Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection

Abstract

Background: The literature of ceftazidime-avibactam for bloodstream infections is limited, and whether meropenem (MIC ≥ 16 mg/L) can be used is also a perplexing issue for clinicians. Aim: To observe the clinical efficacy and safety of ceftazidime-avibactam combined with high dose meropenem in the treatment of extensively drug-resistant (XDR) klebsiella pneumonia (Kp) bacteremia. Methods: In 1 critically ill patient with XDR-Kp diagnosed through blood culture, tigecycline combined with cefoperazone-sulbactam and tigecycline combined with polymyxin B were successively given, and both showed poor anti-infection effects. The clinical pharmacists recommend ceftazidime-avibactam combined with high dose meropenem for anti-infection therapy. Through literature review, clinical pharmacists dynamically adjusted the dose according to the creatinine clearance rate of patients. Clinical pharmacists analyzed whether meropenem (MIC ≥ 16 mg/L) could be combined with ceftazidine-avibactam for XDR-Kp and recommended the dose of meropenem for 2g q8h and intravenous pumping for 4 hours. Results: Ceftazidime-avibactam combined with a large dose of meropenem pumped into the vein for a long time made XDR-Kp rapidly negative conversion, with clinical symptoms, signs and inflammatory indicators such as body temperature, PCT, and CRP significantly improved, without adverse reactions such as liver and kidney function. Conclusion: Ceftazidime-avibactam combined with high dose meropenem has a significant therapeutic effect on XDR-Kp and the efficacy is safe and reliable.