TY - JOUR T1 - Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae. AU - Tumbarello,Mario, AU - Trecarichi,Enrico Maria, AU - Corona,Alberto, AU - De Rosa,Francesco Giuseppe, AU - Bassetti,Matteo, AU - Mussini,Cristina, AU - Menichetti,Francesco, AU - Viscoli,Claudio, AU - Campoli,Caterina, AU - Venditti,Mario, AU - De Gasperi,Andrea, AU - Mularoni,Alessandra, AU - Tascini,Carlo, AU - Parruti,Giustino, AU - Pallotto,Carlo, AU - Sica,Simona, AU - Concia,Ercole, AU - Cultrera,Rosario, AU - De Pascale,Gennaro, AU - Capone,Alessandro, AU - Antinori,Spinello, AU - Corcione,Silvia, AU - Righi,Elda, AU - Losito,Angela Raffaella, AU - Digaetano,Margherita, AU - Amadori,Francesco, AU - Giacobbe,Daniele Roberto, AU - Ceccarelli,Giancarlo, AU - Mazza,Ernestina, AU - Raffaelli,Francesca, AU - Spanu,Teresa, AU - Cauda,Roberto, AU - Viale,Pierluigi, PY - 2018/03/28/received PY - 2018/06/06/accepted PY - 2018/6/13/pubmed PY - 2018/6/13/medline PY - 2018/6/13/entrez SP - 355 EP - 364 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 68 IS - 3 N2 - Background: Ceftazidime-avibactam (CAZ-AVI) has been approved in Europe for the treatment of complicated intra-abdominal and urinary tract infections, as well as hospital-acquired pneumonia, and for gram-negative infections with limited treatment options. CAZ-AVI displays in vitro activity against Klebsiella pneumoniae carbapenemase (KPC) enzyme producers, but clinical trial data on its efficacy in this setting are lacking. Methods: We retrospectively reviewed 138 cases of infections caused by KPC-producing K. pneumoniae (KPC-Kp) in adults who received CAZ-AVI in compassionate-use programs in Italy. Case features and outcomes were analyzed, and survival was then specifically explored in the large subcohort whose infections were bacteremic. Results: The 138 patients started CAZ-AVI salvage therapy after a first-line treatment (median, 7 days) with other antimicrobials. CAZ-AVI was administered with at least 1 other active antibiotic in 109 (78.9%) cases. Thirty days after infection onset, 47 (34.1%) of the 138 patients had died. Thirty-day mortality among the 104 patients with bacteremic KPC-Kp infections was significantly lower than that of a matched cohort whose KPC-Kp bacteremia had been treated with drugs other than CAZ-AVI (36.5% vs 55.8%, P = .005). Multivariate analysis of the 208 cases of KPC-Kp bacteremia identified septic shock, neutropenia, Charlson comorbidity index ≥3, and recent mechanical ventilation as independent predictors of mortality, whereas receipt of CAZ-AVI was the sole independent predictor of survival. Conclusions: CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/29893802/Efficacy_of_Ceftazidime_Avibactam_Salvage_Therapy_in_Patients_With_Infections_Caused_by_Klebsiella_pneumoniae_Carbapenemase_producing_K__pneumoniae_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciy492 DB - PRIME DP - Unbound Medicine ER -