头孢他啶-阿维巴坦联合氨曲南与其他活性抗生素对产金属β-内酰胺酶肠杆菌菌血症死亡率的影响：一项多中心靶点试验模拟

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-07-05 DOI:10.1016/j.lana.2025.101175

Ivan Alfredo Huespe , Emilio Felipe Huaier Arriazu , Marisa Sanchez , Vanina Stanek , Javier Alberto Pollán , Susana Bauque , Débora Ávila Poletti , Verónica Monzón , Paola Novelli Poisson , María Virginia Boutet , Eleonora Cunto , Viviana Chediack , Melina Tatiana Beloso , Victoria Rucci , Marina Lagostena , Ricardo Cabrera , María José Gutiérrez , María Georgina Gómez , Sebastián Gabriel Arias , Clarisa Taffarel , Pascual Valdez

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引用次数: 0

摘要

由产生金属β-内酰胺酶（MBL）的肠杆菌引起的菌血症是一个严峻的挑战，因为它们的治疗选择有限。虽然头孢他啶-阿维巴坦（CAZAVI）联合氨曲南（ATM）已显示出体外疗效，但尚未有研究严格比较其与其他活性抗生素（OAAs）的临床疗效。本研究旨在评估CAZAVI + ATM与OAAs在MBL菌血症大队列中的疗效和安全性。方法2016年1月至2024年10月在阿根廷17家医院进行回顾性、多中心、目标试验模拟。确诊为MBL菌血症的患者，在MBL确诊24小时内开始积极抗生素治疗，并在96小时内采血。使用治疗加权逆概率（IPTW）来减少指征偏倚，并分析了阿根廷公共、私营和社会保障卫生系统内的医院聚类。主要结局是30天全因死亡率，次要结局包括临床失败（复发、并发症或死亡）和不良事件。结果243例患者中（CAZAVI + ATM组93例，OAA组150例），CAZAVI + ATM组30天死亡率为35%，OAA组为47%(校正优势比[OR] 0.63, 95% CI 0.43 ~ 0.91, p <；0·01)。CAZAVI + ATM组临床失败发生率为46%，OAA组为53%(校正风险比[HR] 0.65, 95% CI 0.44 - 0.97；P = 0·03)。CAZAVI + ATM组不良事件发生率较低（9.6%比22.8%,p = 0.014）。这些发现表明，与oaa相比，在mbl型肠杆菌菌血症患者中，CAZAVI + ATM可能与更低的死亡率、更少的临床失败和更少的不良事件有关。需要进一步的前瞻性研究来证实这些观察结果。本研究未获特别资助。

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Mortality of metallo-β-lactamase-producing Enterobacterales bacteremias with combined ceftazidime–avibactam plus aztreonam vs. other active antibiotics: a multicenter target trial emulation

Background

Bacteremias caused by metallo-β-lactamase (MBL)-producing Enterobacterales are a critical challenge due to their limited treatment options. Although ceftazidime-avibactam (CAZAVI) combined with aztreonam (ATM) has shown in vitro efficacy, no prior studies have rigorously compared its clinical effectiveness to Other Active Antibiotics (OAAs). This study aims to evaluate the efficacy and safety of CAZAVI + ATM vs. OAAs in a large cohort of MBL bacteremia.

Methods

A retrospective, multicenter, target trial emulation was conducted across 17 hospitals in Argentina between January 2016 and October 2024. Patients with confirmed MBL bacteremia who initiated active antibiotic treatment within 24 h of MBL identification and 96 h of blood sampling were included. Inverse probability of treatment weighting (IPTW) was used to reduce indication bias, and the analysis accounted for hospital clustering within Argentina's public, private, and social security health systems. The primary outcome was 30-day all-cause mortality, with secondary outcomes including clinical failure (relapse, complications, or death) and adverse events.

Findings

Among 243 patients (93 receiving CAZAVI + ATM and 150 receiving OAAs), the 30-day mortality rate was 35% in the CAZAVI + ATM group vs. 47% in the OAA group (adjusted odds ratio [OR] 0·63, 95% CI 0·43–0·91, p < 0·01). Clinical failure occurred in 46% of the CAZAVI + ATM group and 53% of the OAA group (adjusted hazard ratio [HR] 0·65, 95% CI 0·44–0·97; p = 0·03). Adverse events were lower with CAZAVI + ATM (9·6% vs. 22·8%, p = 0·014).

Interpretation

These findings suggest CAZAVI + ATM might be associated with lower mortality, reduced clinical failure, and fewer adverse events compared to OAAs in patients with MBL-type Enterobacterales bacteremia. Further prospective studies are warranted to confirm these observations.

Funding

No specific funding was provided for this study.

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来源期刊

Lancet Regional Health-Americas Multiple-

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8.00

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0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.