Ceftazidime-avibactam in the treatment of infections caused by KPC-producing Klebsiella pneumoniae: factors associated with clinical efficacy in a single-center cohort.
Aged
Azabicyclo Compounds
/ therapeutic use
Bacterial Proteins
/ metabolism
Carbapenem-Resistant Enterobacteriaceae
/ drug effects
Ceftazidime
/ therapeutic use
Drug Combinations
Drug Resistance, Bacterial
/ physiology
Female
Humans
Klebsiella Infections
/ drug therapy
Klebsiella pneumoniae
/ drug effects
Male
Middle Aged
Retrospective Studies
Spain
Treatment Outcome
beta-Lactamases
/ metabolism
Carbapenemase
Ceftazidime-avibactam
Clinical failure
KPC-producing Klebsiella pneumoniae
Journal
International journal of antimicrobial agents
ISSN: 1872-7913
Titre abrégé: Int J Antimicrob Agents
Pays: Netherlands
ID NLM: 9111860
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
04
09
2019
revised:
09
01
2020
accepted:
28
06
2020
pubmed:
7
7
2020
medline:
20
5
2021
entrez:
7
7
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 32629116
pii: S0924-8579(20)30245-4
doi: 10.1016/j.ijantimicag.2020.106075
pii:
doi:
Substances chimiques
Azabicyclo Compounds
0
Bacterial Proteins
0
Drug Combinations
0
avibactam, ceftazidime drug combination
0
Ceftazidime
9M416Z9QNR
beta-lactamase KPC-1
EC 3.5.2.-
beta-Lactamases
EC 3.5.2.6
carbapenemase
EC 3.5.2.6
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
106075Informations de copyright
Copyright © 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.