Tags

Type your tag names separated by a space and hit enter

Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms.
Antimicrob Agents Chemother. 2017 02; 61(2)AA

Abstract

Ceftazidime-avibactam (CAZ-AVI) is a recently approved β-lactam-β-lactamase inhibitor combination with the potential to treat serious infections caused by carbapenem-resistant organisms. Few patients with such infections were included in the CAZ-AVI clinical trials, and clinical experience is lacking. We present a case series of patients with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) or Pseudomonas aeruginosa (CRPa) who were treated with CAZ-AVI salvage therapy on a compassionate-use basis. Physicians who had prescribed CAZ-AVI completed a case report form. We used descriptive statistics to summarize patient characteristics and treatment outcomes. We used the Wilcoxon rank sum test and Fisher's exact test to compare patients by treatment outcome. The sample included 36 patients infected with CRE and two with CRPa. The most common infections were intra-abdominal. Physicians categorized 60.5% of patients as having life-threatening infections. All but two patients received other antibiotics before CAZ-AVI, for a median of 13 days. The median duration of CAZ-AVI treatment was 16 days. Twenty-five patients (65.8%) concurrently received other antibiotics to which their pathogen was nonresistant in vitro Twenty-eight patients (73.7%, 95% confidence interval [CI], 56.9 to 86.6%) experienced clinical and/or microbiological cure. Five patients (20.8%) with documented microbiological cure died, whereas 10 patients (71.4%) with no documented microbiological cure died (P = 0.01). In three-quarters of cases, CAZ-AVI (alone or combined with other antibiotics) cured infections caused by carbapenem-resistant organisms, 95% of which had failed previous therapy. Microbiological cure was associated with improved survival. CAZ-AVI shows promising clinical results for infections for which treatment options are limited.

Authors+Show Affiliations

Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.Department of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain. Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain.Department of Infectious Disease, University Medical Center Ljubljana, Ljubljana, Slovenia.Infectious Diseases Unit, Department of Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.Infectious Diseases Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.Department of Clinical Microbiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.Department of Infectious Diseases, Hospital Universitario Reina Sofía, Córdoba, Spain. Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, Córdoba, Spain.Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain.Department of Infectious Diseases, Hospital Clínic, IDIBAPS, Barcelona University, Barcelona, Spain.Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain.Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain.Infectious Diseases Unit, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.Department of Critical Care Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain.Critical Care Department, Hospital Clínico San Carlos, Madrid, Spain.Department of Medical Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.Centre Hospitalier Universitaire Bichat-Claude Bernard, AP-HP, Paris, France. Université Paris Diderot, Paris, France.Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel yehudac@tlvmc.gov.il. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27895014

Citation

Temkin, Elizabeth, et al. "Ceftazidime-Avibactam as Salvage Therapy for Infections Caused By Carbapenem-Resistant Organisms." Antimicrobial Agents and Chemotherapy, vol. 61, no. 2, 2017.
Temkin E, Torre-Cisneros J, Beovic B, et al. Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms. Antimicrob Agents Chemother. 2017;61(2).
Temkin, E., Torre-Cisneros, J., Beovic, B., Benito, N., Giannella, M., Gilarranz, R., Jeremiah, C., Loeches, B., Machuca, I., Jiménez-Martín, M. J., Martínez, J. A., Mora-Rillo, M., Navas, E., Osthoff, M., Pozo, J. C., Ramos Ramos, J. C., Rodriguez, M., Sánchez-García, M., Viale, P., ... Carmeli, Y. (2017). Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms. Antimicrobial Agents and Chemotherapy, 61(2). https://doi.org/10.1128/AAC.01964-16
Temkin E, et al. Ceftazidime-Avibactam as Salvage Therapy for Infections Caused By Carbapenem-Resistant Organisms. Antimicrob Agents Chemother. 2017;61(2) PubMed PMID: 27895014.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Carbapenem-Resistant Organisms. AU - Temkin,Elizabeth, AU - Torre-Cisneros,Julian, AU - Beovic,Bojana, AU - Benito,Natividad, AU - Giannella,Maddalena, AU - Gilarranz,Raúl, AU - Jeremiah,Cameron, AU - Loeches,Belén, AU - Machuca,Isabel, AU - Jiménez-Martín,María José, AU - Martínez,José Antonio, AU - Mora-Rillo,Marta, AU - Navas,Enrique, AU - Osthoff,Michael, AU - Pozo,Juan Carlos, AU - Ramos Ramos,Juan Carlos, AU - Rodriguez,Marina, AU - Sánchez-García,Miguel, AU - Viale,Pierluigi, AU - Wolff,Michel, AU - Carmeli,Yehuda, Y1 - 2017/01/24/ PY - 2016/09/13/received PY - 2016/11/08/accepted PY - 2017/07/24/pmc-release PY - 2016/11/30/pubmed PY - 2017/9/20/medline PY - 2016/11/30/entrez KW - carbapenem resistance KW - case series KW - ceftazidime-avibactam JF - Antimicrobial agents and chemotherapy JO - Antimicrob. Agents Chemother. VL - 61 IS - 2 N2 - Ceftazidime-avibactam (CAZ-AVI) is a recently approved β-lactam-β-lactamase inhibitor combination with the potential to treat serious infections caused by carbapenem-resistant organisms. Few patients with such infections were included in the CAZ-AVI clinical trials, and clinical experience is lacking. We present a case series of patients with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) or Pseudomonas aeruginosa (CRPa) who were treated with CAZ-AVI salvage therapy on a compassionate-use basis. Physicians who had prescribed CAZ-AVI completed a case report form. We used descriptive statistics to summarize patient characteristics and treatment outcomes. We used the Wilcoxon rank sum test and Fisher's exact test to compare patients by treatment outcome. The sample included 36 patients infected with CRE and two with CRPa. The most common infections were intra-abdominal. Physicians categorized 60.5% of patients as having life-threatening infections. All but two patients received other antibiotics before CAZ-AVI, for a median of 13 days. The median duration of CAZ-AVI treatment was 16 days. Twenty-five patients (65.8%) concurrently received other antibiotics to which their pathogen was nonresistant in vitro Twenty-eight patients (73.7%, 95% confidence interval [CI], 56.9 to 86.6%) experienced clinical and/or microbiological cure. Five patients (20.8%) with documented microbiological cure died, whereas 10 patients (71.4%) with no documented microbiological cure died (P = 0.01). In three-quarters of cases, CAZ-AVI (alone or combined with other antibiotics) cured infections caused by carbapenem-resistant organisms, 95% of which had failed previous therapy. Microbiological cure was associated with improved survival. CAZ-AVI shows promising clinical results for infections for which treatment options are limited. SN - 1098-6596 UR - https://www.unboundmedicine.com/medline/citation/27895014/Ceftazidime_Avibactam_as_Salvage_Therapy_for_Infections_Caused_by_Carbapenem_Resistant_Organisms_ L2 - http://aac.asm.org/cgi/pmidlookup?view=long&pmid=27895014 DB - PRIME DP - Unbound Medicine ER -