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

{"title":"Real-world use and treatment outcomes of ceftazidime-avibactam in gram-negative bacterial infection in Taiwan: A multicenter retrospective study","authors":"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","doi":"10.1016/j.jiph.2025.102735","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>Klebsiella pneumoniae</em> (64.4 %, 304/472), <em>Pseudomonas aeruginosa</em> (17.8 %, 84/472), <em>Escherichia coli</em> (8.3 %, 39/472), and <em>Enterobacter</em> spp<em>.</em> (2.3 %, 11/472). The overall clinical success rate is 58.1 % (274/472). The in-hospital mortality rate is 41.1 % (194/472).</div></div><div><h3>Conclusions</h3><div>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 <em>Enterobacter</em> 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.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 6","pages":"Article 102735"},"PeriodicalIF":4.7000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S187603412500084X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

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.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

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.