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Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature.
Burastero, Giulia Jole; Orlando, Gabriella; Santoro, Antonella; Menozzi, Marianna; Franceschini, Erica; Bedini, Andrea; Cervo, Adriana; Faltoni, Matteo; Bacca, Erica; Biagioni, Emanuela; Coloretti, Irene; Melegari, Gabriele; Maccieri, Jessica; Busani, Stefano; Bertellini, Elisabetta; Girardis, Massimo; Ferrarini, Giulia; Rofrano, Laura; Sarti, Mario; Mussini, Cristina; Meschiari, Marianna.
  • Burastero GJ; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Orlando G; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Santoro A; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Menozzi M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Franceschini E; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Bedini A; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Cervo A; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Faltoni M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Bacca E; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Biagioni E; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Coloretti I; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Melegari G; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Maccieri J; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Busani S; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Bertellini E; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Girardis M; Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Ferrarini G; Clinical Microbiology Unit, AUSL, Modena, Via Giardini 1355, 41126 Baggiovara, Italy.
  • Rofrano L; Clinical Microbiology Unit, AUSL, Modena, Via Giardini 1355, 41126 Baggiovara, Italy.
  • Sarti M; Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
  • Mussini C; Clinic of Infectious Diseases, Department of Infectious Diseases, University of Modena, 41124 Modena, Italy.
  • Meschiari M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy.
Antibiotics (Basel) ; 11(8)2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1957212
ABSTRACT
Ventilator-associated pneumonia (VAP) in critically ill patients with COVID-19 represents a very huge global threat due to a higher incidence rate compared to non-COVID-19 patients and almost 50% of the 30-day mortality rate. Pseudomonas aeruginosa was the first pathogen involved but uncommon non-fermenter gram-negative organisms such as Burkholderia cepacea and Stenotrophomonas maltophilia have emerged as other potential etiological causes. Against carbapenem-resistant gram-negative microorganisms, Ceftazidime/avibactam (CZA) is considered a first-line option, even more so in case of a ceftolozane/tazobactam resistance or shortage. The aim of this report was to describe our experience with CZA in a case series of COVID-19 patients hospitalized in the ICU with VAP due to difficult-to-treat (DTT) P. aeruginosa, Burkholderia cepacea, and Stenotrophomonas maltophilia and to compare it with data published in the literature. A total of 23 patients were treated from February 2020 to March 2022 19/23 (82%) VAPs were caused by Pseudomonas spp. (16/19 DTT), 2 by Burkholderia cepacea, and 6 by Stenotrophomonas maltophilia; 12/23 (52.1%) were polymicrobial. Septic shock was diagnosed in 65.2% of the patients and VAP occurred after a median of 29 days from ICU admission. CZA was prescribed as a combination regimen in 86% of the cases, with either fosfomycin or inhaled amikacin or cotrimoxazole. Microbiological eradication was achieved in 52.3% of the cases and the 30-day overall mortality rate was 14/23 (60.8%). Despite the high mortality of critically ill COVID-19 patients, CZA, especially in combination therapy, could represent a valid treatment option for VAP due to DTT non-fermenter gram-negative bacteria, including uncommon pathogens such as Burkholderia cepacea and Stenotrophomonas maltophilia.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Etiology study / Observational study Language: English Year: 2022 Document Type: Article Affiliation country: Antibiotics11081007

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Etiology study / Observational study Language: English Year: 2022 Document Type: Article Affiliation country: Antibiotics11081007