The place of ceftazidime/avibactam and ceftolozane/tazobactam for therapy of haematological patients with febrile neutropenia.
Adult
Aged
Allografts
Anti-Bacterial Agents
/ therapeutic use
Autografts
Azabicyclo Compounds
/ therapeutic use
Bacteremia
/ complications
Carbapenems
/ pharmacology
Ceftazidime
/ therapeutic use
Cephalosporins
/ therapeutic use
Drug Combinations
Drug Resistance, Multiple, Bacterial
Febrile Neutropenia
/ complications
Female
Gram-Negative Bacteria
/ drug effects
Gram-Negative Bacterial Infections
/ complications
Humans
Male
Middle Aged
Retrospective Studies
Tazobactam
/ therapeutic use
Treatment Outcome
Young Adult
Ceftazidime/avibactam
Ceftolozane/tazobactam
Empirical therapy of febrile neutropenia
Haematopoietic stem cell transplantation
Multi-drug resistant Gram-negative blood-stream infections
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:
Jun 2021
Jun 2021
Historique:
received:
13
03
2020
revised:
22
01
2021
accepted:
27
03
2021
pubmed:
11
4
2021
medline:
5
10
2021
entrez:
10
4
2021
Statut:
ppublish
Résumé
To evaluate ceftazidime/avibactam (C/A) and ceftolozane/tazobactam (C/T) use in haematological patients with febrile neutropenia receiving high-dose chemotherapy and haematopoietic stem cell transplantation (HSCT). A retrospective study was conducted to assess C/A and C/T efficacy through infection-related mortality (IRM) and bacteraemia clearance for carbapenem-resistant Gram-negative bacteria (CR-GNB) pre-engraftment blood-stream infections (PE-BSIs) between January-December 2018. Seventy patients underwent allogeneic HSCT: C/A and C/T were dispensed in 13% and 3%, respectively. C/A was administered as definite therapy for carbapenem-resistant Klebsiella pneumoniae (CR-Kp) PE-BSI in four carriers (bacteraemia clearance in 5 days), empirical therapy for a clinically documented infection in two patients (one carrier with pneumonia and one non-carrier with shock) and empirical therapy for fever of unknown origin in three CR-Kp carriers. C/T was administered as definite therapy for carbapenem-resistant Pseudomonas aeruginosa (CR-Pa) intra-abdominal infection in one carrier and empirical therapy for a clinically documented infection (pneumonia) in one non-carrier. Among patients without PE-BSIs and with Gram-positive bacteria PE-BSIs, IRM was 0% at +30 days; conversely, it was 30% in GNB PE-BSIs (two CR-Kp and one CR-Pa C/T-resistant). Thirty-nine patients underwent autologous HSCT: C/A and C/T were administered, respectively, as definite therapy for CR-Kp PE-BSI in one carrier (bacteraemia clearance in 3 days) and for Pa PE-BSI (three strains, one CR-Pa) in one non-carrier (bacteraemia clearance in 2 days). Overall, IRM at +30 days was 0%. Monitoring multidrug-resistant GNB colonisation enabled selection of carriers who benefit from prompt administration of new antibiotics, improving HSCT outcomes in a high-risk population. C/A and C/T were effective in bacteraemia clearance; unfortunately, multidrug-resistant GNB PE-BSIs were still a burden to IRM.
Identifiants
pubmed: 33838223
pii: S0924-8579(21)00072-8
doi: 10.1016/j.ijantimicag.2021.106335
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Azabicyclo Compounds
0
Carbapenems
0
Cephalosporins
0
Drug Combinations
0
avibactam, ceftazidime drug combination
0
ceftolozane, tazobactam drug combination
0
Ceftazidime
9M416Z9QNR
Tazobactam
SE10G96M8W
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106335Informations de copyright
Copyright © 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.