Risk factors for clinical treatment failure and death in patients with ceftazidime-avibactam-resistant Gram-negative bacteria: A single-centre retrospective analysis

Abstract

Objective: In recent years, the number of Gram-negative bacteria (GNB) resistant to ceftazidime-avibactam (CZA) isolated from clinic has been increasing. We aimed to evaluate the clinical efficacy in patients with CZA-resistant GNB infections, and analyze the risk factors for clinical treatment failure and death.

Methods: Clinical data of patients with CZA-resistant GNB infections were collected retrospectively, and the influencing factors were analyzed by binary logistic regression.

Results: A total of 75 patients with CZA-resistant GNB infections were enrolled in the study, and the clinical effective rate was 56% (42/75). Multivariate analysis showed that continuous renal replacement therapy (CRRT) during anti-infection treatment was an independent risk factor for clinical treatment failure (OR 0.177, 95% CI 0.05–0.63, p=0.008). The 28-day mortality rate in 75 patients was 18.7% (14/75). Multivariate analysis showed that the regimen of colistin E 750,000 U q12h (OR 0.020, 95% CI 0.00–0.56, p=0.021), co-administration of tigecycline (OR 8.851, 95% CI 2.38–1316.87, p=0.012) and CRRT during anti-infection treatment (OR 79.610, 95% CI 4.87–1300.26, p=0.002) were independent affecting factors for 28-day mortality in patients with CZA-resistant GNB infections.

Conclusions: Patients with CZA-resistant GNB infections had a higher possibility of clinical treatment failure and death. The results of the study based on small sample size from a single center showed that clinical treatment failure and death were more likely to happen in patients on CRRT, and the regimen of colistin E 750,000 U q12h or co-administration of tigecycline may reduce or increase mortality, respectively. Further validation in rigorously designed multicenter clinical studies with larger sample sizes is needed.

Keywords

Ceftazidime-avibactam resistant / Gram-negative bacteria / Clinical efficacy / Mortality / Risk factors

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