title: Clinical efficacy of ceftazidime/avibactam versus other active agents for the treatment of bacteremia due to carbapenemase-producing Enterobacteriaceae in hematologic patients.
abstract: OBJECTIVE
  The primary objective was to describe clinical features, treatment and outcomes in patients with carbapenemase-producing Enterobacteriaceae (CPE) bacteremia. Additionally, patients treated with ceftazidime/avibactam (study group) were compared to the rest of the patients (comparator group) to determine the influence of the treatment in both crude mortality and clinical cure.
  
  
  METHODS
  Multicenter and retrospective study that included patients with hematologic malignancies who had CPE bacteremia. A bivariate analysis was performed to compare the clinical variables between the study group and the control group.
  
  
  RESULTS
  31 patients were included. Bacteremia was considered primary in 14 (45%) patients. Overall crude mortality at 30days was 45.2% (n=14). Mortality was more frequent when septic shock (78.6% vs 11.8%; p>0.001) and higher Pitt score (6+14 vs 1.5+4; p<0.01) were present. 8 patients (25.8%) received treatment with ceftazidime/avibactam. No significant differences in crude mortality were found between study and comparator groups (p=0.19). In contrast, patients in study group had higher clinical cure rates than the comparator group within 14days of initiating treatment (85.7% vs. 34.8%, respectively, p=0.031).
  
  
  CONCLUSIONS
  CPE bacteremia is associated with high mortality in patients with hematologic malignancies. Ceftazidime/avibactam may be an effective alternative for treating these patients.
authors.affiliation: Infectious Diseases Unit Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Castón
authors.affiliation: Pediatric and Specialties Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Lacort-Peralta
authors.affiliation: Infectious Diseases Service, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Martín-Dávila
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Loeches
authors.affiliation: Departament of Hematology, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Tabares
authors.affiliation: Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Liz
authors.initials: L
authors.lastname: Temkin
authors.affiliation: Infectious Diseases Unit Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain. Electronic address: julian.torre.sspa@juntadeandalucia.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; Present address: Division of Infectious Diseases Hospital Clínico Universitario "Lozano Blesa"-IIS Aragón, Zaragoza, Spain.
authors.forename: José R
authors.initials: JR
authors.lastname: Paño-Pardo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D053961:Azabicyclo Compounds / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D001426:Bacterial Proteins / Q000096:biosynthesis; D002442:Ceftazidime / Q000627:therapeutic use*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004755:Enterobacteriaceae / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D053961:Azabicyclo Compounds; D001426:Bacterial Proteins; C543519:avibactam; D002442:Ceftazidime; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Bloodstream infections; Carbapenemase-producing Enterobacteriaceae; Ceftazidime-avibactam