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Open Access 17-06-2024 | Carbapenem Antibiotic | Research

Ceftazidime/avibactam versus polymyxin B in carbapenem-resistant Klebsiella pneumoniae infections: a propensity score-matched multicenter real-world study

Authors: Hai-Hui Zhuang, Qiang Qu, Wen-Ming Long, Qin Hu, Xiao-Li Wu, Ying Chen, Qing Wan, Tian-Tian Xu, Yue Luo, Hai-Yan Yuan, Qiong Lu, Jian Qu

Published in: Infection

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Abstract

Objectives

In this retrospective observational multicenter study, we aimed to assess efficacy and mortality between ceftazidime/avibactam (CAZ/AVI) or polymyxin B (PMB)-based regimens for the treatment of Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, as well as identify potential risk factors.

Methods

A total of 276 CRKP-infected patients were enrolled in our study. Binary logistic and Cox regression analysis with a propensity score-matched (PSM) model were performed to identify risk factors for efficacy and mortality.

Results

The patient cohort was divided into PMB-based regimen group (n = 98, 35.5%) and CAZ/AVI-based regimen group (n = 178, 64.5%). Compared to the PMB group, the CAZ/AVI group exhibited significantly higher rates of clinical efficacy (71.3% vs. 56.1%; p = 0.011), microbiological clearance (74.7% vs. 41.4%; p < 0.001), and a lower incidence of acute kidney injury (AKI) (13.5% vs. 33.7%; p < 0.001). Binary logistic regression revealed that the treatment duration independently influenced both clinical efficacy and microbiological clearance. Vasoactive drugs, sepsis/septic shock, APACHE II score, and treatment duration were identified as risk factors associated with 30-day all-cause mortality. The CAZ/AVI-based regimen was an independent factor for good clinical efficacy, microbiological clearance, and lower AKI incidence.

Conclusions

For patients with CRKP infection, the CAZ/AVI-based regimen was superior to the PMB-based regimen.
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Metadata
Title
Ceftazidime/avibactam versus polymyxin B in carbapenem-resistant Klebsiella pneumoniae infections: a propensity score-matched multicenter real-world study
Authors
Hai-Hui Zhuang
Qiang Qu
Wen-Ming Long
Qin Hu
Xiao-Li Wu
Ying Chen
Qing Wan
Tian-Tian Xu
Yue Luo
Hai-Yan Yuan
Qiong Lu
Jian Qu
Publication date
17-06-2024
Publisher
Springer Berlin Heidelberg
Published in
Infection
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-024-02324-8
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