目的:头孢他啶-阿维巴坦(CZA)是产生碳青霉烯酶A类(尤其是blaKPC)和D类(blaOXA)的革兰氏阴性杆菌感染的良好选择。然而,尚不清楚它是否会对金属β-内酰胺酶(blaMBL)的选择产生影响。该研究的目的是在引入CZA后的两年内比较碳青霉烯和CZA肺炎克雷伯菌(KPN)的敏感性。
方法:这项研究是在布宜诺斯艾利斯一家三级医院的36张病床的成人ICU中进行的,阿根廷。抗微生物剂消耗量表示为每100名患者的治疗天数-天(DOT)。
结果:共分析了第一年的123株KPN菌株和第二年的172株。第二年检测到碳青霉烯敏感性的惊人下降(OR0.5[0.3-0.8]p<.001)。并行,CZA易感性降低(OR0.5[0.3-0.9]p<.05)。这些发现与blaMBL-KPN的上升有关(32.1%与45.1%,或1.7[1.1-2.9],p<.04)第二年。这种新的KPN敏感性曲线促进了CZA的增加(1.0DOT与6.6DOT,OR6.6[4.9-9.1]p<.001)和氨曲南(0.3DOTvs.4.1DOT,或16.3[9.1-29.3]p<.001)消费。因此,碳青霉烯类处方药减少(17.8DOTvs.15.4DOT,或0.8[0.8-0.9]p<.001)。
结论:在CZA引入两年后,blaMBL-KPN率上升,导致CZA和碳青霉烯敏感性降低,CZA和氨曲南处方增加。
OBJECTIVE: Ceftazidime-avibactam (CZA) is a good option for Gram-negative bacilli infections that produce carbapenemase Classes A (especially blaKPC) and D (blaOXA). However, it is unknown whether it would have an impact on metallo-β-lactamases (blaMBL) selection. The aim of the study was to compare carbapenem and CZA Klebsiella pneumoniae (KPN) susceptibility profiles for a period of two years following the introduction of CZA.
METHODS: The study was conducted in a 36-bed adult ICU of a tertiary hospital in Buenos Aires, Argentina. Antimicrobial consumption was expressed as days of treatment per 100 patients-day (DOT).
RESULTS: A total of 123 KPN strains in the first year and 172 in the second year were analyzed. An alarming decrease in carbapenem susceptibility was detected in the second year (OR 0.5 [0.3-0.8] p<.001). In parallel, there was a decrease in CZA susceptibility (OR 0.5 [0.3-0.9] p<.05). These findings were linked to a rise in blaMBL-KPN (32.1% vs. 45.1%, OR 1.7 [1.1-2.9], p <.04) during the second year. This new KPN susceptibility profile promoted an increment in CZA (1.0 DOT vs. 6.6 DOT, OR 6.6 [4.9-9.1] p<.001) and aztreonam (0.3 DOT vs. 4.1 DOT, OR 16.3 [9.1-29.3] p<.001) consumption. Thus, there was a decrease in carbapenem prescription (17.8 DOT vs. 15.4 DOT, OR 0.8 [0.8-0.9] p<.001).
CONCLUSIONS: There was an escalation of blaMBL-KPN rate two years after CZA introduction, leading to a decrease in CZA and carbapenem susceptibility and an increase in CZA and aztreonam prescriptions.