Pharmacoepidemiology of Ceftazidime-Avibactam Use: A Retrospective Cohort Analysis of 210 US Hospitals
Pharmacoepidemiology of Ceftazidime-Avibactam Use: A Retrospective Cohort Analysis of 210 US Hospitals
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DOI：
10.1093/cid/ciaa061
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发表时间：
2021-02-15
影响因子：
11.8
通讯作者：
Kadri, Sameer S.
中科院分区：
文献类型：
--
作者：
Strich, Jeffrey R.;Ricotta, Emily;Kadri, Sameer S.
背景资料。头孢他啶-阿维巴坦在体外对一些碳青霉烯耐药的革兰氏阴性感染(GNI)具有活性，因此可能是一种有效的替代毒性更强的抗生素，如粘菌素。了解头孢他啶-阿巴坦的吸收和使用模式将为医院处方、管理和抗生素开发提供信息。一项回顾队列研究评估了Vizient数据库中的住院患者遭遇。对于假定的碳青霉烯类耐药GNI，头孢他啶-阿维巴坦和粘菌素治疗被归类为推定经验性(连续3天或以下，排除合格)和靶向治疗(>；=连续4天)。使用改进的泊松回归计算季度百分比变化(QPC)和靶向头孢他啶-阿维巴坦与粘菌素相遇的频率的相对变化。使用广义估计方程确定了与优先接受靶向头孢他啶-阿巴坦与粘菌素相关的因素。在2015年第一季度至2017年第四季度，头孢他啶-阿维巴坦在1901次相遇中使用了21215次。头孢他啶-阿维巴坦的住院处方从2015年第一季度的0.44/10000增加到2017年第四季度的7.7/万(QPC，+11%；95%CI，10-13%；P<；.01)，而粘菌素处方每季度减少5%(95%CI，4-6%；P<；0.01)。头孢他啶-阿巴坦治疗被归类为经验性治疗的25%，靶向性治疗的65%，不确定治疗的10%。慢性肾脏疾病患者接受靶向头孢他啶-阿维巴坦的可能性是粘菌素的两倍(RR，2.02；95%CI，1.82-2.25)，而透析患者接受头孢他啶-阿巴坦的可能性低于粘菌素(RR，0.71；95%CI，0.61-.83)。自2015年获得批准以来，头孢他啶-阿维巴坦在推定对碳青霉烯类抗生素耐药的GNI中的使用量有所增加，而粘菌素的使用量相应减少。肾功能决定了头孢他啶-阿巴坦和粘菌素作为靶向治疗的选择。
Background. Ceftazidime-avibactam has in vitro activity against some carbapenem-resistant gram-negative infections (GNIs), and therefore may be a useful alternative to more toxic antibiotics such as colistin. Understanding ceftazidime-avibactam uptake and usage patterns would inform hospital formularies, stewardship, and antibiotic development.Methods. A retrospective cohort study assessed inpatient encounters in the Vizient database. Ceftazidime-avibactam and colistin administrations were categorized into presumed empiric (3 consecutive days of therapy or less with qualifying exclusions) versus targeted therapy (>= 4 consecutive days of therapy) for presumed carbapenem-resistant GNIs. Quarterly percentage change (QPC) using modified Poisson regression and relative change in frequency of targeted ceftazidime-avibactam to colistin encounters was calculated. Factors associated with preferentially receiving targeted ceftazidime-avibactam versus colistin were identified using generalized estimating equations.Results. Between 2015 quarter (q) 1 and 2017q4, ceftazidime-avibactam was administered 21 215 times across 1901 encounters. Inpatient prescriptions for ceftazidime-avibactam increased from 0.44/10 000 hospitalizations in 2015q1 to 7.7/10 000 in 2017q4 (QPC, +11%; 95% CI, 10-13%; P < .01), while conversely colistin prescriptions decreased quarterly by 5% (95% CI, 4-6%; P < .01). Ceftazidime-avibactam therapy was categorized as empiric 25% of the time, targeted 65% of the time, and indeterminate 10% of the time. Patients with chronic kidney disease were twice as likely to receive targeted ceftazidime-avibactam versus colistin (RR, 2.02; 95% CI, 1.82-2.25), whereas those on dialysis were less likely to receive ceftazidime-avibactam than colistin (RR, 0.71; 95% CI, .61-.83).Conclusions. Since approval in 2015, ceftazidime-avibactam use has grown for presumed carbapenem-resistant GNIs, while colistin has correspondingly declined. Renal function drove the choice between ceftazidime-avibactam and colistin as targeted therapy.