Ceftazidime/avibactam experience in tertiary hospital in Türkiye

Aims: Real-life experience with ceftazidime/avibactam in the treatment of multidrug-resistant Klebsiella pneumoniae is still limited. This retrospective study aims to evaluate the efficacy of ceftazidime/avibactam in the treatment of critically ill patients with infections due to carbapenem-resistant pathogens. Methods: In our study, patients who were hospitalized in the ICUs of our hospital for more than three days between 01-01-2022 and 31-12-2022, who had only ceftazidime/avibactam susceptibility growth and were started on ceftazidime/avibactam treatment were retrospectively analyzed. 38 patients older than 18 years of age were included in the study. Results: Pneumonia was the most common cause of hospitalization in the ICU, followed by cerebrovascular events and internal diseases, respectively. The mean time from taking the culture samples to obtaining the laboratory results was 4.6 ±1.46 days. After the culture result was confirmed by the laboratory, the mean time between the patient's consultation by infection diseases specialist and initiation of treatment was 1.7±1.3 days. Patients received a mean of 10.6 ±4.63 days of CAZ-AVI treatment as monotherapy (57.9%) or combined therapy (42.1). Clinical response was obtained in 52.6% of the patients, and microbiological response was obtained in 63.2% of the patients. The 90-day all-cause mortality rate of patients receiving CAZ-AVI was 60.5% (n=23), and the mortality rate attributed to 14-day infection was 52.17%. Side effects developed in 18.4% of the patients. None of the developed side effects were such as to require discontinuation of treatment. There was no statistical difference in clinical response and microbiological response in patients receiving combination therapy and monotherapy. Mortality was significantly lower in patients receiving CAZ-AVI monotherapy (p<0.05). Conclusion: We attribute our low clinical success to the late initiation of treatment due to drug reimbursement criteria. Therefore, we think that CAZ-AVI treatment should be started empirically and as soon as possible. We think that our study is valuable in terms of showing that CAZ-AVI treatment should be given in empirical treatment.