Abstract：
OBJECTIVE: This study aimed to evaluate the clinical and microbiological risk factors associated with mortality in patients treated with ceftazidime-avibactam for carbapenem-resistant Gram-negative bacterial infections.
METHODS: This multicentric prospective cohort study included hospitalized adult patients with a microbiologically confirmed infection treated with ceftazidime-avibactam for ≥48 hours. The clinical and microbiological risk factors for 30-day mortality were evaluated using a Cox regression model.
RESULTS: Of the 193 patients evaluated from the five tertiary hospitals, 127 were included in the study. Thirty-five patients (27.6%) died within 30 days. Infections with AmpC beta-lactamase-carrying bacteria were independently related to 30-day mortality (adjusted hazard ratio [aHR] 2.49, 95% confidence interval [CI] 1.28-4.84, P < 0.01) after adjusting for time from infection to antimicrobial prescription (P = 0.04). Further, these bacterial infections were also related to higher in-hospital mortality (aHR 2.17, 95% CI 1.24-3.78, P < 0.01). Only one patient developed resistance to ceftazidime-avibactam during treatment.
CONCLUSIONS: Treatment with ceftazidime-avibactam had worse clinical outcomes in patients with infections with bacteria with chromosomally encoded AmpC beta-lactamase. However, these findings should be confirmed in future studies.
METHODS: This multicentric prospective cohort study included hospitalized adult patients with a microbiologically confirmed infection treated with ceftazidime-avibactam for ≥48 hours. The clinical and microbiological risk factors for 30-day mortality were evaluated using a Cox regression model.
RESULTS: Of the 193 patients evaluated from the five tertiary hospitals, 127 were included in the study. Thirty-five patients (27.6%) died within 30 days. Infections with AmpC beta-lactamase-carrying bacteria were independently related to 30-day mortality (adjusted hazard ratio [aHR] 2.49, 95% confidence interval [CI] 1.28-4.84, P < 0.01) after adjusting for time from infection to antimicrobial prescription (P = 0.04). Further, these bacterial infections were also related to higher in-hospital mortality (aHR 2.17, 95% CI 1.24-3.78, P < 0.01). Only one patient developed resistance to ceftazidime-avibactam during treatment.
CONCLUSIONS: Treatment with ceftazidime-avibactam had worse clinical outcomes in patients with infections with bacteria with chromosomally encoded AmpC beta-lactamase. However, these findings should be confirmed in future studies.
摘要：
目的：本研究旨在评估头孢他啶-阿维巴坦治疗耐碳青霉烯类革兰阴性菌感染患者与死亡率相关的临床和微生物危险因素。
方法：这项多中心前瞻性队列研究包括接受头孢他啶-阿维巴坦治疗≥48小时的微生物证实感染的住院成年患者。使用Cox回归模型评估30天死亡率的临床和微生物危险因素。
结果：在五家三级医院评估的193名患者中，127人被纳入研究。35例患者（27.5%）在30天内死亡。AmpCβ-内酰胺酶携带细菌感染与30天死亡率独立相关（校正后的风险比[aHR]2.49，95％置信区间[CI]1.28-4.84，P<0.01）。Further,这些细菌感染也与更高的住院死亡率相关(aHR2.17,95%CI1.24-3.78,P<0.01).只有一名患者在治疗期间对头孢他啶-阿维巴坦产生耐药性。
结论：头孢他啶-阿维巴坦治疗对染色体编码AmpCβ-内酰胺酶细菌感染患者的临床预后较差。然而,这些发现应该在未来的研究中得到证实.
方法：这项多中心前瞻性队列研究包括接受头孢他啶-阿维巴坦治疗≥48小时的微生物证实感染的住院成年患者。使用Cox回归模型评估30天死亡率的临床和微生物危险因素。
结果：在五家三级医院评估的193名患者中，127人被纳入研究。35例患者（27.5%）在30天内死亡。AmpCβ-内酰胺酶携带细菌感染与30天死亡率独立相关（校正后的风险比[aHR]2.49，95％置信区间[CI]1.28-4.84，P<0.01）。Further,这些细菌感染也与更高的住院死亡率相关(aHR2.17,95%CI1.24-3.78,P<0.01).只有一名患者在治疗期间对头孢他啶-阿维巴坦产生耐药性。
结论：头孢他啶-阿维巴坦治疗对染色体编码AmpCβ-内酰胺酶细菌感染患者的临床预后较差。然而,这些发现应该在未来的研究中得到证实.
