2047. Outcomes with ceftazidime/avibactam in patients with carbapenem-resistant Enterobacteriaceae (CRE) infections: a multi-center study
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • CAZAVI for CRE ID week 2016.pdf (480.3 kB)
  • Background: Ceftazidime-avibactam (CAZAVI) is a cephalosporin-beta-lactamase inhibitor combination that is active against Enterobacteriaceae and Pseudomonas aeruginosathat is resistant to other agents, including carbapenems and late-generation cephalosporins. This purpose of this study is to describe the outcomes of patients receiving ceftazidime-avibactam for CRE infections.

    Methods: A retrospective chart review was completed from March 2015 through April 2016 at 9 hospitals in the United States for adult patients who received ceftazidime/avibactam for a CRE infection. Patients were included if they received CAZAVI for at least 24 hours for a carbapenem-resistant Enterobacteriaceae. Dosage was chosen by providers at individual sites. The primary outcome was in-hospital mortality. Microbiologic and clinical outcomes were also evaluated. Microbiological success required a negative culture at the end of therapy. Clinical success was judged by improved symptoms, improved imaging where relevant, and defervesence.

    Results:

    Characteristic

    Results (N=47)

    Male gender, n(%)

    28 (60)

    Age (median, IQR)

    59 (51-71)

    Charlson Comorbidity Index (median, IQR)

    5 (3-8)

    Pitt Bacteremia Score (median, IQR)

    2 (0-5)

    ICU, n(%)

    30 (64)

    Moderate-severe renal disease

    18 (38)

    Moderate-severe liver disease

    7 (15)

    Primary organism, n(%)

    Klebsiella pneumoniae

    Enterobacter aerogenes

    Escherichia coli

    Providencia stuartii

    Serratia marcescens

    40 (85)

    3 (6)

    3 (6)

    1 (2)

    1 (2)

    Primary infection, n(%)

    Bacteremia

    Pneumonia

    Urinary tract

    Wound

    Intra-abdominal

    Bone/joint

    19 (40)

    16 (34)

    11 (23)

    5 (11)

    2 (4)

    2 (4)

    Hospital day CRE infection diagnosed (median, IQR)

    2 (1-16)

    Hospital day CAZAVI started (median, IQR)

    8 (5-23)

    Patients receiving concomitant therapy for index pathogen, n(%)

    25 (53)

    Isolates susceptible to CAZAVI, n/N (%)

    27/28 (96)

    In-hospital mortality, n(%)

    17 (36)

    Microbiologic cure, n(%)

    24 (51)

    Clinical success, n(%)

    31 (66)

    Conclusion: In this severely ill population, 51% of patients had microbiological cure, 66% had clinical success, and 64% were alive at the end of their hospital stay. Ceftazidime/avibactam is a potential option for patients with multi-drug resistant organisms causing Enterobacteriaceae infections, including those in intensive care.

    Madeline King, PharmD, Temple University School of Pharmacy, Philadelphia, PA, Emily Heil, PharmD, Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, Safia Kuriakose, PharmD, St. Joseph's Regional Medical Center, Paterson, NJ, Tiffany Bias, PharmD, BCPS, AAHIVP, Pharmacy, Hahnemann University Hospital, Philadelphia, PA, Vanthida Huang, PharmD, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, Claudine El-Beyrouty, PharmD, BCPS, Thomas Jefferson University Hospital, Philadelphia, PA, Dorothy McCoy, PharmD, BCPS AQ-ID, Pharmacy Practice and Administration, Ernest Mario Sch. of Pharmacy at Rutgers, the State Univ. of New Jersey, Piscataway, NJ, Jon Hiles, PharmD, Indiana University Health – Methodist and University Hospitals, Indianapolis, IN, Julianne Gardner, PharmD, Christiana Care Health System, Newark, DE and Jason Gallagher, PharmD, FCCP, FIDSA, BCPS, Temple University, Philadelphia, PA

    Disclosures:

    M. King, None

    E. Heil, None

    S. Kuriakose, None

    T. Bias, Actavis, Inc: Investigator , Research grant

    V. Huang, None

    C. El-Beyrouty, None

    D. McCoy, None

    J. Hiles, None

    J. Gardner, None

    J. Gallagher, Allergan: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium
    Merck: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium
    Astellas: Scientific Advisor and Speaker's Bureau , Consulting fee and Speaker honorarium

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