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Kastamonu Medical Journal

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Original Article
Ceftazidime/avibactam experience in tertiary hospital in Türkiye
Abstract
Aims: Real-life experience with ceftazidime/avibactam in the treatment of multidrug-resistant Klebsiella pneumoniae is still limited. This retrospective study aims to evaluate the efficacy of ceftazidime/avibactam in the treatment of critically ill patients with infections due to carbapenem-resistant pathogens.
Methods: In our study, patients who were hospitalized in the ICUs of our hospital for more than three days between 01-01-2022 and 31-12-2022, who had only ceftazidime/avibactam susceptibility growth and were started on ceftazidime/avibactam treatment were retrospectively analyzed. 38 patients older than 18 years of age were included in the study.
Results: Pneumonia was the most common cause of hospitalization in the ICU, followed by cerebrovascular events and internal diseases, respectively. The mean time from taking the culture samples to obtaining the laboratory results was 4.6 ±1.46 days. After the culture result was confirmed by the laboratory, the mean time between the patient's consultation by infection diseases specialist and initiation of treatment was 1.7±1.3 days. Patients received a mean of 10.6 ±4.63 days of CAZ-AVI treatment as monotherapy (57.9%) or combined therapy (42.1). Clinical response was obtained in 52.6% of the patients, and microbiological response was obtained in 63.2% of the patients. The 90-day all-cause mortality rate of patients receiving CAZ-AVI was 60.5% (n=23), and the mortality rate attributed to 14-day infection was 52.17%. Side effects developed in 18.4% of the patients. None of the developed side effects were such as to require discontinuation of treatment. There was no statistical difference in clinical response and microbiological response in patients receiving combination therapy and monotherapy. Mortality was significantly lower in patients receiving CAZ-AVI monotherapy (p<0.05).
Conclusion: We attribute our low clinical success to the late initiation of treatment due to drug reimbursement criteria. Therefore, we think that CAZ-AVI treatment should be started empirically and as soon as possible. We think that our study is valuable in terms of showing that CAZ-AVI treatment should be given in empirical treatment.

Keywords : Ceftazidime/avibactam, drug resistanc, experience, klebsiella pneumonia

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1. Shirley M. Ceftazidime-avibactam: a review in the treatment ofserious gram-negative bacterial ınfections. Drugs. 2018;78(6):675-692.doi:10.1007/s40265-018-0902-x
2. Mazuski JE, Wagenlehner F. Clinical and microbiological outcomesof ceftazidime-avibactam treatment in adults with gram-negativebacteremia : a subset analysis from the phase 3 clinical trial program.Infect Dis Ther. 2021;10(4):2399-2414. doi:10.1007/s40121-021-00506-7
3. Centers for Disease Control and Prevention. Antibiotic resistance threatsin the United States, 2019. US Department of Health and Human Services,Centres for Disease Control and Prevention.; 2019.
4. Bush K. Bench-to-bedside review: the role of &beta;-lactamases in antibiotic-resistant gram-negative infections. Crit care. 2010;14(3):1-8.
5. Tansarli GS, Andreatos N, Pliakos EE, Mylonakis E. A systematic reviewand meta-analysis of antibiotic treatment duration for bacteremia due toEnterobacteriaceae. Antimicrob Agents Chemother. 2019;63(5):e02495-18.
6. van Duin D, Kaye KS, Neuner EA, Bonomo RA. Carbapenem-resistantEnterobacteriaceae: a review of treatment and outcomes. Diagn MicrobiolInfect Dis. 2013;75(2):115-120.
7. Falcone M, Bassetti M, Tiseo G, et al. Time to appropriate antibiotic therapyis a predictor of outcome in patients with bloodstream infection caused byKPC-producing Klebsiella pneumoniae. Crit Care. 2020;24(1):1-12.
8. Falagas ME, Lourida P, Poulikakos P, Rafailidis PI, Tansarli GS. Antibiotictreatment of infections due to carbapenem-resistant Enterobacteriaceae:systematic evaluation of the available evidence. Antimicrob AgentsChemother. 2014;58(2):654-663.
9. Vincent JL, Rello J, Marshall J, et al. International study of the prevalenceand outcomes of infection in intensive care units. Jama. 2009;302(21):2323-2329.
10. Tsolaki V, Mantzarlis K, Mpakalis A, et al. Ceftazidime-avibactam to treatlife-threatening infections by carbapenem-resistant pathogens in criticallyill mechanically ventilated patients. Antimicrob Agents Chemother.2020;64(3):e02320-19.
11. Bebrone C, Lassaux P, Vercheval L, et al. Current challenges inantimicrobial chemotherapy: focus on &beta;-lactamase inhibition. Drugs.2010;70:651-679.
12. Ehmann DE, Jahic H, Ross PL, et al. Avibactam is a covalent,reversible, non-&beta;-lactam &beta;-lactamase inhibitor. Proc Natl Acad Sci.2012;109(29):11663-11668.
13. Berkhout J, Melchers MJ, van Mil AC, Nichols WW, Mouton JW. In vitroactivity of ceftazidime-avibactam combination in in vitro checkerboardassays. Antimicrob Agents Chemother. 2015;59(2):1138-1144.
14. Lagac&eacute;-Wiens PRS, Tailor F, Simner P, et al. Activity of NXL104 incombination with &beta;-lactams against genetically characterized Escherichiacoli and Klebsiella pneumoniae isolates producing class A extended-spectrum &beta;-lactamases and class C &beta;-lactamases. Antimicrob AgentsChemother. 2011;55(5):2434-2437.
15. Levasseur P, Girard AM, Miossec C, Pace J, Coleman K. In vitroantibacterial activity of the ceftazidime-avibactam combinationagainst Enterobacteriaceae, including strains with well-characterized&beta;-lactamases. Antimicrob Agents Chemother. 2015;59(4):1931-1934.
16. FDA US. Avycaz (ceftazidime and avibactam) for injection, for intravenoususe: US prescribing information. 2018. Published online 2018.
17. Agency EM. Zavicefta: summary of product characteristics. Publishedonline 2018.
18. Shields RK, Nguyen MH, Chen L, et al. Ceftazidime-avibactam issuperior to other treatment regimens against carbapenem-resistantKlebsiella pneumoniae bacteremia. Antimicrob Agents Chemother.2017;61(8):e00883-17.
19. Van Duin D, Lok JJ, Earley M, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistantEnterobacteriaceae. Clin Infect Dis. 2018;66(2):163-171.
20. Karaiskos I, Daikos GL, Gkoufa A, et al. Ceftazidime/avibactam in theera of carbapenemase-producing Klebsiella pneumoniae: experience froma national registry study. J Antimicrob Chemother. 2021;76(3):775-783.doi:10.1093/jac/dkaa503
21. Social security institution health application notification. Published 2021.https://www.resmigazete.gov.tr/eskiler/2021/04/20210428M1-1.htm
22. Guimar&atilde;es T, Nou&eacute;r SA, Martins RCR, et al. Ceftazidime-avibactam assalvage therapy for infections caused by Enterobacteriales coresistantto carbapenems and polymyxins. Antimicrob Agents Chemother.2019;63(10):e00528-19.
23. Temkin E, Torre-Cisneros J, Beovic B, et al. Ceftazidime-avibactam assalvage therapy for infections caused by carbapenem-resistant organisms.Antimicrob Agents Chemother. 2017;61(2):e01964-16.
24. Shields RK, Nguyen MH, Chen L, Press EG, Kreiswirth BN, ClancyCJ. Pneumonia and renal replacement therapy are risk factors forceftazidime-avibactam treatment failures and resistance among patientswith carbapenem-resistant Enterobacteriaceae infections. AntimicrobAgents Chemother. 2018;62(5):e02497-17.
25. Jorgensen SCJ, Trinh TD, Zasowski EJ, et al. Real-world experience withceftazidime-avibactam for multidrug-resistant gram-negative bacterialinfections. In: Open Forum Infectious Diseases. Vol 6. Oxford UniversityPress US; 2019:ofz522.
26. Daikos GL, Tsaousi S, Tzouvelekis LS, et al. Carbapenemase-producingKlebsiella pneumoniae bloodstream infections: lowering mortality byantibiotic combination schemes and the role of carbapenems. AntimicrobAgents Chemother. 2014;58(4):2322-2328.
27. Tumbarello M, Trecarichi EM, De Rosa FG, et al. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in amulticentre study. J Antimicrob Chemother. 2015;70(7):2133-2143.
28. Tumbarello M, Trecarichi EM, Corona A, et al. Efficacy of ceftazidime-avibactam salvage therapy in patients with infections caused by Klebsiellapneumoniae carbapenemase-producing K. pneumoniae. Clin Infect Dis.2019;68(3):355-364.
29. Onorato L, Di Caprio G, Signoriello S, Coppola N. Efficacy of ceftazidime/avibactam in monotherapy or combination therapy against carbapenem-resistant gram-negative bacteria: a meta-analysis. Int J Antimicrob Agents.2019;54(6):735-740.
30. Fiore M, Alfieri A, Di Franco S, et al. Ceftazidime-avibactam combinationtherapy compared to ceftazidime-avibactam monotherapy for thetreatment of severe infections due to carbapenem-resistant pathogens: asystematic review and network meta-analysis. Antibiotics. 2020;9(7):388.
31. Sousa A, Pe T, Soto A, et al. Effectiveness of ceftazidime/avibactam assalvage therapy for treatment of infections due to OXA-48 carbapenemase-producing Enterobacteriaceae. 2018;73(11):3170-3175. doi:10.1093/jac/dky295
32. Tumbarello M, Raffaelli F, Giannella M, et al. Ceftazidime-avibactam usefor Klebsiella pneumoniae carbapenemase - producing K. pneumoniaeinfections: a retrospective observational multicenter study. Clin Infect Dis.2021;73(9):1664-1676. doi:10.1093/cid/ciab176
33. Lucasti C, Popescu I, Ramesh M, Lipka J, Sable C. Efficacy and safety ofceftazidime/NXL104 plus metronidazole vs. meropenem in the treatmentof complicated intra-abdominal infections in hospitalised adults,abstr. P1532. In: 21st European Congress of Clinical Microbiology andInfectious Diseases-27th International Congress of Chemotherapy, Milan,Italy. 2011.
34. Goodlet KJ, Nicolau DP, Nailor MD. Ceftolozane/tazobactam andceftazidime/avibactam for the treatment of complicated intra-abdominalinfections. Ther Clin Risk Manag. 2016;12:1811-1826.
35. Guimar&atilde;es T, Nou&eacute;r SA, Martins RCR, et al. Ceftazidime-avibactam assalvage therapy for ınfections caused by Enterobacteriales coresistantto carbapenems and polymyxins. Antimicrob Agents Chemother.2019;63(10):e00528-19. doi:10.1128/AAC.00528-19
Article available in :
Volume 3, Issue 2, 2023
Page : 68-74
https://doi.org/10.51271/KMJ-0101
Article Information
Received : 06 Nis 2023
Accepted : 09 May 2023
Published : 26 Haz 2023
Corresponding Author :

Alper Tahmaz: Antalya Eğitim ve Araştırma Hastanesi

[email protected]
Citation : Tahmaz A, Şeremet Keskin A. Ceftazidime/avibactam experience in tertiary hospital in Turkey. Kastamonu Med J. 2023;3(2):68-74

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