Effect of ceftazidime/avibactam plus fosfomycin combination on 30â
day mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae: results from a multicentre retrospective study.
JAC Antimicrob Resist
; 4(6): dlac121, 2022 Dec.
Article
in English
| MEDLINE | ID: covidwho-2161069
ABSTRACT
Introduction:
The primary outcome of the study was to evaluate the effect on 30â day mortality of the combination ceftazidime/avibactamâ+âfosfomycin in the treatment of bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Materials andmethods:
From October 2018 to March 2021, a retrospective, two-centre study was performed on patients with KPC-Kp BSI hospitalized at Sapienza University (Rome) and ISMETT-IRCCS (Palermo) and treated with ceftazidime/avibactam-containing regimens. A matched cohort (11) analysis was performed. Cases were patients receiving ceftazidime/avibactamâ+âfosfomycin and controls were patients receiving ceftazidime/avibactam alone or in combination with in vitro non-active drugs different from fosfomycin (ceftazidime/avibactamâ±âother). Patients were matched for age, Charlson comorbidity index, ward of isolation (ICU or non-ICU), source of infection and severity of BSI, expressed as INCREMENT carbapenemase-producing Enterobacteriaceae (CPE) score.Results:
Overall, 221 patients were included in the study. Following the 11 match, 122 subjects were retrieved 61 cases (ceftazidime/avibactamâ+âfosfomycin) and 61 controls (ceftazidime/avibactamâ±âother). No difference in overall mortality emerged between cases and controls, whereas controls had more non-BSI KPC-Kp infections and a higher number of deaths attributable to secondary infections. Almost half of ceftazidime/avibactamâ+âfosfomycin patients were prescribed fosfomycin without MIC fosfomycin availability. No difference in the outcome emerged after stratification for fosfomycin susceptibility availability and dosage. SARS-CoV-2 infection and ICSâ≥â8 independently predicted 30â day mortality, whereas an appropriate definitive therapy was protective.Conclusions:
Our data show that fosfomycin was used in the treatment of KPC-Kp BSI independently from having its susceptibility testing available. Although no difference was found in 30â day overall mortality, ceftazidime/avibactamâ+âfosfomycin was associated with a lower rate of subsequent KPC-Kp infections and secondary infections than other ceftazidime/avibactam-based regimens.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Language:
English
Journal:
JAC Antimicrob Resist
Year:
2022
Document Type:
Article
Affiliation country:
Jacamr
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