Ceftazidime/avibactam versus other antibiotics for the treatment of KPC carbapenemase-producing Enterobacterales bacteremia: real-life data from a university hospital in Argentina

Abstract

Background: KPC-producing Enterobacterales bacteremia (KPC-CPE) is associated with a high mortality rate and limited therapeutic options. Aim: To describe and compare the outcome of patients with KPC-CPE bacteremia treated with ceftazidime/avibactam (CA) versus other antibiotics (OA). Methods: Prospective and retrospective cases and control study performed in adult patients with KPC-CPE bacteremia, with a 1:2 ratio between cases treated with CA and controls treated with OA. Clinical, epidemiological, and outcome variables were analyzed. Results: Forty-eight patients (16 CA and 32 OA) were included. Cases were more frequently neutropenic (50 vs. 16%, p=0.012), presented higher median APACHE II score and lower Pitt score. Of the total cohort, 65% had a clinical source, and Klebsiella pneumoniae was the most frequently isolated microorganism. Cases received more adequate empirical antibiotic treatment (81 vs. 53%, p=0.05). Targeted antibiotic therapy in cases and controls was combined in 38 and 91%, p=0.009. Cases had a lower 7-day mortality and 30-day infection-related mortality (0 vs. 22%, p=0.04 and 0 vs. 34%, p=0.008). Only controls developed shock, were admitted to the intensive care unit, and had breakthrough bacteremia. Conclusion: CA showed clinical benefit over OA in the treatment of patients with EPC-KPC bacteremia.