作者
Elena Pérez‐Nadales,Mario Fernández‐Ruiz,Alejandra M. Natera,Belén Gutiérrez,Alessandra Mularoni,Giovanna Russelli,Lígia Câmera Pierrotti,Maristela Pinheiro Freire,Marco Falcone,Giusy Tiseo,Mario Tumbarello,Francesca Raffaelli,Edson Abdala,Marta Bodro,Elena Gervasi,María Carmen Fariñas,Elena Seminari,Juan José Castón,Juan Antonio Marín-Sanz,Víctor Gálvez-Soto,Meenakshi Rana,Belén Loeches,Pilar Martín-Dávila,Álvaro Pascual,Jesús Rodríguez-Baño,Estela Paz‐Artal,Luis Martínez-Martínez,J Torre-Cisneros,Mical Paul,Jordi Carratalà,Isabel Oriol,Regino Rodríguez-Álvarez,Elisa Cordero,José Antonio Lepe,Esperanza Merino de Lucas,Patricia Muñóz,Jesús Fortün,Julien Coussement,Laurent Dewispelaere,Björn Eriksson,Christian van Delden,Oriol Manuel,Wanessa Trindade Clemente,Tânia Mara Varejão Strabelli,Benoît Pilmis,Emmanuel Roilides,Iyer Ranganathan N,Paolo Grossi,Fabio Soldani,Marco Rizzi,Ban Hock Tan,Warren Lowman,Filiz Günseren,Hande Arslan,Zeliha Koçak Tufan,Esra Kazak,Miruna David,Seema Mehta Steinke,Darin Ostrander,Robin K. Avery,Erika D. Lease
摘要
We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.