Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae.
INCREMENT-SOT project
bloodstream infections
carbapenem-resistant Klebsiella pneumoniae
ceftazidime-avibactam
solid-organ transplantation
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
31
01
2023
accepted:
14
03
2023
medline:
4
7
2023
pubmed:
8
4
2023
entrez:
7
4
2023
Statut:
ppublish
Résumé
We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.
Identifiants
pubmed: 37028515
pii: S1600-6135(23)00354-4
doi: 10.1016/j.ajt.2023.03.011
pii:
doi:
Substances chimiques
avibactam, ceftazidime drug combination
0
carbapenemase
EC 3.5.2.6
Anti-Bacterial Agents
0
Drug Combinations
0
Banques de données
ClinicalTrials.gov
['NCT02852902']
Types de publication
Observational Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1022-1034Investigateurs
Mical Paul
(M)
Jordi Carratala
(J)
Isabel Oriol
(I)
Regino José Rodríguez-Álvarez
(RJ)
Elisa Cordero
(E)
José Antonio Lepe
(JA)
Esperanza Merino de Lucas
(EM)
Patricia Muñoz
(P)
Jesús Fortún
(J)
Julien Coussement
(J)
Laurent Dewispelaere
(L)
Britt Marie Eriksson
(BM)
Christian van Delden
(C)
Oriol Manuel
(O)
Wanessa T Clemente
(WT)
Tania Mara Varejão Strabelli
(TMV)
Benoit Pilmis
(B)
Emmanuel Roilides
(E)
Iyer Ranganathan N
(I)
Paolo A Grossi
(PA)
Fabio Soldani
(F)
Marco Rizzi
(M)
Ban Hock Tan
(BH)
Warren Lowman
(W)
Filiz Gunseren
(F)
Hande Arslan
(H)
Zeliha Koçak Tufan
(ZK)
Esra Kazak
(E)
Miruna D David
(MD)
Seema Mehta Steinke
(SM)
Darin Ostrander
(D)
Robin Avery
(R)
Erika D Lease
(ED)
Informations de copyright
Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.