Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-22 DOI:10.1016/j.jiph.2025.102836

Yi-Tsung Lin , Shih-Neng Lin , Chien Chuang , Szu-Yu Liu , Yu-Chien Ho , Chih-Han Juan , Hsiang-Ling Ho , Sheng-Hua Chou

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引用次数: 0

Abstract

Background

Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP bacteremia.

Methods

Patients with CZA-susceptible CRKP bacteremia who received CZA for a minimum of 5 days at our hospital from February 2020 to September 2023 were enrolled. The resistance mechanisms of the CRKP isolates were determined. Cox regression analysis was used to analyze the factors associated with 28-day mortality, and logistic regression was used to study 14-day clinical failure.

Results

A total of 135 adults who received CZA for CRKP bacteremia were identified. Among the CRKP isolates, 85 (63.0 %) were KPC-2 producers and 17 (12.6 %) were OXA-48 producers. Monotherapy with CZA was identified in 98 cases (72.5 %). The 28-day mortality rate was 28.1 %, and the 14-day clinical failure rate was 41.5 %. In multivariate analysis, 28-day mortality was positively associated with older age, malignancy, and INCREMENT score ≥8. Charlson comorbidity index and the SOFA score were independent predictors of 14-day clinical failure. Among patients with SOFA score >6, malignancy was an independent risk factor for 28-day mortality, and early initiation of CZA therapy within 4 days was a protective factor against 28-day mortality.

Conclusion

Older age, malignancy, and INCREMENT score ≥8 are predictors for mortality in CZA-susceptible CRKP bacteremia treated with CZA. Early treatment with CZA is associated with survival in patients with high disease severity.

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头孢他啶-阿维巴坦治疗对头孢他啶-阿维巴坦敏感的耐碳青霉烯肺炎克雷伯菌血症患者死亡率的危险因素

背景：头孢他啶-阿维巴坦（CZA）是耐碳青霉烯肺炎克雷伯菌（CRKP）感染的首选治疗药物。本研究旨在探讨CZA易感CRKP菌血症患者接受CZA治疗28天死亡率和14天临床失败的预后因素。方法纳入2020年2月至2023年9月在我院接受CZA治疗至少5天的CZA敏感CRKP菌血症患者。确定了CRKP分离株的耐药机制。28天死亡率相关因素采用Cox回归分析，14天临床失败相关因素采用logistic回归分析。结果135例成人因CRKP菌血症接受CZA治疗。其中，85株（63.0 %）为KPC-2产生菌，17株（12.6 %）为OXA-48产生菌。CZA单药治疗98例（72.5 %）。28天死亡率28.1 %，14天临床失败率41.5 %。在多变量分析中，28天死亡率与年龄、恶性肿瘤和INCREMENT评分≥8呈正相关。Charlson合并症指数和SOFA评分是14天临床失败的独立预测因子。在SOFA评分为>；6的患者中，恶性肿瘤是28天死亡率的独立危险因素，4天内早期开始CZA治疗是28天死亡率的保护因素。结论年龄、恶性、INCREMENT评分≥8是CZA治疗CZA敏感CRKP菌血症患者死亡率的预测因素。CZA的早期治疗与疾病严重程度高的患者的生存率相关。

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.