Antibiotics (Apr 2023)

Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study

  • Laura Campogiani,
  • Pietro Vitale,
  • Alessandra Lodi,
  • Alessandra Imeneo,
  • Carla Fontana,
  • Cartesio D’Agostini,
  • Mirko Compagno,
  • Luigi Coppola,
  • Ilaria Spalliera,
  • Vincenzo Malagnino,
  • Elisabetta Teti,
  • Marco Iannetta,
  • Massimo Andreoni,
  • Loredana Sarmati

DOI
https://doi.org/10.3390/antibiotics12050820
Journal volume & issue
Vol. 12, no. 5
p. 820

Abstract

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Background: Ceftazidime/avibactam (CAZ-AVI) resistance amongst Enterobacterales is worryingly increasing worldwide. Objectives: The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant Klebsiella pneumoniae (KP) isolates in our University Hospital, with the ultimate goal of evaluating possible risk factors related to the acquisition of resistance. Methods: This is a retrospective observational study, including unique Klebsiella pneumoniae (KP) isolates resistant to CAZ-AVI (CAZ-AVI-R) and producing only KPC, collected from July 2019 to August 2021 at Policlinico Tor Vergata, Rome, Italy. The pathogen’s list was obtained from the microbiology laboratory; clinical charts of the corresponding patients were reviewed to collect demographic and clinical data. Subjects treated as outpatients or hospitalized for Results: Forty-six unique isolates corresponding to 46 patients were included in the study. The majority of patients (60.9%) were hospitalized in an intensive care unit, 32.6% in internal medicine wards and 6.5% in surgical wards. A total of 15 (32.6%) isolates were collected from rectal swabs, representing a colonization. Amongst clinically relevant infections, pneumonia and urinary tract infections were the most commonly found (5/46, 10.9% each). Half of the patients received CAZ-AVI prior to isolation of the KP-KPC CAZ-AVI-R (23/46). This percentage was significantly higher in patients in the S group compared to patients in the R group (69.3% S group vs. 25% R group, p = 0.003). No differences between the two groups were documented in the use of renal replacement therapy or in the infection site. The clinically relevant CAZ-AVI-R KP infections (22/46, 47.8%) were all treated with a combination therapy, 65% including colistin and 55% including CAZ-AVI, with an overall clinical success of 38.1%. Conclusions: Prior use of CAZ-AVI was associated with the emergence of drug resistance.

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