UNASSIGNED:新型的最后手段β-内酰胺抗生素现在可用于治疗由于产生新德里金属-β-内酰胺酶(NDM)的肠杆菌和具有难以治疗耐药性的非发酵菌引起的感染。然而,有关使用亚胺培南-西司他丁-释放巴坦(IMI-REL)的数据,头孢地洛(CFD)和头孢他啶-阿维巴坦加氨曲南(CAZ-AVI-ATM)在现实生活中很少见。这项研究旨在描述最后手段β-内酰胺抗生素的使用,微生物学和结果,在三级医院住院的患者中。
UNASSIGNED:我们从2020/01/01到2022/08/31进行了单中心观察队列研究。我们筛查了尼姆大学医院收治的所有患者,这些患者在研究期间接受了≥1剂量的最后手段β-内酰胺抗生素,使用药房数据库。我们包括接受IMI-REL治疗的患者,CFD和CAZ-AVI-ATM。主要终点是无感染生存率。我们还计算了微生物和临床治愈率,反复感染,死亡和不良事件。
UNASSIGNED:研究中纳入了27例患者,分析了30个疗程:CFD(N=24;80%),CAZ-AVI-ATM(N=3;10%)和IMI-REL(N=3;10%)。21名男性(70%)和9名女性(30%)使用抗生素,中位年龄为65岁[50-73.5],中位Charlson指数为1[0-2]。几乎所有患者碳青霉烯类耐药菌的危险因素均≥1,其中一半因重症COVID-19住院,大部分抗生素疗程(N=26;87%)与ICU入住相关.在研究人群中,在启动最后手段β-内酰胺治疗后第90天,无感染生存的概率为48.4%CI95%[33.2~70.5].临床失败率为30%,微生物失败率为33%,死亡率为23%。在5个抗生素疗程(17%)中记录了不良事件。在细节上,铜绿假单胞菌主要采用CFD和IMI-REL治疗,用CFD和CAZ-AVI-ATM,A.鲍曼不动杆菌与CFD,和NDM生产-K肺炎与CAZ-AVI-ATM和CFD。经过CFD治疗后,CAZ-AVI-ATM和IMI-REL,无感染生存率为48%CI95%[10.4-73.5],33.3%CI95%[6.7-100],66.7%可信区间95%[30-100],分别。
UNASSIGNED:在现实生活中使用最后手段的β-内酰胺类抗微生物药物是一种安全有效的治疗选择,用于治疗与革兰氏阴性菌耐药相关的严重感染。
Novel last resort beta-lactam antibiotics are now available for management of infections due to New-Delhi Metallo-Beta-Lactamase (NDM) producing Enterobacterales and non-fermenters with Difficult-to-Treat Resistance. However, data regarding the use of imipenem-cilastatin-relebactam (IMI-REL), cefiderocol (CFD) and ceftazidime-avibactam plus aztreonam (CAZ-AVI-ATM) are scarce in real-life settings. This study aimed to describe the use of last resort beta-lactam antibiotics, the microbiology and the outcome, in patients hospitalized in a tertiary hospital.
We conducted a monocentric observational cohort study from 2020/01/01, to 2022/08/31. We screened all patients admitted to Nimes University Hospital who have received ≥ 1 dose of last resort beta-lactam antibiotics during the study period, using the Pharmacy database. We included patients treated with IMI-REL, CFD and CAZ-AVI-ATM. The primary endpoint was the infection-free survival rate. We also calculated rates of microbiological and clinical cure, recurrent infection, death and adverse events.
Twenty-seven patients were included in the study and 30 treatment courses were analyzed: CFD (N=24; 80%), CAZ-AVI-ATM (N=3; 10%) and IMI-REL (N=3; 10%). Antibiotics were used in 21 males (70%) and 9 females (30%) with a median age at 65-year-old [50-73.5] and a median Charlson index at 1 [0-2]. Almost all the patients had ≥ 1 risk factor for carbapenem resistant bacteria, a half of them was hospitalized for severe COVID-19, and most of antibiotic courses (N=26; 87%) were associated with ICU admission. In the study population, the probability of infection-free survival at day-90 after last resort beta-lactam therapy initiation was 48.4% CI95% [33.2-70.5]. Clinical failure rate was at 30%, microbiological failure rate at 33% and mortality rate at 23%. Adverse events were documented in 5 antibiotic courses (17%). In details, P. aeruginosa were mainly treated with CFD and IMI-REL, S. maltophilia with CFD and CAZ-AVI-ATM, A. baumannii with CFD, and NDM producing-K. pneumoniae with CAZ-AVI-ATM and CFD. After a treatment course with CFD, CAZ-AVI-ATM and IMI-REL, the probability of infection-free survival was 48% CI95% [10.4-73.5], 33.3% CI95% [6.7-100], 66.7% CI95% [30-100], respectively.
Use of last resort beta-lactam antimicrobials in real-life settings was a safe and efficient therapeutic option for severe infections related to Gram-negative bacteria with Difficult-to-Treat Resistance.