Experience in Ceftazidime-Avibactam for treatment of MDR BGN infection in Oncologic Children

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases Pub Date : 2025-02-21 DOI:10.1016/j.bjid.2025.104515

Wilson Toyohiro Hoshino , Adriana Maria Paixão De Sousa da Silva , Antonio Carlos Pignatari , Ana Cristina Gales , Fabianne Carlesse

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引用次数: 0

Abstract

Background

Ceftazidime-Avibactam (CAZ-AVI) plays a key role in the treatment of Multidrug Resistant Gram-Negative Bacilli (MDR-GNB) infections. In pediatrics, CAZ-AVI is clinically approved for treatment of urinary tract or intra-abdominal infection. However, there is limited data available about its use in children with cancer who have complicated infections caused by MDR-GNB.

Objective

This study aims to describe our experience in using CAZ-AVI for the treatment of MDR GNB infections in children with cancer.

Methods

This retrospective observational study was conducted at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP), including pediatric oncologic patients who received CAZ-AVI for the treatment of infections caused by GNB.

Results

From Jan/2021 to Jun/2022, 11 patients with 13 episodes were included in the analysis. Among them, 45 % were female, with a median age of 7 years. Three patients had Acute lymphoblastic Leukemia (ALL), three had Acute Myeloid Leukemia (AML), two had Non-Hodgkin Lymphoma (NHL). Additionally, there was one case each of medulloblastoma, fibrosarcoma, and craniopharyngioma. All patients presented significant risk factors for MDR-GNB, such as neutropenia and two were submitted to Hematopoietic Stem Cell Transplantation (HSCT). The infection episodes included six Bloodstream Infections (BSI), two Urinary Tract Infections (UTI), two tracheobronchitis cases, along with one case each of necrotizing pneumonia, ventriculitis, and endocarditis. The identified pathogens included Klebsiella pneumoniae, Pseudomonas spp., Enterobacter cloacae, and Stenotrophomonas maltophilia. The primary reason for prescribing CAZ-AVI was either Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection or clinical worsening after initial therapy. Combination therapy was prescribed in eight episodes with a median prescription length of nine days. Microbiological sterilization was achieved in 92 % of episodes, and the 30-day survival rate was 84 %. Notably, no deaths were associated with treatment failure, and no adverse events associated with CAZ-AVI use were observed.

Conclusion

CAZ-AVI could be used for treating GNB infections in oncologic pediatric patients.

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头孢他啶-阿维巴坦治疗肿瘤儿童耐多药BGN感染的经验

背景头孢他啶-阿维巴坦（CAZ-AVI）在治疗耐多药革兰氏阴性杆菌（MDR-GNB）感染中发挥着关键作用。在儿科，CAZ-AVI被临床批准用于治疗尿路或腹腔感染。然而，关于它在患有耐多药- gnb引起的并发感染的癌症儿童中的应用的数据有限。目的本研究旨在描述我们使用CAZ-AVI治疗癌症儿童耐多药GNB感染的经验。方法本回顾性观察性研究在儿科肿瘤研究所（IOP/GRAACC/UNIFESP）进行，包括接受CAZ-AVI治疗GNB感染的儿科肿瘤患者。结果从2021年1月至2022年6月，11例患者13次发作纳入分析。其中女性占45%，中位年龄为7岁。3例为急性淋巴细胞白血病（ALL）， 3例为急性髓系白血病（AML）， 2例为非霍奇金淋巴瘤（NHL）。髓母细胞瘤、纤维肉瘤、颅咽管瘤各1例。所有患者均存在耐多药gnb的显著危险因素，如中性粒细胞减少症，其中2例接受了造血干细胞移植（HSCT）。感染事件包括6例血流感染（BSI）， 2例尿路感染（UTI）， 2例气管支气管炎，以及坏死性肺炎、脑室炎和心内膜炎各1例。病原菌包括肺炎克雷伯菌、假单胞菌、阴沟肠杆菌和嗜麦芽窄养单胞菌。开CAZ-AVI的主要原因是耐多药革兰氏阴性菌（MDR-GNB）感染或初始治疗后临床恶化。联合治疗共8次，平均处方时间为9天。微生物灭菌率达到92%，30天生存率为84%。值得注意的是，没有观察到与治疗失败相关的死亡，也没有观察到与CAZ-AVI使用相关的不良事件。结论caz - avi可用于治疗小儿肿瘤患者GNB感染。

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

Brazilian Journal of Infectious Diseases 医学-传染病学

CiteScore

5.50

自引率

0.00%

发文量

925

审稿时长

41 days

期刊介绍： The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents. The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor, since its inception it has garnered a growing share of the publishing market.