Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae

Pérez-Nadales, Elena; Fernández-Ruiz, Mario; Natera, Alejandra; Gutiérrez-Gutiérrez, Belén; Mularoni, Alessandra; Russelli, Giovanna; Pierrotti, Ligia; Pinheiro Freire, Maristela; Falcone, Marco; Tiseo, Giusy; Tumbarello, Mario; Raffaelli, Francesca; Abdala, Edson; Bodro, Marta; Gervasi, Elena; Fariñas, María; Seminari, Elena; Castón, Juan; Marín-Sanz, Juan; Gálvez-Soto, Víctor; Rana, Meenakshi; Loeches, Belén; Martín-Dávila, Pilar; Pascual, Álvaro; Rodríguez-Baño, Jesús; Aguado, José; Martínez-Martínez, Luis; Torre-Cisneros, Julián; Paul, Mical; Carratala, Jordi; Oriol, Isabel; Rodríguez-Álvarez, Regino; Cordero, Elisa; Lepe, José; de Lucas, Esperanza; Muñoz, Patricia; Fortún, Jesús; Coussement, Julien; Dewispelaere, Laurent; Eriksson, Britt; van Delden, Christian; Manuel, Oriol; Clemente, Wanessa; Strabelli, Tania; Pilmis, Benoit; Roilides, Emmanuel; Ranganathan N, Iyer; Grossi, Paolo; Soldani, Fabio; Rizzi, Marco; Tan, Ban; Lowman, Warren; Gunseren, Filiz; Arslan, Hande; Tufan, Zeliha; KAZAK, ESRA; David, Miruna; Steinke, Seema; Ostrander, Darin; Avery, Robin; Lease, Erika

doi:10.1016/j.ajt.2023.03.011

Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae

Atıf İçin Kopyala

Pérez-Nadales E., Fernández-Ruiz M., Natera A. M., Gutiérrez-Gutiérrez B., Mularoni A., Russelli G., ...Daha Fazla

American Journal of Transplantation, cilt.23, sa.7, ss.1022-1034, 2023 (SCI-Expanded)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 23 Sayı: 7
Basım Tarihi: 2023
Doi Numarası: 10.1016/j.ajt.2023.03.011
Dergi Adı: American Journal of Transplantation
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, CAB Abstracts, EMBASE, MEDLINE, Public Affairs Index, Veterinary Science Database
Sayfa Sayıları: ss.1022-1034
Anahtar Kelimeler: bloodstream infections, carbapenem-resistant Klebsiella pneumoniae, ceftazidime-avibactam, INCREMENT-SOT project, solid-organ transplantation
Bursa Uludağ Üniversitesi Adresli: Evet

Özet

We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.