Comparing ceftazidime/avibactam and polymyxin B for treating carbapenem-resistant organisms infections: a propensity score-matched retrospective cohort study.
{"title":"Comparing ceftazidime/avibactam and polymyxin B for treating carbapenem-resistant organisms infections: a propensity score-matched retrospective cohort study.","authors":"Chunmei Liu, Bing Leng, Maoyu Xie, Shuangyan Jiang, Xiaoyan Guan, Jiahui Xu, Yuqing Guo, Jinjiao Jiang, Juan Zeng","doi":"10.1016/j.ijantimicag.2024.107418","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aim: </strong>Comparative studies of Ceftazidime/avibactam(CAZ/AVI) versus polymyxin B (PMB) for carbapenem-resistant organisms (CRO) infections are limited. We aims to compare the efficacy and safety of CAZ/AVI and PMB in treating CRO infections.</p><p><strong>Methods: </strong>This single-center, propensity score-matched (PSM) retrospective cohort study involved adult patients with CRO infections. Patients who received a CAZ/AVI-based regimen were included in the cohort group, while those prescribed with a PMB-based regimen were in the control group. The primary outcome was 28-day all-cause mortality.</p><p><strong>Results: </strong>Among 298 eligible patients, 96 patients in each group were included in the PSM cohort. The CAZ/AVI group showed no improvement in 28-day or 14-day all-cause mortality, nor in 14-day clinical response, compared to the PMB group. However, the CAZ/AVI-based regimen showed higher 14-day clinical response rates than PMB-based regimen in subgroups of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections and monotherapy. The CAZ/AVI group achieved more CRO eradication than the PMB group (crude OR 1.658; 95% CI, 1.108-2.480; P=0.014; adjusted OR 1.718; 95% CI, 1.055-2.798; P=0.030). This advantage in CRO eradication with CAZ/AVI was consistent in most subgroups including septic shock, bloodstream infection and lower respiratory tract infection. The CAZ/AVI and PMB groups had comparable nephrotoxicity (crude OR 0.577; 95% CI, 0.306-1.089; P=0.090, adjusted OR, 0.741; 95% CI, 0.361-1.521; P= 0.414).</p><p><strong>Conclusion: </strong>CAZ/AVI-based and PMB-based regimens demonstrated similar clinical efficacy and nephrotoxicity in treating CRO infections. However, CAZ/AVI was superior to PMB in CRO eradication and treating CRPA infections. CAZ/AVI monotherapy was more effective than PMB monotherapy for CRO infections.</p><p><strong>Trial registration: </strong>ChiCTR2300078790 prospectively registered on Dec 19, 2023 (https://www.chictr.org.cn).</p>","PeriodicalId":13818,"journal":{"name":"International Journal of Antimicrobial Agents","volume":" ","pages":"107418"},"PeriodicalIF":4.9000,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Antimicrobial Agents","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijantimicag.2024.107418","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aim: Comparative studies of Ceftazidime/avibactam(CAZ/AVI) versus polymyxin B (PMB) for carbapenem-resistant organisms (CRO) infections are limited. We aims to compare the efficacy and safety of CAZ/AVI and PMB in treating CRO infections.
Methods: This single-center, propensity score-matched (PSM) retrospective cohort study involved adult patients with CRO infections. Patients who received a CAZ/AVI-based regimen were included in the cohort group, while those prescribed with a PMB-based regimen were in the control group. The primary outcome was 28-day all-cause mortality.
Results: Among 298 eligible patients, 96 patients in each group were included in the PSM cohort. The CAZ/AVI group showed no improvement in 28-day or 14-day all-cause mortality, nor in 14-day clinical response, compared to the PMB group. However, the CAZ/AVI-based regimen showed higher 14-day clinical response rates than PMB-based regimen in subgroups of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections and monotherapy. The CAZ/AVI group achieved more CRO eradication than the PMB group (crude OR 1.658; 95% CI, 1.108-2.480; P=0.014; adjusted OR 1.718; 95% CI, 1.055-2.798; P=0.030). This advantage in CRO eradication with CAZ/AVI was consistent in most subgroups including septic shock, bloodstream infection and lower respiratory tract infection. The CAZ/AVI and PMB groups had comparable nephrotoxicity (crude OR 0.577; 95% CI, 0.306-1.089; P=0.090, adjusted OR, 0.741; 95% CI, 0.361-1.521; P= 0.414).
Conclusion: CAZ/AVI-based and PMB-based regimens demonstrated similar clinical efficacy and nephrotoxicity in treating CRO infections. However, CAZ/AVI was superior to PMB in CRO eradication and treating CRPA infections. CAZ/AVI monotherapy was more effective than PMB monotherapy for CRO infections.
Trial registration: ChiCTR2300078790 prospectively registered on Dec 19, 2023 (https://www.chictr.org.cn).
期刊介绍：
The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
