Background
Carbapenemase producing Enterobacteriaceae (CPE) infections have dramatically increased in the last decade. In Argentina, it is estimated that more than 20/10.000 hospital discharges suffer from these difficult-to-treat infections that are associated with high mortality rates and limited therapeutic options. New antibiotics for CPE as ceftazidime-avibactam (CAZAVI) appear to improve outcomes in CPE-infected patients, but there are no data published regarding this issue in Argentina. The aim of this study is to describe the clinical course and outcomes of patients with CPE infections treated with CAZAVI in a real world scenario.
Methods
Retrospective, multicenter, longitudinal cohort study performed from August 2018 to September 2019. Adult patients with KPC or OXA48 CPE infections were included from 10 centers. We compared clinical and microbiological cure and in-hospital mortality of patients who received at least 48 hs of CAZ-AVI empirically or targeted as monotherapy or combination therapy. We used descriptive statistics to summarize the characteristics of the patients and the results of treatment by Stata V12.
Results
One hundred and two consecutive patients with CPE infections treated with CAZ AVI were included. Mean age: 54.8 years (SD 18.5); men 62.7%. Co-morbidities: immunosuppressive therapy 30.4%, cancer 27.4%. Time from admission to CPE infection: 22.4 days (median; SD 35); life threatening infection 61%, CPE colonized patients 67.7%. Source of infection: catheter related/primary bacteremia 30%, intraabdominal 21%, cUTI 20%, respiratory 11%, SSTI 7%, CNS 5%, bone and joint 5%, infectious endocarditis 3%. K. pneumoniae was the most frequent isolated microorganism. CAZ AVI was used as empiric therapy in 33% and targeted therapy in 67%. In both indications, combination treatment was used in 62% and monotherapy in 38%. Clinical cure: 79.4%; microbiological cure (global) 95%; in-hospital mortality 23.5% (monotherapy 15.5%; combined 28.3%; p=0.38). There were no statistically significant differences between patients who received empirical or targeted treatment.
Conclusion
Our study showed a high clinical and microbiological cure rate in these serious infections. There were no differences in mortality in monotherapy or combination therapy. However, studies on a larger sample are needed to address this important issue.
