{"title":"恶性血液病患者耐碳青霉烯肺炎克雷伯菌脓毒症的抗菌治疗","authors":"N. Barantsevich, E. Barantsevich","doi":"10.36488/cmac.2022.4.383-387","DOIUrl":null,"url":null,"abstract":"Objective. To compare the efficacy of ceftazidime-avibactam and aztreonam combination therapy with “standard” therapy in patients with hematological malignancies and sepsis, caused by carbapenemresistant K. pneumoniae. Materials and Methods. In this open, single center prospective-retrospective, cohort study, during 2019–2022, we analyze medical documentation of 81 hospitalized patients with hematologic malignancies and K. pneumoniae sepsis. K. pneumoniae was identified by MALDI-TOF mass-spectrometry; antimicrobial susceptibility testing was performed in accordance with current versions of EUCAST guidelines. Patients with sepsis, caused by carbapenem-resistant K. pneumoniae isolates (n = 53), received either ceftazidimeavibactam plus aztreonam combined therapy (1st group, n = 26), or “standard” antimicrobial therapy (2nd group, n = 27). Results. K. pneumoniae sepsis was diagnosed in 81 patient with hematologic malignancies during 3 years study period. In 53 (65.4%) cases sepsis was caused by carbapenem-resistant K. pneumoniae isolates. Mortality in patients that received combination therapy with ceftazidime-avibactam and aztreonam was significantly lower (34.6%), than in patients that received other antimicrobial therapy (63.0%), p = 0.039. When ceftazidime-avibactam plus aztreonam therapy was started ≥7 days after the onset of infection the mortality rates in both groups were similar (p > 0.05). Conclusions. The incidence of carbapenem-resistance in K. pneumoniae sepsis in hematologic malignancies was 65.4% in the present study. Early administration of ceftazidime-avibactam and aztreonam combined therapy was associated with lower mortality (34.6%) comparing alternative antibiotic regimens (63.0%).","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antimicrobial therapy of sepsis caused by carbapenem-resistant Klebsiella pneumoniae in patients with hematological malignancies\",\"authors\":\"N. Barantsevich, E. Barantsevich\",\"doi\":\"10.36488/cmac.2022.4.383-387\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective. To compare the efficacy of ceftazidime-avibactam and aztreonam combination therapy with “standard” therapy in patients with hematological malignancies and sepsis, caused by carbapenemresistant K. pneumoniae. Materials and Methods. In this open, single center prospective-retrospective, cohort study, during 2019–2022, we analyze medical documentation of 81 hospitalized patients with hematologic malignancies and K. pneumoniae sepsis. K. pneumoniae was identified by MALDI-TOF mass-spectrometry; antimicrobial susceptibility testing was performed in accordance with current versions of EUCAST guidelines. Patients with sepsis, caused by carbapenem-resistant K. pneumoniae isolates (n = 53), received either ceftazidimeavibactam plus aztreonam combined therapy (1st group, n = 26), or “standard” antimicrobial therapy (2nd group, n = 27). Results. K. pneumoniae sepsis was diagnosed in 81 patient with hematologic malignancies during 3 years study period. In 53 (65.4%) cases sepsis was caused by carbapenem-resistant K. pneumoniae isolates. Mortality in patients that received combination therapy with ceftazidime-avibactam and aztreonam was significantly lower (34.6%), than in patients that received other antimicrobial therapy (63.0%), p = 0.039. When ceftazidime-avibactam plus aztreonam therapy was started ≥7 days after the onset of infection the mortality rates in both groups were similar (p > 0.05). Conclusions. The incidence of carbapenem-resistance in K. pneumoniae sepsis in hematologic malignancies was 65.4% in the present study. Early administration of ceftazidime-avibactam and aztreonam combined therapy was associated with lower mortality (34.6%) comparing alternative antibiotic regimens (63.0%).\",\"PeriodicalId\":53392,\"journal\":{\"name\":\"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.36488/cmac.2022.4.383-387\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36488/cmac.2022.4.383-387","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Antimicrobial therapy of sepsis caused by carbapenem-resistant Klebsiella pneumoniae in patients with hematological malignancies
Objective. To compare the efficacy of ceftazidime-avibactam and aztreonam combination therapy with “standard” therapy in patients with hematological malignancies and sepsis, caused by carbapenemresistant K. pneumoniae. Materials and Methods. In this open, single center prospective-retrospective, cohort study, during 2019–2022, we analyze medical documentation of 81 hospitalized patients with hematologic malignancies and K. pneumoniae sepsis. K. pneumoniae was identified by MALDI-TOF mass-spectrometry; antimicrobial susceptibility testing was performed in accordance with current versions of EUCAST guidelines. Patients with sepsis, caused by carbapenem-resistant K. pneumoniae isolates (n = 53), received either ceftazidimeavibactam plus aztreonam combined therapy (1st group, n = 26), or “standard” antimicrobial therapy (2nd group, n = 27). Results. K. pneumoniae sepsis was diagnosed in 81 patient with hematologic malignancies during 3 years study period. In 53 (65.4%) cases sepsis was caused by carbapenem-resistant K. pneumoniae isolates. Mortality in patients that received combination therapy with ceftazidime-avibactam and aztreonam was significantly lower (34.6%), than in patients that received other antimicrobial therapy (63.0%), p = 0.039. When ceftazidime-avibactam plus aztreonam therapy was started ≥7 days after the onset of infection the mortality rates in both groups were similar (p > 0.05). Conclusions. The incidence of carbapenem-resistance in K. pneumoniae sepsis in hematologic malignancies was 65.4% in the present study. Early administration of ceftazidime-avibactam and aztreonam combined therapy was associated with lower mortality (34.6%) comparing alternative antibiotic regimens (63.0%).