PDF(Pubmed)
Abstract：
BACKGROUND: Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant gram-negative bacteria (CRB). Our aim was to describe the use of CAZ-AVI in children admitted to pediatric intensive care units (PICUs), with suspected or proven CRB infections.
METHODS: A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included.
RESULTS: CAZ-AVI was used in 37 patients. The median age was 28 months (range 1-215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1-138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1-22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%.
CONCLUSIONS: Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.
METHODS: A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included.
RESULTS: CAZ-AVI was used in 37 patients. The median age was 28 months (range 1-215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1-138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1-22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%.
CONCLUSIONS: Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.
摘要：
背景：头孢他啶-阿维巴坦（CAZ-AVI）是可用于治疗碳青霉烯类耐药革兰氏阴性菌（CRB）感染的新型抗生素之一。我们的目的是描述CAZ-AVI在儿科重症监护病房（PICU）住院的儿童中的使用，怀疑或证实CRB感染。
方法：在里约热内卢的两个PICU中进行了回顾性描述性研究，巴西,2020年1月至2024年1月。包括接受CAZ-AVI超过24小时的0至18岁儿童。
结果：37例患者使用CAZ-AVI。中位年龄为28个月（范围1-215），男性17人（45.9%）。从患者入院到CAZ-AVI的初始处方的中位时间为39.9天(范围1-138)。34（91.9％）儿童在入院时至少有一种合并症，并且（91.9％）在CAZ-AVI处方之前使用了至少一种侵入性设备，89.2%的患者之前曾接受过碳青霉烯;15例(40.5%)患者在使用CAZ-AVI之前曾接受过医疗保健相关感染(HAI)。CAZ-AVI的平均使用时间为11天（范围1-22）。在处方前24小时或处方当天，从12名（32.4％）患者的培养物中分离出革兰氏阴性细菌。在五名患者中，CRB在文化中得到证实，在其中四个（80%）中，治疗7天后验证微生物清除。30天死亡率为37.8%。
结论：几乎所有使用CAZ-AVI的患者都是患有多种合并症且既往使用过碳青霉烯类抗生素的危重患儿。在CRB确认的感染中，7天内微生物学清除率高。
方法：在里约热内卢的两个PICU中进行了回顾性描述性研究，巴西,2020年1月至2024年1月。包括接受CAZ-AVI超过24小时的0至18岁儿童。
结果：37例患者使用CAZ-AVI。中位年龄为28个月（范围1-215），男性17人（45.9%）。从患者入院到CAZ-AVI的初始处方的中位时间为39.9天(范围1-138)。34（91.9％）儿童在入院时至少有一种合并症，并且（91.9％）在CAZ-AVI处方之前使用了至少一种侵入性设备，89.2%的患者之前曾接受过碳青霉烯;15例(40.5%)患者在使用CAZ-AVI之前曾接受过医疗保健相关感染(HAI)。CAZ-AVI的平均使用时间为11天（范围1-22）。在处方前24小时或处方当天，从12名（32.4％）患者的培养物中分离出革兰氏阴性细菌。在五名患者中，CRB在文化中得到证实，在其中四个（80%）中，治疗7天后验证微生物清除。30天死亡率为37.8%。
结论：几乎所有使用CAZ-AVI的患者都是患有多种合并症且既往使用过碳青霉烯类抗生素的危重患儿。在CRB确认的感染中，7天内微生物学清除率高。
