Ceftazidime/avibactam versus carbapenems for the treatment of infections caused by Enterobacteriaceae: A meta-analysis of randomised controlled trials

Enterobacteriaceae are the most common pathogens in nosocomial and community infections. Carbapenems are widely used as the most effective antibacterial agents against Enterobacteriaceae. However, increasing use of carbapenems has accelerated the emergence of carbapenem-resistant Enterobacteriaceae. This was a systematic review of recently published data to compare the clinical efficacy and safety of ceftazidime/avibactam (CAZ-AVI) and carbapenems in the treatment of Enterobacteriaceae infections. Moreover, we also attempted to assess whether it is feasible to treat Enterobacteriaceae infections with CAZ-AVI instead of carbapenems. A comprehensive search was performed using Medline, Embase and Cochrane Library for randomised controlled trials (RCTs) comparing the efficacy and safety of CAZ-AVI and carbapenems for the treatment of Enterobacteriaceae infections. Clinical success, microbiological success, adverse events (AEs), serious adverse events (SAEs) and mortality were assessed as the main outcomes. Three RCTs (1186 patients) were included in the meta-analysis. The meta-analysis showed that there were no significant differences between CAZ-AVI and carbapenems in clinical success [risk difference (RD) = 0.00, 95% confidence interval (CI) –0.06 to 0.06; P = 0.99], microbiological success (RD = 0.07, 95% CI –0.04 to 0.18; P = 0.21) or AEs (RD = 0.00, 95% CI –0.02 to 0.03; P = 0.81). SAEs with CAZ-AVI were numerically higher than with carbapenems (RD = 0.02, 95% CI –0.00 to 0.04; P = 0.06). CAZ-AVI is comparable with carbapenems in efficacy and safety for Enterobacteriaceae infections. More high-quality and large-scale RCTs are needed to further confirm the safety of CAZ-AVI. [PROSPERO ID: CRD42019116685.]