Ceftazidime-Avibactam Versus Polymyxin-Based Combination Therapies: A Study on 30-Day Mortality in Carbapenem-Resistant Enterobacterales Bloodstream Infections in an OXA-48-Endemic Region.

IF 4.3 2区医学 Q1 INFECTIOUS DISEASES

Antibiotics-Basel Pub Date : 2024-10-18 DOI:10.3390/antibiotics13100990

Rıdvan Dumlu, Meyha Şahin, Okan Derin, Özlem Gül, Sedef Başgönül, Rehile Zengin, Çiğdem Arabacı, Funda Şimşek, Serap Gençer, Ayşe Sesin Kocagöz, Ali Mert

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引用次数: 0

Abstract

Background: Ceftazidime-avibactam (CAZ-AVI) is recommended as first-line treatment for Oxacillinase-48 (OXA-48) β-Lactamase-producing carbapenem-resistant Enterobacterales (CRE) infections, while polymyxin-based combination therapies (PBCTs) are used as a last resort when CAZ-AVI is unavailable. Research comparing the effectiveness of CAZ-AVI and PBCT in CRE blood stream infections (CRE-BSIs) is limited, mostly focusing on Klebsiella pneumoniae carbapenemase (KPC)-producing isolates. In Turkey, OXA-48 is endemic and OXA-48-Like is common. Therefore, our study aimed to compare the impact of these treatments on 30-day mortality in patients with CRE-BSIs in endemic regions. Methods: Retrospective data from January 2019 to May 2023 were collected from four tertiary healthcare centers in Istanbul. Demographic, clinical, and outcome data of ICU patients treated with CAZ-AVI monotherapy or PBCT for CRE-BSIs were analyzed. The effect on 30-day survival was evaluated using Cox regression analysis post propensity score matching (PSM). Results: Out of 151 patients, 44.4% (n: 67) received CAZ-AVI and 55.6% (n: 84) received PBCT. All-cause mortality rates were 20% (n: 13) with CAZ-AVI and 36.9% (n: 31) with PBCT. Cox regression analysis post PSM indicated CAZ-AVI monotherapy significantly reduced the mortality risk compared to PBCT (HR: 0.16, 95%CI: 0.07-0.37, p < 0.001), while age increased the risk (HR: 1.02 per year, 95% CI 1.0-1.04, p: 0.01). Conclusions: In OXA-48-predominant areas, CAZ-AVI demonstrated significantly lower mortality in patients with CRE-BSIs compared to PBCT. The results were attributed to the pharmacokinetic and pharmacodynamic disadvantages of polymyxins compared to CAZ-AVI, and the impact of age-related physical conditions. Therefore, CAZ-AVI should be the preferred treatment for CRE-BSIs in OXA-48-endemic regions.

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头孢他啶-阿维巴坦与多粘菌素联合疗法的比较：一项关于 OXA-48 流行地区耐碳纳芬肠杆菌血流感染 30 天死亡率的研究。

背景：头孢唑肟-阿维巴坦（CAZ-AVI）被推荐为治疗产氧西林酶-48（OXA-48）β-内酰胺酶耐碳青霉烯类肠杆菌（CRE）感染的一线疗法，而多粘菌素类联合疗法（PBCT）则是在无法使用 CAZ-AVI 时的最后手段。比较 CAZ-AVI 和 PBCT 对 CRE 血流感染（CRE-BSI）疗效的研究非常有限，主要集中在产碳青霉烯酶（KPC）的肺炎克雷伯菌分离株上。在土耳其，OXA-48 是地方病，OXA-48-Like 也很常见。因此，我们的研究旨在比较这些治疗方法对流行地区 CRE-BSIs 患者 30 天死亡率的影响。研究方法从伊斯坦布尔的四家三级医疗保健中心收集了 2019 年 1 月至 2023 年 5 月的回顾性数据。分析了使用 CAZ-AVI 单药或 PBCT 治疗 CRE-BSIs 的 ICU 患者的人口统计学、临床和结果数据。采用倾向评分匹配 (PSM) 后的 Cox 回归分析评估了对 30 天生存率的影响。结果在151名患者中，44.4%（67人）接受了CAZ-AVI治疗，55.6%（84人）接受了PBCT治疗。CAZ-AVI 的全因死亡率为 20%（13 人），PBCT 为 36.9%（31 人）。PSM 后的 Cox 回归分析表明，与 PBCT 相比，CAZ-AVI 单药治疗可显著降低死亡风险（HR：0.16，95%CI：0.07-0.37，p < 0.001），而年龄会增加风险（HR：每年 1.02，95% CI 1.0-1.04，p：0.01）。结论在以 OXA-48 为主的地区，与 PBCT 相比，CAZ-AVI 可显著降低 CRE-BSIs 患者的死亡率。这一结果归因于多粘菌素与 CAZ-AVI 相比在药代动力学和药效学上的劣势，以及与年龄相关的身体状况的影响。因此，在 OXA-48 流行地区，CAZ-AVI 应作为治疗 CRE-BSIs 的首选药物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Antibiotics-Basel Pharmacology, Toxicology and Pharmaceutics-General Pharmacology, Toxicology and Pharmaceutics

CiteScore

7.30

自引率

14.60%

发文量

1547

审稿时长

11 weeks

期刊介绍： Antibiotics (ISSN 2079-6382) is an open access, peer reviewed journal on all aspects of antibiotics. Antibiotics is a multi-disciplinary journal encompassing the general fields of biochemistry, chemistry, genetics, microbiology and pharmacology. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on the length of papers.