头孢他啶/阿维巴坦
肺炎克雷伯菌
医学
队列
头孢他啶
微生物学
重症监护医学
内科学
铜绿假单胞菌
生物
细菌
大肠杆菌
遗传学
生物化学
基因
作者
Juan José Castón,Marina Gallo,M. Arance García,Ángela Cano,Antonio Escribano,Isabel Machuca,Irene Gracia-Aufinger,Julia Guzmán-Puche,Elena Pérez‐Nadales,Manuel Recio,Monserrat Muñoz,Luis Martínez‐Martínez,Julián Torre‐Cisneros
标识
DOI:10.1016/j.ijantimicag.2020.106075
摘要
Abstract Background Infections caused by KPC-producing Klebsiella pneumoniae (KPC-Kp) are not well represented in pivotal trials with ceftazidime-avibactam (CAZ-AVI). This study aimed to investigate its efficacy in a single-centre cohort of patients infected with KPC-Kp. Methods A retrospective observational study was conducted of consecutive patients treated for > 72 hours with CAZ-AVI for KPC-Kp infections. Fourteen-day clinical response was considered when none of these criteria were present: i) the patient died before day 14, ii) treatment with CAZ-AVI at day 14 for persistence of symptoms or signs of infection, iii) recurrence. A multivariate logistic regression model was used to identify factors predictive of 14-day clinical failure. A propensity score to receive targeted initial treatment with CAZ-AVI was used as a covariate of the analysis. Results Forty-seven patients were included. The median age was 70 years and the median Charlson index was 4. The most frequent sources of infection were intraabdominal (n = 18; 38.3%) followed by pneumonia (n = 14; 29.8%). Twenty-five patients (53.2%) had septic shock. CAZ-AVI was used as monotherapy in 34 (72.3%) of the cases. CAZ-AVI resistance was detected after CAZ-AVI therapy in six of 47 (12.7%) patients. Thirty-day crude mortality was 23.4% (n = 11). The 14-day clinical response rate was 59.6% (n = 28). Pneumonia (OR 7.57; 95% CI 1.45–39.43; P = 0.01), and INCREMENT-CPE score > 7 points (OR 6.73; 95% CI 1.39–34.94; P = 0.02) were associated with 14-day clinical failure. Conclusions CAZ-AVI offers an advance for the treatment of KPC-Kp infections. In patients with pneumonia or an INCREMENT-CPE score > 7 points it may be reasonable to use CAZ-AVI in combination.
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