Abstract：
BACKGROUND: Ceftazidime-avibactam (CAZ-AVI) is a new option to treat KPC- and OXA-48 carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. However, clinical evidence is limited regarding its use in treating CRKP infections, especially in solid organ transplantation (SOT) recipients. In this study, we assessed the efficacy of CAZ-AVI in treating CRKP infections in both the general population and the SOT recipients in comparison with other antibiotic regimens.
METHODS: This is a single-centre retrospective cohort study of patients admitted between January 1, 2018 and June 30, 2021 with the diagnosis of CRKP infections receiving either CAZ-AVI or other regimens ≥ 72 hours and clinical outcomes were analysed.
RESULTS: Of 200 patients with CRKP infections, 67 received CAZ-AVI, 133 received other regimens, and 50 were SOT recipients. In the SOT cohort, 30 patients received CAZ-AVI, and 20 received other regimens. The overall 30-day mortality was 38% in the SOT cohort. Compared with patients receiving other regimens, CAZ-AVI therapy resulted in lower 30-day mortality (23.3% vs. 60%, P = 0.014) and 90-day mortality (35.7% vs. 86.7%, P = 0.003), higher clinical cure (93.3% vs. 40%, P < 0.001) and microbiological clearance. Similar promising results of CAZ-AVI were also shown in the whole population cohort. Moreover, clinical outcomes of SOT recipients receiving CAZ-AVI were not inferior to those without SOT.
CONCLUSIONS: CAZ-AVI therapy was associated with better clinical outcomes in CRKP infections in both the general population and SOT recipients. Considering the limitations of the present study, well-conducted RCTs are still warranted to confirm these findings.
METHODS: This is a single-centre retrospective cohort study of patients admitted between January 1, 2018 and June 30, 2021 with the diagnosis of CRKP infections receiving either CAZ-AVI or other regimens ≥ 72 hours and clinical outcomes were analysed.
RESULTS: Of 200 patients with CRKP infections, 67 received CAZ-AVI, 133 received other regimens, and 50 were SOT recipients. In the SOT cohort, 30 patients received CAZ-AVI, and 20 received other regimens. The overall 30-day mortality was 38% in the SOT cohort. Compared with patients receiving other regimens, CAZ-AVI therapy resulted in lower 30-day mortality (23.3% vs. 60%, P = 0.014) and 90-day mortality (35.7% vs. 86.7%, P = 0.003), higher clinical cure (93.3% vs. 40%, P < 0.001) and microbiological clearance. Similar promising results of CAZ-AVI were also shown in the whole population cohort. Moreover, clinical outcomes of SOT recipients receiving CAZ-AVI were not inferior to those without SOT.
CONCLUSIONS: CAZ-AVI therapy was associated with better clinical outcomes in CRKP infections in both the general population and SOT recipients. Considering the limitations of the present study, well-conducted RCTs are still warranted to confirm these findings.
摘要：
背景：头孢他啶-阿维巴坦（CAZ-AVI）是治疗KPC-和OXA-48碳青霉烯耐药肺炎克雷伯菌（CRKP）感染的新选择。然而,关于其用于治疗CRKP感染的临床证据有限，尤其是实体器官移植（SOT）受者。在这项研究中,我们评估了CAZ-AVI治疗一般人群和SOT受者CRKP感染的疗效,并与其他抗生素治疗方案进行了比较.
方法：这是一项单中心回顾性队列研究，研究对象为2018年1月1日至2021年6月30日收治的诊断为CRKP感染的患者，接受CAZ-AVI或其他方案≥72小时，并分析临床结果。
结果：在200例CRKP感染患者中，67收到CAZ-AVI，133人接受了其他治疗方案，50个是SOT接受者。在SOT队列中，30例患者接受CAZ-AVI,20人接受了其他方案。在SOT队列中，30天的总死亡率为38%。与接受其他治疗方案的患者相比，CAZ-AVI治疗可降低30天死亡率（23.3%vs.60%,p=0.014）和90天死亡率（35.7%vs.86.7%,p=0.003),更高的临床治愈率(93.3%vs.40%,p<0.001)和微生物清除率。CAZ-AVI的类似有希望的结果也显示在整个群体队列中。此外，接受CAZ-AVI的SOT受者的临床结局不亚于没有接受SOT的受者.
结论：CAZ-AVI治疗与一般人群和SOT受者CRKP感染的更好临床结局相关。考虑到本研究的局限性，仍有必要进行良好的RCT来证实这些发现.
方法：这是一项单中心回顾性队列研究，研究对象为2018年1月1日至2021年6月30日收治的诊断为CRKP感染的患者，接受CAZ-AVI或其他方案≥72小时，并分析临床结果。
结果：在200例CRKP感染患者中，67收到CAZ-AVI，133人接受了其他治疗方案，50个是SOT接受者。在SOT队列中，30例患者接受CAZ-AVI,20人接受了其他方案。在SOT队列中，30天的总死亡率为38%。与接受其他治疗方案的患者相比，CAZ-AVI治疗可降低30天死亡率（23.3%vs.60%,p=0.014）和90天死亡率（35.7%vs.86.7%,p=0.003),更高的临床治愈率(93.3%vs.40%,p<0.001)和微生物清除率。CAZ-AVI的类似有希望的结果也显示在整个群体队列中。此外，接受CAZ-AVI的SOT受者的临床结局不亚于没有接受SOT的受者.
结论：CAZ-AVI治疗与一般人群和SOT受者CRKP感染的更好临床结局相关。考虑到本研究的局限性，仍有必要进行良好的RCT来证实这些发现.
