Ceftazidime-Avibactam Effectiveness in Carbapenem-Resistant Enterobacterales Bacteremia: A Retrospective Cohort Study in Korea.

BACKGROUND

Carbapenem-resistant Enterobacterales (CRE) infections pose a global health concern owing to their increasing incidence and limited treatment options. Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising therapeutic option, with some studies reporting improved outcomes in CRE bacteremia. However, evidence regarding its survival benefit remains unclear, particularly in Korea. In this retrospective cohort study, we compared the effectiveness of CAZ-AVI with the best available therapy (BAT) in patients with CRE bacteremia.

METHODS

We included adult patients with CRE bacteremia treated at a tertiary hospital between January 2022 and July 2024. Patients were grouped based on receipt of CAZ-AVI within 5 days of blood culture versus the BAT. The 14-day mortality was compared between the two groups using Pearson's χ² test and the log-rank test. Multivariable Cox regression was performed to evaluate the independent association between CAZ-AVI use and 14-day mortality.

RESULTS

Among 194 patients, 32 (16.5%) and 162 (83.5%) received CAZ-AVI and BAT for CRE bacteremia, respectively. The 14-day mortality rate was significantly lower in the CAZ-AVI group than in the BAT group (12.5% vs. 32.1%, P = 0.043). Kaplan-Meier analysis showed improved 14-day survival with CAZ-AVI (log-rank test, P = 0.027). Multivariable analysis showed that CAZ-AVI use (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.12-0.98; P = 0.046) was significantly associated with reduced mortality, whereas chronic kidney disease (HR, 2.23; 95% CI, 1.09-4.59; P = 0.029), Pitt bacteremia score (HR, 1.10; 95% CI, 1.01-1.20; P = 0.027), and neutropenia (HR, 2.28; 95% CI, 1.00-5.19; P = 0.049) were associated with increased mortality.

CONCLUSION

CAZ-AVI use was associated with improved survival in CRE bacteremia and can be considered for therapy.