Ceftazidime-avibactam use for klebsiella pneumoniae carbapenemase-producing k. pneumoniae infections: A retrospective observational multicenter study

Antonio Cascio, Marianna Rossi, Maddalena Giannella, Gennaro De Pascale, Alessandra Mularoni, Daniele Roberto Giacobbe, Angela Raffaella Losito, Marianna Meschiari, Silvia Corcione, Giusy Tiseo, Mario Tumbarello, Angela Raffaella Losito, Roberto Luzzati, Pierluigi Viale, Alessandro Russo, Alessandra Oliva, Cristina Rovelli, Linda Bussini, Francesca Raffaelli, Matteo BassettiMirko Compagno, Paolo Bonfanti, Enrico Maria Trecarichi, Annalisa Saracino, Francesco Giuseppe De Rosa, Nour Shbaklo, Marco Falcone, Elena Guffanti, Maddalena Peghin, Elisabetta Mantengoli, Ivan Gentile, Teresa Spanu, Carlo Tascini, Loredana Sarmati, Annalisa Saracino, Andrea De Gasperi, Alberto Corona, Spinello Antinori, Mario Venditti, Giampaolo Corti, Roberto Cauda, Paolo Antonio Grossi, Giancarlo Ceccarelli, Massimo Fantoni, Marco Falcone, Cristina Mussini, Alessandro Capone, Gaetano Brindicci

Risultato della ricerca: Articlepeer review

67 Citazioni (Scopus)


Background: A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae. Methods: We retrospectively analyzed observational data on use and outcomes of CAZ-AVI therapy for infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens versus CAZ-AVI monotherapy. Results: The cohort comprised 577 adults with bloodstream infections (n = 391) or nonbacteremic infections involving mainly the urinary tract, lower respiratory tract, and intra-abdominal structures. All received treatment with CAZ-AVI alone (n = 165) or with ≥1 other active antimicrobials (n = 412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs 25.0%, P =. 79). In multivariate analysis, mortality was positively associated with presence at infection onset of septic shock (P =. 002), neutropenia (P <. 001), or an INCREMENT score ≥8 (P =. 01); with lower respiratory tract infection (LRTI) (P =. 04); and with CAZ-AVI dose adjustment for renal function (P =. 01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P =. 006). All associations remained significant after propensity score adjustment. Conclusions: CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug's seemingly more limited efficacy in LRTIs and potential survival benefits of prolonging CAZ-AVI infusions to ≥3 hours.
Lingua originaleEnglish
pagine (da-a)1664-1676
Numero di pagine13
RivistaClinical Infectious Diseases
Stato di pubblicazionePublished - 2021

All Science Journal Classification (ASJC) codes

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  • ???subjectarea.asjc.2700.2725???


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