Clinical Experience with Ceftazidime-Avibactam for the Treatment of Infections due to Multidrug-Resistant Gram-Negative Bacteria Other than Carbapenem-Resistant <em>Enterobacterales</em>
Antonio Vena,
Daniele Roberto Giacobbe,
Nadia Castaldo,
Annamaria Cattelan,
Cristina Mussini,
Roberto Luzzati,
Francesco Giuseppe De Rosa,
Filippo Del Puente,
Claudio Maria Mastroianni,
Antonio Cascio,
Sergio Carbonara,
Alessandro Capone,
Silvia Boni,
Chiara Sepulcri,
Marianna Meschiari,
Francesca Raumer,
Alessandra Oliva,
Silvia Corcione,
Matteo Bassetti,
for the Ceftabuse Study Group
Affiliations
Antonio Vena
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy
Daniele Roberto Giacobbe
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy
Nadia Castaldo
Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine 33100, Italy
Annamaria Cattelan
Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera−Universitaria di Padova, Padua 35128, Italy
Cristina Mussini
Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena 41121, Italy
Roberto Luzzati
Infectious Diseases Unit, University Hospital of Trieste, Trieste 34127, Italy
Francesco Giuseppe De Rosa
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin 10124, Italy
Filippo Del Puente
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy
Claudio Maria Mastroianni
Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Sapienza University of Rome, Rome 00185, Italy
Antonio Cascio
Department of Health Promotion Sciences, Mother and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo 90133, Italy
Sergio Carbonara
Clinic of Infectious Diseases, University Hospital of Bari Consorziale Policlinico, Bari 70121, Italy
Alessandro Capone
Clinical Department, National Institute for Infectious Diseases “L. Spallanzani”, Rome 00149, Italy
Silvia Boni
Divisione di Malattie Infettive, Ospedale Sant’Andrea, La Spezia 19121, Italy
Chiara Sepulcri
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy
Marianna Meschiari
Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena 41121, Italy
Francesca Raumer
Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera−Universitaria di Padova, Padua 35128, Italy
Alessandra Oliva
Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Sapienza University of Rome, Rome 00185, Italy
Silvia Corcione
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin 10124, Italy
Matteo Bassetti
Department of Health Sciences, Infectious Disease Clinic, University of Genoa, Genoa 16132, Italy
Background: Experience in real clinical practice with ceftazidime-avibactam for the treatment of serious infections due to gram−negative bacteria (GNB) other than carbapenem-resistant Enterobacterales (CRE) is very limited. Methods: We carried out a retrospective multicenter study of patients hospitalized in 13 Italian hospitals who received ≥72 h of ceftazidime-avibactam for GNB other than CRE to assess the rates of clinical success, resistance development, and occurrence of adverse events. Results: Ceftazidime-avibactam was used to treat 41 patients with GNB infections other than CRE. Median age was 62 years and 68% of them were male. The main causative agents were P. aeruginosa (33/41; 80.5%) and extended spectrum beta lactamase (ESBL)-producing Enterobacterales (4/41, 9.8%). Four patients had polymicrobial infections. All strains were susceptible to ceftazidime-avibactam. The most common primary infection was nosocomial pneumonia (n = 20; 48.8%), primary bacteremia (n = 7; 17.1%), intra-abdominal infection (n = 4; 9.8%), and bone infection (n = 4; 9.8%). Ceftazidime-avibactam was mainly administered as a combination treatment (n = 33; 80.5%) and the median length of therapy was 13 days. Clinical success at the end of the follow-up period was 90.5%, and the only risk factor for treatment failure at multivariate analysis was receiving continuous renal replacement therapy during ceftazidime-avibactam. There was no association between clinical failures and type of primary infection, microbiological isolates, and monotherapy with ceftazidime-avibactam. Only one patient experienced recurrent infection 5 days after the end of treatment. Development of resistance to ceftazidime-avibactam was not detected in any case during the whole follow-up period. No adverse events related to ceftazidime-avibactam were observed in the study population. Conclusions: Ceftazidime-avibactam may be a valuable therapeutic option for serious infections due to GNB other than CRE.
