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- Title
Efficacy of Ceftazidime-avibactam Plus Aztreonam in Patients With Bloodstream Infections Caused by Metallo-β-lactamase–Producing Enterobacterales.
- Authors
Falcone, Marco; Daikos, George L; Tiseo, Giusy; Bassoulis, Dimitrios; Giordano, Cesira; Galfo, Valentina; Leonildi, Alessandro; Tagliaferri, Enrico; Barnini, Simona; Sani, Spartaco; Farcomeni, Alessio; Ghiadoni, Lorenzo; Menichetti, Francesco
- Abstract
Background In vitro data support the use of combination of aztreonam (ATM) with ceftazidime-avibactam (CAZ-AVI), but clinical studies are lacking. The aim of our study was to compare the outcome of patients with bloodstream infections (BSIs) due to metallo-β-lactamase (MBL)–producing Enterobacterales treated either with CAZ-AVI plus ATM or other active antibiotics (OAAs). Methods This was a prospective observational study including patients admitted to 3 hospitals in Italy and Greece. The primary outcome measure was 30-day all-cause mortality. Secondary outcomes were clinical failure at day 14 and length of stay after BSI diagnosis. Cox regression analysis including a propensity score (PS) for receiving CAZ-AVI + ATM was performed to evaluate primary and secondary outcomes. A PS-based matched analysis was also performed. Results We enrolled 102 patients with BSI; 82 had infections caused by NDM-producing (79 Klebsiella pneumoniae and 3 Escherichia coli) and 20 by VIM-producing (14 K. pneumoniae , 5 Enterobacter species, 1 Morganella morganii) strains. The 30-day mortality rate was 19.2% in the CAZ-AVI + ATM group vs 44% in the OAA group (P = .007). The PS-adjusted analysis showed that the use of CAZ-AVI + ATM was associated with lower 30-day mortality (hazard ratio [HR], 0.37 [95% confidence interval {CI},.13–.74]; P = .01), lower clinical failure at day 14 (HR, 0.30 [95% CI,.14–.65]; P = .002), and shorter length of stay (subdistributional HR, 0.49 [95% CI,.30–.82]; P = .007). The PS-matched analysis confirmed these findings. Conclusions The CAZ-AVI + ATM combination offers a therapeutic advantage compared to OAAs for patients with BSI due to MBL-producing Enterobacterales. Further studies are warranted.
- Subjects
GREECE; ITALY; BACTEREMIA; CEFTAZIDIME; DRUG efficacy; LENGTH of stay in hospitals; COMBINATION drug therapy; SCIENTIFIC observation; CONFIDENCE intervals; MORTALITY; ENTEROBACTERIACEAE diseases; REGRESSION analysis; TREATMENT effectiveness; AZTREONAM; ENZYME inhibitors; LONGITUDINAL method; PROPORTIONAL hazards models; EVALUATION
- Publication
Clinical Infectious Diseases, 2021, Vol 72, Issue 11, p1871
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciaa586