Real-world use and treatment outcomes of ceftazidime-avibactam in gram-negative bacterial infection in Taiwan: A multicenter retrospective study

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-03-06 DOI:10.1016/j.jiph.2025.102735

Tsung-Ying Yang , Ching-Tai Huang , Po-Yu Liu , Yi-Tsung Lin , Yu-Shan Huang , Peng-Hao Chang , Chien-Hao Tseng , Ya-Ting Chang , Po-Liang Lu , Yee-Chun Chen

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引用次数: 0

Abstract

Objectives

Ceftazidime-avibactam (CAZ-AVI) has been launched in Asian countries for five years, but local real-world data about patient characteristics, efficacy, and safety of CAZ-AVI is limited. We conducted a multicenter, retrospective study to investigate the clinical characteristics, microbiology, and outcomes of patients treated with CAZ-AVI for Gram-negative bacterial infection in Taiwan.

Methods

This investigation was conducted as a multicenter retrospective cohort study involving five medical centers in Taiwan. Adult patients with documented/suspected Gram-negative bacterial infection and received ≥ 24 hours of CAZ-AVI were eligible for study cohort enrollment. In-hospital mortality was defined as the primary outcome, while symptom resolution or significant improvement, considered the secondary outcome, was defined as clinical success.

Results

Among the 472 patients treated by CAZ-AVI, 46.2 % (218/472) had respiratory tract infections, 22.0 % (104/472) had complicated urinary tract infections, 14.0 % (66/472) had complicated intra-abdominal infections, and 10.0 % (47/472) had primary bacteremia. Most patients receiving ceftazidime/avibactam in Taiwan are old (mean: 70.6 years old), have a high SOFA score (mean 8.4), and have a high Charlson Comorbidity Index score (345/472, 73.1 % ≥ 4). 90 % of CAZ-AVI were used as targeted therapy for pathogens, including Klebsiella pneumoniae (64.4 %, 304/472), Pseudomonas aeruginosa (17.8 %, 84/472), Escherichia coli (8.3 %, 39/472), and Enterobacter spp. (2.3 %, 11/472). The overall clinical success rate is 58.1 % (274/472). The in-hospital mortality rate is 41.1 % (194/472).

Conclusions

Most patients receiving CAZ-AVI as targeted therapy in Taiwan with characteristics of older age, high SOFA scores, and high CCI scores. Receiving immunomodulators, higher SOFA score, and Enterobacter spp. infections were the significant factors associated with in-hospital mortality, whereas early initiating CAZ-AVI treatment and CAZ-AVI monotherapy are associated with better outcome.

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头孢他啶-阿维巴坦在台湾革兰氏阴性细菌感染中的实际使用和治疗效果：一项多中心回顾性研究

目的头孢他啶-阿维巴坦（CAZ-AVI）已在亚洲国家上市5年，但当地关于CAZ-AVI患者特征、疗效和安全性的真实数据有限。我们进行了一项多中心的回顾性研究，探讨台湾地区接受CAZ-AVI治疗的革兰氏阴性细菌感染患者的临床特征、微生物学和预后。方法采用多中心回顾性队列研究，涉及台湾5个医疗中心。确诊/疑似革兰氏阴性细菌感染且接受≥ 24 小时CAZ-AVI治疗的成年患者符合入选研究队列的条件。住院死亡率被定义为主要结局，而症状缓解或显著改善被认为是次要结局，被定义为临床成功。结果472例患者中，46.2% %（218/472）存在呼吸道感染，22.0% %（104/472）存在并发尿路感染，14.0% %（66/472）存在并发腹腔内感染，10.0% %（47/472）存在原发性菌血症。台湾接受头孢他嗪/阿维巴坦治疗的患者多为老年人（平均70.6岁），SOFA评分高（平均8.4分），Charlson共病指数评分高（345/472,73.1 %≥4）。90% %的CAZ-AVI用于病原菌的靶向治疗，包括肺炎克雷伯菌（64.4 %,304/472）、铜绿假单胞菌（17.8 %,84/472）、大肠杆菌（8.3 %,39/472）和肠杆菌（2.3 %,11/472）。总体临床成功率为58.1% %（274/472）。住院死亡率为41.1 %（194/472）。结论台湾地区接受CAZ-AVI靶向治疗的患者以年龄较大、SOFA评分较高、CCI评分较高为特点。接受免疫调节剂、较高的SOFA评分和肠杆菌感染是与住院死亡率相关的重要因素，而早期开始CAZ-AVI治疗和CAZ-AVI单药治疗与更好的结果相关。

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

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.