Effectiveness of Ceftazidime-Avibactam versus Colistin against Carbapenem-Resistant Enterobacteriaceae- A Retrospective Study

Document Type : Original Research

Authors
N. Gopikrishnan 1
K. S Nair 2
E. Mathew 3
D. Narasimhan 4
M. Alagesan 5
1 Junior Resident, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu
2 Assistant Professor, Department Of General Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu
3 Clinical Pharmacist, Department Of General Medicine, PSG Institute of Medical Sciences Research, Coimbatore, Tamil Nadu
4 Professor, Department Of General Medicine, PSG Institute of Medical Sciences Research, Coimbatore, Tamil Nadu
5 General Medicine, Fellowship in infectious diseases, Professor, Department Of General Medicine, PSG Institute of Medical Sciences Research, Coimbatore, Tamil Nadu
10.52547/iem.10.2.111
Abstract
Background: This study compared the efficacy of ceftazidime-avibactam (CAZ-AVI) with colistin for treating carbapenem-resistant Enterobacteriaceae (CRE) infections.

Materials & Methods: This retrospective study included 120 patients with a confirmed CRE infection and information on causative bacteria and their susceptibility pattern. Patients were divided into two groups: those receiving CAZ-AVI and/or aztreonam (n=53) and those receiving colistin (n=67) for at least seven days. The colistin group was further subdivided into those who switched to CAZ-AVI due to poor outcomes. Patient data, including demographics, clinical history, microbiological data, Charlson comorbidity index, and outcomes, were collected and analyzed. Mann-Whitney U, Chi-square, and Fisher’s exact tests were used to compare the groups. P< .05 was considered statistically significant.

Findings: The findings revealed comparable clinical characteristics, there were no major differences in mean duration of hospitalization, intensive care unit (ICU) admission, and Charlson scores between the two groups. The CAZ-AVI group required a significantly longer duration of antibiotic treatment (p= .018) and more source control measures (p= .009). Klebsiella pneumoniae was the predominant causative pathogen in both groups, with NDM and OXA48 carbapenem resistance genes being the most common. Toxicity (p= .001) and mortality (p= .049) were significantly higher in the colistin group. Higher improvement was observed among the CAZ-AVI group and higher mortality among the colistin group (p= .049).

Conclusion: CAZ-AVI could serve as an alternative to colistin for treating CRE infections. Further research is necessary to confirm these findings and provide evidence-based guidelines for managing CRE infections in India.

Keywords

Subjects

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Infection Epidemiology and Microbiology
Volume 10, Issue 2
June 2024
Pages 111-121