Meropenem-Vaborbactam versus Ceftazidime-Avibactam for Treatment of Carbapenem-Resistant Enterobacteriaceae Infections
Meropenem-Vaborbactam versus Ceftazidime-Avibactam for Treatment of Carbapenem-Resistant Enterobacteriaceae Infections
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DOI：
10.1128/aac.02313-19
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发表时间：
2020-05-01
影响因子：
4.9
通讯作者：
Polk, Christopher
中科院分区：
文献类型：
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作者：
Ackley, Renee;Roshdy, Danya;Polk, Christopher
头孢他啶-阿维巴坦和美罗培南-戊硼巴坦治疗碳青霉烯类耐药肠杆菌科（CRE）感染的疗效比较尚不清楚。这是一项在2015年2月至2018年10月期间接受头孢他啶-阿维巴坦或美罗培南-戊硼巴坦治疗≥ 72小时的CRE感染成人中进行的多中心、回顾性队列研究。排除了首次发作后局部尿路感染和重复研究药物暴露的患者。主要终点是治疗组之间的临床成功比较。次要终点包括30天和90天死亡率、不良事件（AE）、90天CRE感染复发以及复发感染患者的耐药性发展。完成了一项事后亚组分析，比较了接受头孢他啶-阿维巴坦单药治疗、头孢他啶-阿维巴坦联合治疗和美罗培南-伐硼巴坦单药治疗的患者。共纳入131例患者（头孢他啶-阿维巴坦，n = 105;美罗培南-戊硼巴坦，n = 26），其中40%患有菌血症。两组的临床成功率无显著差异（62% vs 69%; P = 0.49）。头孢他啶-阿维巴坦组患者接受联合治疗的频率高于美罗培南-伐硼巴坦组患者（61% vs 15%; P < 0.01）。30天和90天死亡率无差异，两组间AE发生率相似。在复发性感染患者中，3例接受头孢他啶-阿维巴坦单药治疗的患者发生耐药，美罗培南-戊巴坦组无患者发生耐药。接受头孢他啶-阿维巴坦和美罗培南-戊巴坦治疗CRE感染的患者的临床成功相似，尽管头孢他啶-阿维巴坦更常用作联合治疗。头孢他啶-阿维巴坦单药治疗更常见耐药。
The comparative efficacy of ceftazidime-avibactam and meropenem-vaborbactam for treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections remains unknown. This was a multicenter, retrospective cohort study of adults with CRE infections who received ceftazidime-avibactam or meropenem-vaborbactam for >= 72 hours from February 2015 to October 2018. Patients with a localized urinary tract infection and repeat study drug exposures after the first episode were excluded. The primary endpoint was clinical success compared between treatment groups. Secondary endpoints included 30- and 90-day mortality, adverse events (AE), 90-day CRE infection recurrence, and development of resistance in patients with recurrent infection. A post hoc subgroup analysis was completed comparing patients who received ceftazidime-avibactam monotherapy, ceftazidime-avibactam combination therapy, and meropenem-vaborbactam monotherapy. A total of 131 patients were included (ceftazidime-avibactam, n = 105; meropenem-vaborbactam, n = 26), 40% of whom had bacteremia. No significant difference in clinical success was observed between groups (62% versus 69%; P = 0.49). Patients in the ceftazidime-avibactam arm received combination therapy more often than patients in the meropenem-vaborbactam arm (61% versus 15%; P < 0.01). No difference in 30 -and 90-day mortality resulted, and rates of AE were similar between groups. In patients with recurrent infection, development of resistance occurred in three patients that received ceftazidime-avibactam monotherapy and in no patients in the meropenem-vaborbactam arm. Clinical success was similar between patients receiving ceftazidime-avibactam and meropenem-vaborbactam for treatment of CRE infections, despite ceftazidime-avibactam being used more often as a combination therapy. Development of resistance was more common with ceftazidime-avibactam monotherapy.