Outcome of Ceftazidime/Avibactam Versus Alternative Antibiotics for Treatment of Carbapenem-Resistant Enterobacterales Bacteremia in Patients With Hematologic Malignancies.
Until recent introduction of ceftazidime/avibactam (CAZ-AVI) to Korean hospitals in October 2023, alternative antibiotics had been used to treat carbapenem-resistant Enterobacterales (CRE) infection such as high-dose meropenem combination therapy with amikacin, tigecycline, and/or colistin. To compare the outcome of CRE bacteremia between CAZ-AVI (study group) and alternative antibiotics (comparator group) before/after the introduction of CAZ-AVI.
We retrospectively reviewed the adult patients with hematologic malignancy who had CRE bacteremia between January 2020 and July 2024.
A total of 85 patients with CRE bacteremia were analyzed including 25 with CAZ-AVI and 60 with alternative antibiotics. In a time-dependent multivariable Cox model for negative conversion of bacteremia, CAZ-AVI (hazard ratio [HR], 2.475; 95% confidence interval [CI], 1.493-4.102; P < 0.001) and Klebsiella pneumoniae carbapenemase [KPC] (HR, 0.490; 95% CI, 0.296-0.810; P = 0.005) was independently associated with rapid negative conversion. CAZ-AVI was associated with rapid negative conversion of bacteremia in the inverse probability of treatment weighting (IPTW) analysis (HR, 3.030; 95% CI, 1.818-5.263; P < 0.001). In a time-dependent multivariable Cox model, CAZ-AVI was the only independent predictor for 30-day mortality (HR, 0.295; 95% CI, 0.087-0.996; P = 0.049), although CAZ-AVI did not reach any statistical significance for 30-day mortality (HR, 0.513; 95% CI, 0.146-1.804; P = 0.298) in IPTW analysis.
CAZ-AVI showed higher rapid negative conversion for CRE bacteremia in patients with hematologic malignancy, compared to the alternative antibiotics.
We retrospectively reviewed the adult patients with hematologic malignancy who had CRE bacteremia between January 2020 and July 2024.
A total of 85 patients with CRE bacteremia were analyzed including 25 with CAZ-AVI and 60 with alternative antibiotics. In a time-dependent multivariable Cox model for negative conversion of bacteremia, CAZ-AVI (hazard ratio [HR], 2.475; 95% confidence interval [CI], 1.493-4.102; P < 0.001) and Klebsiella pneumoniae carbapenemase [KPC] (HR, 0.490; 95% CI, 0.296-0.810; P = 0.005) was independently associated with rapid negative conversion. CAZ-AVI was associated with rapid negative conversion of bacteremia in the inverse probability of treatment weighting (IPTW) analysis (HR, 3.030; 95% CI, 1.818-5.263; P < 0.001). In a time-dependent multivariable Cox model, CAZ-AVI was the only independent predictor for 30-day mortality (HR, 0.295; 95% CI, 0.087-0.996; P = 0.049), although CAZ-AVI did not reach any statistical significance for 30-day mortality (HR, 0.513; 95% CI, 0.146-1.804; P = 0.298) in IPTW analysis.
CAZ-AVI showed higher rapid negative conversion for CRE bacteremia in patients with hematologic malignancy, compared to the alternative antibiotics.
Authors
Jang Jang, Baek Baek, Lim Lim, Bae Bae, Park Park, Park Park, Choi Choi, Lee Lee, Lee Lee, Kim Kim
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