头孢他啶-阿维巴坦与以碳青霉烯为基础的方案治疗医院耐碳青霉烯肺炎克雷伯菌血液感染的有效性比较。

IF 3.7 2区医学 Q2 IMMUNOLOGY

Journal of Microbiology Immunology and Infection Pub Date : 2025-03-04 DOI:10.1016/j.jmii.2025.03.003

Ruei-Chang Huang , Li-Ying Chen , Ying-Chuan Wang , Chun-Hsiang Chiu

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引用次数: 0

摘要

背景：碳青霉烯耐药肺炎克雷伯菌血流感染（CRKP BSI）与高死亡率和有限的治疗方案相关。本研究比较了头孢他啶-阿维巴坦和以碳青霉烯为基础的方案治疗院内CRKP BSI患者的结果。方法：这是一项单中心、回顾性、观察性研究，分析了2018年1月至2023年12月成人院内CRKP BSI患者。患者分为头孢他啶-阿维巴坦组（n = 47）和碳青霉烯组（n = 54）。主要结局包括7天、14天、21天和28天的死亡率、微生物治愈率和住院时间。进行多变量分析以确定与死亡率相关的因素。结果：经Kaplan-Meier分析，头孢他啶-阿维巴坦组7天死亡率（8.51% vs. 25.93%, p = 0.043）显著降低，生存率显著提高（p = 0.021）。多因素分析显示头孢他啶-阿维巴坦显著降低7天死亡率（校正风险比：0.182,95% CI: 0.050-0.660, p = 0.010）。白血病显著增加了7天死亡率和全因死亡率。白细胞计数和c反应蛋白水平升高与死亡风险增加有关。结论：与以碳青霉烯为基础的方案相比，头孢他啶-阿维巴坦在治疗医院性CRKP BSI方面具有更优越的短期生存益处。然而，长期结果更多地受到基础条件和炎症状态的影响。

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Effectiveness comparison between ceftazidime-avibactam and carbapenem-based regimens in nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Background

Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP BSI) are associated with high mortality rates and limited treatment options. This study compared the outcomes between ceftazidime-avibactam and carbapenem-based regimens in patients with nosocomial CRKP BSI.

Methods

This is a single-center, retrospective, observational study that analyzed adult patients with nosocomial CRKP BSI from January 2018 to December 2023. Patients were divided into ceftazidime-avibactam (n = 47) and carbapenem-based regimen (n = 54) groups. Primary outcomes included 7-, 14-, 21-, and 28-day mortality rates, microbiological cure rates, and length of hospital stay. Multivariate analysis was performed to identify factors associated with mortality.

Results

The ceftazidime-avibactam group showed significantly lower 7-day mortality (8.51 % vs. 25.93 %, p = 0.043) and higher survival rates in Kaplan-Meier analysis (p = 0.021). Multivariate analysis revealed that ceftazidime-avibactam significantly reduced 7-day mortality (adjusted hazard ratio: 0.182, 95 % CI: 0.050–0.660, p = 0.010). Leukemia significantly increased both 7-day and all-cause mortality. Elevated white blood cell counts, and C-reactive protein levels were associated with increased mortality risk.

Conclusion

Ceftazidime-avibactam demonstrated superior short-term survival benefits compared to carbapenem-based regimens in treating nosocomial CRKP BSI. However, long-term outcomes were more influenced by underlying conditions and inflammatory status.

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来源期刊

Journal of Microbiology Immunology and Infection IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

15.90

自引率

5.40%

发文量

159

审稿时长

67 days

期刊介绍： Journal of Microbiology Immunology and Infection is an open access journal, committed to disseminating information on the latest trends and advances in microbiology, immunology, infectious diseases and parasitology. Article types considered include perspectives, review articles, original articles, brief reports and correspondence. With the aim of promoting effective and accurate scientific information, an expert panel of referees constitutes the backbone of the peer-review process in evaluating the quality and content of manuscripts submitted for publication.