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Abstract：
OBJECTIVE: The incidences of nosocomial pneumonia in intensive care units (ICUs) in India have been reported to range from 9% to 58% and are associated with a mortality rate of 30-70%. Ceftazidime-avibactam has activity against OXA-48-like carbapenem-resistant Enterobacterales (CRE) and has a safer adverse effect profile as compared to the nephrotoxic colistin. The current study aimed to assess the effectiveness and usage pattern of ceftazidime-avibactam in gram-negative hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in real-world settings in India.
METHODS: Electronic medical records of hospitalized patients in three prominent medical centers in India (Fortis Memorial Research Centre, Gurugram, S L Raheja Hospital, Mumbai, and Fortis Hospital, Anandapur, Kolkata) with nosocomial pneumonia and documented gram-negative Klebsiella pneumoniae (KP)-confirmed infection were collected. This study assessed the effectiveness, usage pattern of ceftazidime-avibactam, and clinical and microbiological cure rates.
RESULTS: Among the 116 patients included, 78.45% (91/116) showed clinical cure. Microbiological cure was observed in nine out of 13 (69.23%) patients. In the subset analysis, a clinical cure rate of 84.85% (28/33) and microbiological recovery rate of 62.50% (5/8) were observed when ceftazidime-avibactam was initiated within 72 hours of diagnosis. Ceftazidime-avibactam was administered for a mean (±SD) duration of 7.79 ± 4.43 days, with improvement in signs and symptoms reported among 91.38% (106/116). Ceftazidime-avibactam showed a susceptibility of 56% (28/56) in the study.
CONCLUSIONS: The current study showed a better clinical and microbiological cure rate with a safer tolerability profile of ceftazidime-avibactam in carbapenem-resistant KP nosocomial pneumonia and VAP. This study has further demonstrated that ceftazidime-avibactam may be used as one of the viable treatment choices in carbapenem-resistant KP with favorable clinical outcomes.
METHODS: Electronic medical records of hospitalized patients in three prominent medical centers in India (Fortis Memorial Research Centre, Gurugram, S L Raheja Hospital, Mumbai, and Fortis Hospital, Anandapur, Kolkata) with nosocomial pneumonia and documented gram-negative Klebsiella pneumoniae (KP)-confirmed infection were collected. This study assessed the effectiveness, usage pattern of ceftazidime-avibactam, and clinical and microbiological cure rates.
RESULTS: Among the 116 patients included, 78.45% (91/116) showed clinical cure. Microbiological cure was observed in nine out of 13 (69.23%) patients. In the subset analysis, a clinical cure rate of 84.85% (28/33) and microbiological recovery rate of 62.50% (5/8) were observed when ceftazidime-avibactam was initiated within 72 hours of diagnosis. Ceftazidime-avibactam was administered for a mean (±SD) duration of 7.79 ± 4.43 days, with improvement in signs and symptoms reported among 91.38% (106/116). Ceftazidime-avibactam showed a susceptibility of 56% (28/56) in the study.
CONCLUSIONS: The current study showed a better clinical and microbiological cure rate with a safer tolerability profile of ceftazidime-avibactam in carbapenem-resistant KP nosocomial pneumonia and VAP. This study has further demonstrated that ceftazidime-avibactam may be used as one of the viable treatment choices in carbapenem-resistant KP with favorable clinical outcomes.
摘要：
目的：据报道，印度重症监护病房（ICU）医院获得性肺炎的发生率在9％至58％之间，死亡率为30-70％。头孢他啶-阿维巴坦对OXA-48样碳青霉烯类耐药肠杆菌（CRE）具有活性，并且与肾毒性粘菌素相比具有更安全的不良反应。本研究旨在评估头孢他啶-阿维巴坦在印度现实环境中的革兰阴性医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）的有效性和使用模式。
方法：印度三个著名医疗中心住院患者的电子病历（富通纪念研究中心，Gurugram,SLRaheja医院,孟买,和富通医院,Anandapur,收集了加尔各答）医院获得性肺炎和记录的革兰氏阴性肺炎克雷伯菌（KP）证实的感染。这项研究评估了有效性，头孢他啶-阿维巴坦的使用模式,以及临床和微生物治愈率。
结果：在116名患者中，78.45%(91/116)显示临床治愈。13例患者中有9例（69.23％）观察到微生物治愈。在子集分析中，在诊断后72小时内开始使用头孢他啶-阿维巴坦，临床治愈率为84.85％（28/33），微生物回收率为62.50％（5/8）。头孢他啶-阿维巴坦的平均（±SD）时间为7.79±4.43天，在91.38%（106/116）中报告了体征和症状的改善。头孢他啶-阿维巴坦在研究中显示56%(28/56)的易感性。
结论：本研究显示头孢他啶-阿维巴坦在耐碳青霉烯的KP医院性肺炎和VAP中的临床和微生物治愈率较高，耐受性较安全。这项研究进一步证明，头孢他啶-阿维巴坦可作为碳青霉烯类耐药KP的可行治疗选择之一，具有良好的临床疗效。
方法：印度三个著名医疗中心住院患者的电子病历（富通纪念研究中心，Gurugram,SLRaheja医院,孟买,和富通医院,Anandapur,收集了加尔各答）医院获得性肺炎和记录的革兰氏阴性肺炎克雷伯菌（KP）证实的感染。这项研究评估了有效性，头孢他啶-阿维巴坦的使用模式,以及临床和微生物治愈率。
结果：在116名患者中，78.45%(91/116)显示临床治愈。13例患者中有9例（69.23％）观察到微生物治愈。在子集分析中，在诊断后72小时内开始使用头孢他啶-阿维巴坦，临床治愈率为84.85％（28/33），微生物回收率为62.50％（5/8）。头孢他啶-阿维巴坦的平均（±SD）时间为7.79±4.43天，在91.38%（106/116）中报告了体征和症状的改善。头孢他啶-阿维巴坦在研究中显示56%(28/56)的易感性。
结论：本研究显示头孢他啶-阿维巴坦在耐碳青霉烯的KP医院性肺炎和VAP中的临床和微生物治愈率较高，耐受性较安全。这项研究进一步证明，头孢他啶-阿维巴坦可作为碳青霉烯类耐药KP的可行治疗选择之一，具有良好的临床疗效。
