Ceftazidime–avibactam versus polymyxins in treating patients with carbapenem-resistant Enterobacteriaceae infections: a systematic review and meta-analysis

Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to human health and have emerged as a major public health concern. We aimed to compare the efficacy and the safety of ceftazidime–avibactam (CAZ–AVI) and polymyxin in the treatment of CRE infections.

A systematic review and meta-analysis was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library. Published studies on the use of CAZ–AVI and polymyxin in the treatment of CRE infections were collected from the inception of the database until March 2023. Two investigators independently screened the literature according to the inclusion and exclusion criteria, evaluated the methodological quality of the included studies and extracted the data. The meta-analysis was performed using RevMan 5.4 software.

Ten articles with 833 patients were included (CAZ–AVI 325 patients vs Polymyxin 508 patients). Compared with the patients who received polymyxin-based therapy, the patients who received CAZ–AVI therapy had significantly lower 30-days mortality (RR = 0.49; 95% CI 0.01–2.34; I² = 22%; P < 0.00001), higher clinical cure rate (RR = 2.70; 95% CI 1.67–4.38; I² = 40%; P < 0.00001), and higher microbial clearance rate (RR = 2.70; 95% CI 2.09–3.49; I² = 0%; P < 0.00001). However, there was no statistically difference in the incidence of acute kidney injury between patients who received CAZ–AVI and polymyxin therapy (RR = 1.38; 95% CI 0.69–2.77; I² = 22%; P = 0.36). In addition, among patients with CRE bloodstream infection, those who received CAZ–AVI therapy had significantly lower mortality than those who received polymyxin therapy (RR = 0.44; 95% CI 0.27–0.69, I² = 26%, P < 0.00004).

Compared to polymyxin, CAZ–AVI demonstrated superior clinical efficacy in the treatment of CRE infections, suggesting that CAZ–AVI may be a superior option for CRE infections.