Mortality and clinical outcomes of ceftazidime/avibactam vs best available therapy in treating carbapenem-resistant enterobacterales infections: A retrospective cohort study

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-05-09 DOI:10.1016/j.cegh.2025.102061

Nada Alhamed , Mai Hashhoush , Raghad Al-Omari , Marwa Alomani , Reem S. AlOmar

{"title":"Mortality and clinical outcomes of ceftazidime/avibactam vs best available therapy in treating carbapenem-resistant enterobacterales infections: A retrospective cohort study","authors":"Nada Alhamed , Mai Hashhoush , Raghad Al-Omari , Marwa Alomani , Reem S. AlOmar","doi":"10.1016/j.cegh.2025.102061","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The epidemiology of infectious diseases shows that antimicrobial resistance (AMR) is a global health issue. This study aimed to compare 14-day mortality in patients with confirmed Carbapenem-resistant Enterobacterales (CRE) infections treated with Ceftazidime/Avibactam (CAZ-AVI) to the best available therapies (BAT) in the Kingdom of Saudi Arabia where there is a predominance of the OXA-48 gene.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients with confirmed CRE infections treated with CAZ-AVI or BAT between 2018 and 2021. The Cox proportional hazards model was applied to derive both unadjusted and adjusted hazard ratios for 14-days and 30-day mortality. Bivariate analyses included chi-squared tests for categorical data, t-tests and Mann-Whitney tests for continuous data.</div></div><div><h3>Results</h3><div>The study included 157 patients; of those, 88 (56 %) were males, 63 (40.1 %) had malignancy, and the mean age was 54.85 years. Seventy (44.59 %) received CAZ-AVI. Bacteraemia (28 %) and urinary tract infections (27.3 %) were the most common sources. Klebsiella pneumonia (126, 80.25 %) was the predominant pathogen, with OXA-48 gene identified in 35.67 % of cases. The risk of 14-day mortality for patients treated with Ceftazidime/Avibactam was significantly lower compared to patients treated with the best available therapies (adjusted HR = 0.45, 95 % CI = 0.22–0.92).</div></div><div><h3>Conclusion</h3><div>CRE represents a global threat and is associated with high mortality and morbidity. Ceftazidime/Avibactam was associated with a lower risk of 14-day mortality in patients treated for CRE infections. Larger-scale prospective trials to confirm the outcomes of this study are needed.</div></div>","PeriodicalId":46404,"journal":{"name":"Clinical Epidemiology and Global Health","volume":"34 ","pages":"Article 102061"},"PeriodicalIF":2.3000,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Epidemiology and Global Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213398425001502","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The epidemiology of infectious diseases shows that antimicrobial resistance (AMR) is a global health issue. This study aimed to compare 14-day mortality in patients with confirmed Carbapenem-resistant Enterobacterales (CRE) infections treated with Ceftazidime/Avibactam (CAZ-AVI) to the best available therapies (BAT) in the Kingdom of Saudi Arabia where there is a predominance of the OXA-48 gene.

Methods

This retrospective cohort study included adult patients with confirmed CRE infections treated with CAZ-AVI or BAT between 2018 and 2021. The Cox proportional hazards model was applied to derive both unadjusted and adjusted hazard ratios for 14-days and 30-day mortality. Bivariate analyses included chi-squared tests for categorical data, t-tests and Mann-Whitney tests for continuous data.

Results

The study included 157 patients; of those, 88 (56 %) were males, 63 (40.1 %) had malignancy, and the mean age was 54.85 years. Seventy (44.59 %) received CAZ-AVI. Bacteraemia (28 %) and urinary tract infections (27.3 %) were the most common sources. Klebsiella pneumonia (126, 80.25 %) was the predominant pathogen, with OXA-48 gene identified in 35.67 % of cases. The risk of 14-day mortality for patients treated with Ceftazidime/Avibactam was significantly lower compared to patients treated with the best available therapies (adjusted HR = 0.45, 95 % CI = 0.22–0.92).

Conclusion

CRE represents a global threat and is associated with high mortality and morbidity. Ceftazidime/Avibactam was associated with a lower risk of 14-day mortality in patients treated for CRE infections. Larger-scale prospective trials to confirm the outcomes of this study are needed.

查看原文本刊更多论文

头孢他啶/阿维巴坦治疗耐碳青霉烯肠杆菌感染的死亡率和临床结果：一项回顾性队列研究

目的传染病流行病学表明，抗生素耐药性（AMR）是一个全球性的卫生问题。本研究旨在比较沙特阿拉伯王国OXA-48基因占优势的Ceftazidime/Avibactam （CAZ-AVI）治疗的确诊碳青霉烯耐药肠杆菌（CRE）感染患者的14天死亡率。方法本回顾性队列研究纳入2018年至2021年间接受CAZ-AVI或BAT治疗的确诊CRE感染的成年患者。应用Cox比例风险模型推导14天和30天死亡率的未调整和调整风险比。双变量分析包括分类数据的卡方检验，连续数据的t检验和Mann-Whitney检验。结果纳入157例患者；其中男性88例（56%），恶性肿瘤63例（40.1%），平均年龄54.85岁。70例（44.59%）接受CAZ-AVI治疗。菌血症（28%）和尿路感染（27.3%）是最常见的来源。主要病原菌为肺炎克雷伯菌（126,80.25%），检出OXA-48基因的占35.67%。接受头孢他啶/阿维巴坦治疗的患者14天死亡风险显著低于接受最佳可用治疗的患者（调整后HR = 0.45, 95% CI = 0.22-0.92）。结论cre是一种全球性威胁，具有高死亡率和高发病率。头孢他啶/阿维巴坦与接受CRE感染治疗的患者14天死亡率降低相关。需要更大规模的前瞻性试验来证实本研究的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.