Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae.
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Tumbarello Mario, Trecarichi Enrico Maria, Corona Alberto, De Rosa Francesco Giuseppe, Bassetti Matteo, Mussini Cristina, Menichetti Francesco, Viscoli Claudio, Campoli Caterina, Venditti Mario, De Gasperi Andrea, Mularoni Alessandra, Tascini Carlo, Parruti Giustino, Pallotto Carlo, Sica Simona, Concia Ercole, Cultrera Rosario, De Pascale Gennaro, Capone Alessandro, Antinori Spinello, Corcione Silvia, Righi Elda, Losito Angela Raffaella, Digaetano Margherita, Amadori Francesco, Giacobbe Daniele Roberto, Ceccarelli Giancarlo, Mazza Ernestina, Raffaelli Francesca, Spanu Teresa, Cauda Roberto, Viale Pierluigi
Аннотация
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.