Multicenter Evaluation of Ceftazidime-avibactam Use in Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections in OXA-48 Endemic Regions

Overview

Journal Sci Rep

Specialty Science

Date 2024 Nov 2

PMID 39487308

Authors

Ali Mert

Okan Derin

Halis Akalin

Ridvan Dumlu

Sibel Gundes

Rehile Zengin

Sesin Kocagoz

Yasemin Gundogdu

Iftihar Koksal

Demet Yalcin

Cemal Ustun

Mahir Kapmaz

Levent Gorenek

Kadriye Karahangil

Fusun Can

Onder Ergonul

Affiliations

Soon will be listed here.

Abstract

Data in the literature on the use of ceftazidime-avibactam (CAZ-AVI) in carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are limited especially in OXA-48 (Oxacillinase-48) predominant regions. Our study aimed to evaluate the effect of CAZ-AVI use on outcomes in CRKP-BSIs in Turkey, where OXA-48 is endemic. A multicenter retrospective observational study was conducted between January 2017 and September 2021. The effects of clinical and treatment characteristics on 30-day mortality and relapse in CRKP-BSIs were analyzed. Predictors of outcomes were detected using a Cox regression model. The study enrolled 106 adults with CAZ-AVI-sensitive CRKP-BSIs who received CAZ-AVI for at least 72 h. Patients who received CAZ-AVI as initial therapy had lower mortality rates when compared to those who switched from last resort regimens [14.3% (n = 3/21) vs. 37.7% (n = 32/85), p = 0.04]. In multivariate analysis, older age and severe neutropenia were detected to be associated with higher mortality, significantly. Initiation of CAZ-AVI on the day of blood culture was obtained, was found to be significantly associated with lower mortality (HR: 0.25, CI: 0.07-0.84, p = 0.025). CAZ-AVI monotherapy is an important treatment option for CRKP-BSIs in OXA-48 endemic areas. Early initiation of CAZ-AVI should be preferred rather than switching from a last-resort regimen as it profoundly improves the survival rates.

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