Microorganisms (Jan 2024)

Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with <i>Klebsiella pneumoniae</i> Carbapenemase-Producing Enterobacterales Bacteremia

  • Fabián Herrera,
  • Diego Torres,
  • Ana Laborde,
  • Rosana Jordán,
  • Noelia Mañez,
  • Lorena Berruezo,
  • Sandra Lambert,
  • Nadia Suchowiercha,
  • Patricia Costantini,
  • Andrea Nenna,
  • María Laura Pereyra,
  • José Benso,
  • María Luz González Ibañez,
  • María José Eusebio,
  • Laura Barcán,
  • Nadia Baldoni,
  • Lucas Tula,
  • Inés Roccia Rossi,
  • Martín Luck,
  • Vanesa Soto,
  • Verónica Fernández,
  • Alberto Ángel Carena

DOI
https://doi.org/10.3390/microorganisms12010195
Journal volume & issue
Vol. 12, no. 1
p. 195

Abstract

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Few studies have evaluated the efficacy of ceftazidime–avibactam (CA) for Klebsiella pneumoniae carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients with multi-drug resistant Enterobacterales bacteremia. They were compared according to the resistance mechanism and definitive treatment provided: KPC-CPE treated with CA (G1), KPC-CPE treated with other antibiotics (G2), and patients with ESBL-producing Enterobacterales bacteremia who received appropriate definitive therapy (G3). Thirty-day mortality was evaluated using a logistic regression model, and survival was analyzed with Kaplan–Meier curves. A total of 238 patients were included: 18 (G1), 52 (G2), and 168 (G3). Klebsiella spp. (60.9%) and Escherichia coli (26.4%) were the Enterobacterales most frequently isolated, and 71% of the bacteremias had a clinical source. The resistance profile between G1 and G2 was colistin 35.3% vs. 36.5%, amikacin 16.7% vs. 40.4%, and tigeclycline 11.1% vs. 19.2%. The antibiotics prescribed in combination with G2 were carbapenems, colistin, amikacin, fosfomycin, tigecycline, and fluoroquinolones. Seven-day clinical response in G1 vs. G2 vs. G3 was 94.4% vs. 42.3% vs. 82.7%, respectively (p p p 4: OR 3.63, 95% CI, 1.18–11.14 (p = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58–30.33 (p = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01–0.08 (p < 0.001). High-risk neutropenic patients with KPC-CPE treated with CA had an outcome similar to those treated for ESBL-producing Enterobacterales, with higher 7-day clinical response and lower overall and infection-related mortality than those treated with other antibiotics. In view of these data, CA may be considered the preferred therapeutic option for KPC-PEB in high-risk neutropenic patients.

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