Ceftazidime-avibactam brightens outlook in CRE bacteraemia

Treatment with ceftazidime-avibactam in patients with carbapenem-resistant Enterobacteriaceae (CRE) bacteraemia appears to reduce the risk of death over 2 weeks when compared with colistin, according to a study.

The analysis included 61 patients (mean age 53.7 years, 59 percent male, 88.5 percent had secondary bacteraemia), among whom 32 received ceftazidime-avibactam and 29 did colistin. Baseline demographics and clinical characteristics were similar in the two groups, apart from a higher rate of nontransplant surgery in the colistin group 14 days prior to therapy initiation.

Multivariable Cox regression analysis showed that the primary outcome of 14-day mortality was 68-percent lower in patients who received ceftazidime-avibactam than in those on colistin (hazard ratio [HR] 0.32, 95 percent confidence interval [CI] 0.10–0.99; p=0.049).

There were no significant between-group differences in 30-day mortality (HR 0.50, 95 percent CI 0.20–1.21; p=0.12) and median time until death (16 days with ceftazidime-avibactam vs 14 days with colistin; p=0.32).

Ceftazidime-avibactam, while associated with only a nominally higher frequency of bacterial eradication within 72 hours (68.8 percent vs 44.8 percent; p=0.059), yielded a more favourable clinical success rate as compared with colistin (46.8 percent vs 20.4 percent; p=0.047).

The findings warrant larger prospective studies to confirm the effect of ceftazidime-avibactam on CRE bacteraemia outcomes.