Ceftazidime-Avibactam in the Treatment of Patients with Bacteremia or Nosocomial Pneumonia: A Systematic Review and Meta-analysis

Overview

Journal Infect Dis Ther

Specialty Infectious Diseases

Date 2024 May 31

PMID 38822167

Authors

Ryan K Shields

Juan P Horcajada

Shweta Kamat

Paurus M Irani

Margaret Tawadrous

Tobias Welte

Affiliations

Soon will be listed here.

Abstract

Introduction: Ceftazidime-avibactam (CAZ-AVI) is a combination of the third-generation cephalosporin ceftazidime and the novel, non-β-lactam β-lactamase inhibitor avibactam that is approved for the treatment of pediatric (≥ 3 months) and adult patients with complicated infections including hospital-acquired and ventilator-associated pneumonia (HAP/VAP), and bacteremia. This systematic literature review and meta-analysis (PROSPERO registration: CRD42022362856) aimed to provide a quantitative and qualitative synthesis to evaluate the effectiveness of CAZ-AVI in treating adult patients with bacteremia or nosocomial pneumonia caused by carbapenem-resistant Enterobacterales (non metallo-β-lactamase-producing strains) and multi-drug resistant (MDR) Pseudomonas aeruginosa infections.

Methods: The databases included in the search, until November 7, 2022, were Embase and PubMed. A total of 24 studies (retrospective: 22, prospective: 2) with separate outcomes for patients with bacteremia or pneumonia were included.

Results: The outcomes assessed were all-cause mortality, clinical cure, and microbiological cure. Qualitative (24 studies) and quantitative (8/24 studies) syntheses were performed. The quality of the studies was assessed using the MINORS checklist and the overall risk of bias was moderate to high.

Conclusions: In studies included in the meta-analysis, lower all-cause mortality for patients with bacteremia (OR = 0.30, 95% CI 0.19-0.46) and improved rates of clinical cure for patients with bacteremia (OR = 4.90, 95% CI 2.60-9.23) and nosocomial pneumonia (OR = 3.20, 95% CI 1.55-6.60) was observed in the CAZ-AVI group compared with the comparator group. Data provided here may be considered while using CAZ-AVI for the treatment of patients with difficult-to-treat infections.

Systematic Review Registration: PROSPERO CRD42022362856.

Citing Articles

Comparative Outcomes of Meropenem-Vaborbactam vs. Ceftazidime-Avibactam Among Adults Hospitalized with an Infectious Syndrome in the US, 2019-2021.

Zilberberg M, Nathanson B, Redell M, Sulham K, Shorr A Antibiotics (Basel). 2025; 14(1).

PMID: 39858315 PMC: 11762528. DOI: 10.3390/antibiotics14010029.

References

Mancuso G, Midiri A, Gerace E, Biondo C . Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens. 2021; 10(10). PMC: 8541462. DOI: 10.3390/pathogens10101310. View

Wang Y, Wang J, Wang R, Cai Y . Resistance to ceftazidime-avibactam and underlying mechanisms. J Glob Antimicrob Resist. 2019; 22:18-27. DOI: 10.1016/j.jgar.2019.12.009. View

Breijyeh Z, Karaman R . Comprehensive Review on Alzheimer's Disease: Causes and Treatment. Molecules. 2020; 25(24). PMC: 7764106. DOI: 10.3390/molecules25245789. View

Daikos G, da Cunha C, Rossolini G, Stone G, Baillon-Plot N, Tawadrous M . Review of Ceftazidime-Avibactam for the Treatment of Infections Caused by . Antibiotics (Basel). 2021; 10(9). PMC: 8467554. DOI: 10.3390/antibiotics10091126. View

Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan A . Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med. 2023; 49(2):178-190. PMC: 9916499. DOI: 10.1007/s00134-022-06944-2. View

Patolia S, Abate G, Patel N, Patolia S, Frey S . Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia. Ther Adv Infect Dis. 2018; 5(1):11-18. PMC: 5761922. DOI: 10.1177/2049936117727497. View

Lin T, Chang P, Chen I, Lai W, Chen Y, Li W . Risk factors and mortality associated with multi-drug-resistant Gram-negative bacterial infection in adult patients following abdominal surgery. J Hosp Infect. 2021; 119:22-32. DOI: 10.1016/j.jhin.2021.09.021. View

Shirley M . Ceftazidime-Avibactam: A Review in the Treatment of Serious Gram-Negative Bacterial Infections. Drugs. 2018; 78(6):675-692. DOI: 10.1007/s40265-018-0902-x. View

Chen Y, Huang H, Peng J, Weng L, Du B . Efficacy and Safety of Ceftazidime-Avibactam for the Treatment of Carbapenem-Resistant Bloodstream Infection: a Systematic Review and Meta-Analysis. Microbiol Spectr. 2022; 10(2):e0260321. PMC: 9045088. DOI: 10.1128/spectrum.02603-21. View

10.

Soriano A, Carmeli Y, Omrani A, Moore L, Tawadrous M, Irani P . Ceftazidime-Avibactam for the Treatment of Serious Gram-Negative Infections with Limited Treatment Options: A Systematic Literature Review. Infect Dis Ther. 2021; 10(4):1989-2034. PMC: 8355581. DOI: 10.1007/s40121-021-00507-6. View

11.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73(9):712-6. DOI: 10.1046/j.1445-2197.2003.02748.x. View

12.

Chen J, Liang Q, Chen X, Wu J, Wu Y, Teng G . Ceftazidime/Avibactam versus Polymyxin B in the Challenge of Carbapenem-Resistant Infection. Infect Drug Resist. 2022; 15:655-667. PMC: 8887910. DOI: 10.2147/IDR.S350976. View

13.

Corbella L, Boan J, San-Juan R, Fernandez-Ruiz M, Carretero O, Lora D . Effectiveness of ceftazidime-avibactam for the treatment of infections due to Pseudomonas aeruginosa. Int J Antimicrob Agents. 2022; 59(2):106517. DOI: 10.1016/j.ijantimicag.2021.106517. View

14.

Bassetti M, Vena A, Sepulcri C, Giacobbe D, Peghin M . Treatment of Bloodstream Infections Due to Gram-Negative Bacteria with Difficult-to-Treat Resistance. Antibiotics (Basel). 2020; 9(9). PMC: 7558339. DOI: 10.3390/antibiotics9090632. View

15.

de la Calle C, Rodriguez O, Morata L, Marco F, Cardozo C, Garcia-Vidal C . Clinical characteristics and prognosis of infections caused by OXA-48 carbapenemase-producing Enterobacteriaceae in patients treated with ceftazidime-avibactam. Int J Antimicrob Agents. 2018; 53(4):520-524. DOI: 10.1016/j.ijantimicag.2018.11.015. View

16.

Meng H, Han L, Niu M, Xu L, Xu M, An Q . Risk Factors for Mortality and Outcomes in Hematological Malignancy Patients with Carbapenem-Resistant Bloodstream Infections. Infect Drug Resist. 2022; 15:4241-4251. PMC: 9359710. DOI: 10.2147/IDR.S374904. View

17.

King M, Heil E, Kuriakose S, Bias T, Huang V, El-Beyrouty C . Multicenter Study of Outcomes with Ceftazidime-Avibactam in Patients with Carbapenem-Resistant Enterobacteriaceae Infections. Antimicrob Agents Chemother. 2017; 61(7). PMC: 5487633. DOI: 10.1128/AAC.00449-17. View

18.

Tumbarello M, Raffaelli F, Giannella M, Mantengoli E, Mularoni A, Venditti M . Ceftazidime-Avibactam Use for Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Infections: A Retrospective Observational Multicenter Study. Clin Infect Dis. 2021; 73(9):1664-1676. DOI: 10.1093/cid/ciab176. View

19.

Tumbarello M, Trecarichi E, Corona A, De Rosa F, Bassetti M, Mussini C . Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae. Clin Infect Dis. 2018; 68(3):355-364. DOI: 10.1093/cid/ciy492. View

20.

Chen Y, Ying S, Jiang L, Dong S, Dai J, Jin X . A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by . Infect Drug Resist. 2022; 15:1317-1328. PMC: 8976504. DOI: 10.2147/IDR.S349236. View