Ceftazidime/avibactam (CAZ-AVI) is a newly approved antimicrobial for the treatment of complicated urinary tract infection (cUTI) and complicated intra-abdominal infection (cIAI). CAZ-AVI has in vitro activity against Klebsiella pneumoniae Carbapenemase (KPC) producing Enterobacteriaceae.However, there are minimal data evaluating the use of CAZ-AVI for non-FDA-labeled indications or infections caused by these multi-drug resistant organisms. The purpose of this evaluation was to characterize the use and clinical outcomes of CAZ-AVI at a health system with a large academic medical center.
This retrospective case-series included adult patients who received ≥ 1 dose of CAZ-AVI from April 2015 to February 2016. The primary objective was to describe utilization of the agent. Secondary objectives included detailing clinical and microbiological outcomes as well as susceptibility of identified organisms to CAZ-AVI.
Eighty-one courses of CAZ-AVI were prescribed during the study period. At initiation of therapy, CAZ-AVI was used empirically in 50.6% of cases, as pathogen-directed therapy in 43.2% of cases, and as prophylaxis in 6.2% of cases. The most common indications were pneumonia (28.4%), cUTI (23.6%), and cIAI (14.8%), with 24/81 (29.6%) cases having concomitant bacteremia. Combination antimicrobial therapy targeting Gram-negative bacteria was prescribed in 48.1% of cases. CAZ-AVI susceptibility was confirmed in 34/34 (100%) carbapenem-resistant K. pneumoniae, 2/3 (66.6%) E. coli, and 8/9 (88.9%) P. aeruginosa. Clinical cure occurred in 38/49 (77.6%) cases with a susceptible pathogen identified. In the subset of patients with confirmed carbapenem-resistant Enterobacteriaceae infection, clinical cure occurred in 29/39 (74.5%) cases. Microbiological cure occurred in 37/41 (90.2%) cases evaluable for the microbiological outcome. The rate of hospital mortality was 19.8%.
CAZ-AVI was utilized for a variety of indications in this evaluation with a high rate of clinical and microbiological cure observed. Additional data are needed, but in this evaluation CAZ-AVI was effective for treatment of infections caused by multi-drug resistant organisms in cUTI, cIAI, and non-labeled indications.
V. Athans, None
A. Pallotta, None
S. Bauer, None
S. Bass, None
E. Cober, None