.229 | 19.1 (18.3) | 7.0 (11.3) | 0.199 |
Heart failure | 19 (17.8) | 12 (19.4) | 0.041 | 17.6 (16.8) | 9.1 (14.6) | 0.062 |
Hematology tumor | 41 (38.3) | 15 (24.2) | 0.308 | 35.6 (34.0) | 22.5 (36.1) | 0.045 |
Solid tumor | 16 (15.0) | 20 (32.3) | 0.416 | 22.5 (21.5) | 14.5 (23.2) | 0.041 |
COVID-19 | 14 (13.1) | 11 (17.7) | 0.129 | 15.8 (15.1) | 9.0 (14.4) | 0.020 |
Immunosuppression | 40 (37.4) | 19 (30.6) | 0.143 | 36.1 (34.5) | 28.3 (45.4) | 0.224 |
Abdominal surgery | 21 (19.6) | 16 (25.8) | 0.148 | 22.8 (21.8) | 13.7 (22.0) | 0.003 |
Surgical disease | 27 (25.2) | 25 (40.3) | 0.326 | 30.4 (29.1) | 17.3 (27.7) | 0.031 |
Previous CRE infection | 8 (7.5) | 3 (4.8) | 0.098 | 8.3 (7.9) | 8.9 (14.2) | 0.202 |
Previous antibiotic treatment | 82 (76.6) | 47 (75.8) | 0.019 | 81.8 (78.2) | 50.8 (81.5) | 0.083 |
Previous hospital stay in days, mean (SD) | 17.7 (16.8) | 21.5 (25.4) | 0.174 | 17.8 (17.7) | 18.8 (20.6) | 0.055 |
Urinary catheter | 7 (6.5) | 8 (12.9) | 0.216 | 9.2 (8.8) | 6.4 (10.2) | 0.048 |
Severity of the disease, n (%) | ||||||
Critical care stay | 57 (53.3) | 31 (48.4) | 0.098 | 53.5 (51.2) | 31.2 (50.0) | 0.025 |
Septic shock | 38 (35.5) | 25 (40.3) | 0.099 | 38.2 (36.6) | 23.1 (37.0) | 0.010 |
SOFA, mean (SD) | 5.8 (3.1) | 5.3 (3.4) | 0.152 | 5.6 (3.14) | 5.3 (3.56) | 0.101 |
INCREMENT, mean (SD) | 7.4 (3.8) | 7.02 (3.9) | 0.102 | 7.3 (3.8) | 7.3 (3.9) | 0.007 |
Pitt score, mean (SD) | 2.1 (2.5) | 2.1 (2.6) | 0.023 | 2.1 (2.5) | 2.1 (2.6) | 0.006 |
Invasive mechanical ventilation | 35 (32.7) | 23 (37.1) | 0.092 | 36.0 (34.4) | 21.4 (34.3) | 0.001 |
Treatment Option | N (%) |
---|---|
Monotherapy | 5 (7.2) |
Combined antimicrobial therapy | 57 (82.6) |
Based on carbapenems | 42 (60.9) |
Doble carbapenem | 14 (20.3) |
Based on colistin/polymyxin | 24 (34.8) |
Tigecycline use | 16 (23.2) |
Aminoglycoside use | 9 (13.0) |
Quinolone use | 8 (11.6) |
Fosfomycin use | 6 (8.6) |
Total N = 169 | CAZ/AVI (n = 107) | BAT (n = 62) | |
---|---|---|---|
Length of hospitalization, days (SD) | 41.5 (27.8) | 40.9 (26.8) | 43.7 (26.2) |
Length of antibiotic therapy, days (SD) | 13.7 (11.3) | 13.3 (10.8) | 12.9 (9.8) |
Length of post-antibiotic treatment, days (SD) | 22.4 (17.2) | 21.3 (16.4) | 21.07 (15.1) |
Acute kidney injury, n (%) | 17 (10.0) | 7.0 (6.6) | 10.0 (15.4) |
In-hospital mortality, n (%) | 57 (34.0) | 36 (34.5) | 21 (33.2) |
In-hospital death caused by the infection, n (%) | 44 (76.4) | 25 (68.9) | 19 (90.7) |
Infection relapse, n (%) | 21 (13.0) | 14 (12.8) | 7 (10.5) |
Clinical response, n (%) | 106 (62.7) | 66 (61.8) | 40 (61.6) |
Microbiological cure | |||
Yes, n (%) | 14 (8.3) | 6.0 (5.6) | 8.0 (12.3) |
No, n (%) | 24 (14.4) | 22 (20.6) | 2 (2.8) |
Not applicable | 131 (77.3) | 78 (73.8) | 53 (48.9) |
Measure of Association | Value | Lower Limit | Upper Limit | |
---|---|---|---|---|
CZA in-hospital mortality | HR | 0.86 | 0.40 | 1.83 |
ATM in-hospital mortality | HR | 1.23 | 0.52 | 2.91 |
Microbiological cure | OR | 1.31 | 0.46 | 3.67 |
Clinical response | OR | 1.39 | 0.35 | 5.43 |
Acute kidney injury | OR | 0.56 | 0.11 | 2.80 |
Relapse | OR | 0.99 | 0.17 | 5.51 |
Variable | OR | Lower Limit | Upper Limit | p-Value |
---|---|---|---|---|
Ceftazidime/avibactam use | 0.65 | 0.26 | 1.62 | 0.362 |
Aztreonam use | 2.48 | 0.86 | 7.12 | 0.090 |
Charlson score | 1.27 | 1.08 | 1.50 | 0.004 |
Urinary infection | 0.08 | 0.008 | 0.91 | 0.042 |
SOFA | 1.55 | 1.31 | 1.84 | 0.000 |
Previous stay before bacteremia | 1.02 | 1.00 | 1.04 | 0.003 |
Bacteremia time before definitive antibiotic therapy (per day) | 1.15 | 1.00 | 1.33 | 0.042 |
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Arboleda, D.; Buitrago, C.; Vergara, E.P.; Nocua-Báez, L.C.; Saavedra, C.H.; Cortés, J.A. Impact of Antibiotic Therapy with Ceftazidime Avibactam vs. Best Available Therapy in Adult Patients with Bacteremia Caused by Carbapenem-Resistant Enterobacterales. Antibiotics 2025, 14, 226. https://doi.org/10.3390/antibiotics14030226
Arboleda D, Buitrago C, Vergara EP, Nocua-Báez LC, Saavedra CH, Cortés JA. Impact of Antibiotic Therapy with Ceftazidime Avibactam vs. Best Available Therapy in Adult Patients with Bacteremia Caused by Carbapenem-Resistant Enterobacterales. Antibiotics. 2025; 14(3):226. https://doi.org/10.3390/antibiotics14030226
Chicago/Turabian StyleArboleda, Daniel, Camilo Buitrago, Erika Paola Vergara, Laura Cristina Nocua-Báez, Carlos Humberto Saavedra, and Jorge Alberto Cortés. 2025. "Impact of Antibiotic Therapy with Ceftazidime Avibactam vs. Best Available Therapy in Adult Patients with Bacteremia Caused by Carbapenem-Resistant Enterobacterales" Antibiotics 14, no. 3: 226. https://doi.org/10.3390/antibiotics14030226
APA StyleArboleda, D., Buitrago, C., Vergara, E. P., Nocua-Báez, L. C., Saavedra, C. H., & Cortés, J. A. (2025). Impact of Antibiotic Therapy with Ceftazidime Avibactam vs. Best Available Therapy in Adult Patients with Bacteremia Caused by Carbapenem-Resistant Enterobacterales. Antibiotics, 14(3), 226. https://doi.org/10.3390/antibiotics14030226