Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam

In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due...

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Published in:Brazilian journal of microbiology 2024-03, Vol.55 (1), p.333-341
Main Authors: Neves, Camila Soares, Moura, Líbia Cristina Rocha Vilela, Da Costa Lima, Jailton Lobo, Maciel, Maria Amélia Vieira
Format: Article
Language:English
Subjects:
Aged
Anemia
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Azabicyclo Compounds
Bacteria
Biomedical and Life Sciences
Carbapenems
Ceftazidime
Ceftazidime - pharmacology
Ceftazidime - therapeutic use
Cephalosporins - pharmacology
Cephalosporins - therapeutic use
Clinical Microbiology - Research Paper
Comorbidity
Drug Resistance, Multiple, Bacterial
Drugs
Food Microbiology
Gram-Negative Bacteria
Health services
Hematology
Hospitals
Humans
Intensive care
Intensive Care Units
Klebsiella
Life Sciences
Mechanical ventilation
Medical Microbiology
Microbial Ecology
Microbial Genetics and Genomics
Microbial Sensitivity Tests
Microbiology
Mortality
Multidrug resistance
Mycology
Neurological diseases
Nosocomial infection
Nosocomial infections
Patients
Pseudomonas aeruginosa
Tazobactam
Tazobactam - pharmacology
Tazobactam - therapeutic use
Thrombocytopenia
Thrombocytosis
Urinary tract
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Summary:In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections. Pseudomonas aeruginosa was the prevailing agent in the sample evaluation (34.3%), followed by Klebsiella pneumoniae (30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.
ISSN:1517-8382
1678-4405
1678-4405
DOI:10.1007/s42770-023-01193-x