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.
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.