背景:头孢他啶/阿维巴坦是碳青霉烯类耐药肠杆菌(CRE)的首选治疗方案之一。然而,头孢他啶/阿维巴坦与另一种抗生素合用的益处尚不清楚.
目的:确定在使用头孢他啶/阿维巴坦治疗CRE感染期间与治疗失败相关的变量,并评估氨基糖苷类与头孢他啶/阿维巴坦联用的效果。
方法:这是一项回顾性队列研究,对2015年至2021年间在134个退伍军人事务(VA)机构中接受头孢他啶/阿维巴坦治疗的CRE培养阳性患者进行了研究。主要结局是30天死亡率,次要结局是院内死亡率。还对接受氨基糖苷的患者进行了亚分析。
结果:共纳入303例患者。总体30天和住院死亡率分别为12.5%和24.1%,分别。年龄(aOR1.052,95%CI1.013-1.093),ICU中的存在(OR2.704,95%CI1.071-6.830),以及在开始服用头孢他啶/阿维巴坦之前接受氨基糖苷类药物(aOR4.512,95%CI1.797~11.327)与30日死亡率独立相关.在接受氨基糖苷的患者亚组(n=77)中,他们与头孢他啶/阿维巴坦联用的30日死亡率aOR为0.321(95%CI,0.089-1.155).
结论:在使用头孢他啶/阿维巴坦治疗CRE感染的退伍军人中,年龄增长,收到经验性氨基糖苷,并且在指数培养时在ICU的存在与更高的30天死亡率相关.在接受氨基糖苷类药物治疗的患者中,它们与头孢他啶/阿维巴坦联合使用,趋势是保护30天死亡率,提示这种组合在治疗重症患者CRE感染方面的潜在作用。
BACKGROUND: Ceftazidime/avibactam is one of the preferred treatment options for carbapenem-resistant Enterobacterales (CRE). However, the benefit of combining ceftazidime/avibactam with another antibiotic remains unclear.
OBJECTIVE: To identify variables associated with treatment failure during the use of ceftazidime/avibactam for CRE infections and assess the effect of combining an
aminoglycoside with ceftazidime/avibactam.
METHODS: This was a retrospective cohort study of patients with a positive CRE culture treated with ceftazidime/avibactam between 2015 and 2021 in 134 Veterans Affairs (VA) facilities. The primary outcome was 30-day mortality and the secondary outcome was in-hospital mortality. A subanalysis in patients who received an
aminoglycoside was also performed.
RESULTS: A total of 303 patients were included. The overall 30-day and in-hospital mortality rates were 12.5% and 24.1%, respectively. Age (aOR 1.052, 95% CI 1.013-1.093), presence in the ICU (aOR 2.704, 95% CI 1.071-6.830), and receipt of an
aminoglycoside prior to initiation of ceftazidime/avibactam (aOR 4.512, 95% CI 1.797-11.327) were independently associated with 30-day mortality. In the subgroup of patients that received an
aminoglycoside (n=77), their use in combination with ceftazidime/avibactam had a 30-day mortality aOR of 0.321 (95% CI, 0.089-1.155).
CONCLUSIONS: In veterans treated with ceftazidime/avibactam for CRE infections, increased age, receipt of an empiric aminoglycoside, and presence in the ICU at the time of index culture were associated with higher 30-day mortality. Among patients who received an
aminoglycoside, their use in combination with ceftazidime/avibactam trended toward protectiveness of 30-day mortality, suggesting a potential role for this combination to treat CRE infections in patients who are more severely ill.