Using Ceftazidime-Avibactam to Treat Antibiotic-Resistant Infections

Madeline King, PharmD, assistant professor of Clinical Pharmacy at the University of the Sciences, Philadelphia College of Pharmacy in Philadelphia, Pennsylvania, discusses her findings regarding patients treated with ceftazidime-avibactam for carbapenem-resistant Enterobacteriaceae infections and carbapenem-resistant Pseudomonas infections.

Interview Transcript (slightly modified for readability)

“What we did is, I had a study that was kind of broken down. I looked at patients who received ceftazidime-avibactam for carbapenem-resistant Enterobacteriaceae infections, and separately for carbapenem-resistant Pseudomonas infections.

There were 60 patients included in the CRE portion of the study, [and] that was a multi-center study, so there were nine hospitals that contributed data to this. In that study we had a 32% in hospital mortality rate, which doesn’t sound great, but in the literature we see rates up to 60, or even higher, percent mortality for patients that have these CRE infections.

There’s no one drug that’s studied in the literature; it’s combinations of things, so I guess you can say it’s kind of on the lower end of what’s been reported but again, it’s small studies, you can’t really compare them at this point.

In this study, we also had a lot of severe infections, so a good amount of the patients, over 30%, had bacteremia, another large portion of the patients had pneumonia, a lot of [critically ill] patients were in the ICU, and a lot of patients were immunosuppressed; so, we had patients with a lot of other things going on.

So, it seems like [ceftazidime-avibactam] is probably an option for these patients. I don’t know if we can say that it should be used on its own or with other things, because so many patients in this study were receiving concomitant antibiotics along with ceftazidime-avibactam.

Separately, in the studies that looked at Pseudomonas patients, there were only ten patients in that study, so even a lot smaller, but it was 20% mortality, so two out of the 10 patients died and then we had a 50% microbiologic success and 70% clinical success, so the numbers look good, but again, it’s only ten patients, so you can’t say a whole lot about that at this point.

So, it does look promising; we’re seeing some pretty good results out of that. We did compare patients who were critically ill, so in the ICU, versus patients who were not in the ICU, with their mortality rates in the CRE portion of the study, and significantly more of the patients in the ICU had in hospital mortality versus those who were not. So, it may just be that these patients are sicker, it may not be necessarily be entirely due to the infection.”