Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia
Background: Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP...
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Elsevier
2025-09-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034125001856 |
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| author | Yi-Tsung Lin Shih-Neng Lin Chien Chuang Szu-Yu Liu Yu-Chien Ho Chih-Han Juan Hsiang-Ling Ho Sheng-Hua Chou |
| author_facet | Yi-Tsung Lin Shih-Neng Lin Chien Chuang Szu-Yu Liu Yu-Chien Ho Chih-Han Juan Hsiang-Ling Ho Sheng-Hua Chou |
| author_sort | Yi-Tsung Lin |
| collection | DOAJ |
| description | Background: Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP bacteremia. Methods: Patients with CZA-susceptible CRKP bacteremia who received CZA for a minimum of 5 days at our hospital from February 2020 to September 2023 were enrolled. The resistance mechanisms of the CRKP isolates were determined. Cox regression analysis was used to analyze the factors associated with 28-day mortality, and logistic regression was used to study 14-day clinical failure. Results: A total of 135 adults who received CZA for CRKP bacteremia were identified. Among the CRKP isolates, 85 (63.0 %) were KPC-2 producers and 17 (12.6 %) were OXA-48 producers. Monotherapy with CZA was identified in 98 cases (72.5 %). The 28-day mortality rate was 28.1 %, and the 14-day clinical failure rate was 41.5 %. In multivariate analysis, 28-day mortality was positively associated with older age, malignancy, and INCREMENT score ≥8. Charlson comorbidity index and the SOFA score were independent predictors of 14-day clinical failure. Among patients with SOFA score >6, malignancy was an independent risk factor for 28-day mortality, and early initiation of CZA therapy within 4 days was a protective factor against 28-day mortality. Conclusion: Older age, malignancy, and INCREMENT score ≥8 are predictors for mortality in CZA-susceptible CRKP bacteremia treated with CZA. Early treatment with CZA is associated with survival in patients with high disease severity. |
| format | Article |
| id | doaj-art-5ea46dbf1c0d4838949d0d2fd389ebca |
| institution | DOAJ |
| issn | 1876-0341 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj-art-5ea46dbf1c0d4838949d0d2fd389ebca2025-08-20T02:49:37ZengElsevierJournal of Infection and Public Health1876-03412025-09-0118910283610.1016/j.jiph.2025.102836Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremiaYi-Tsung Lin0Shih-Neng Lin1Chien Chuang2Szu-Yu Liu3Yu-Chien Ho4Chih-Han Juan5Hsiang-Ling Ho6Sheng-Hua Chou7Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Correspondence to: Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Number 201, Section 2, Shih-Pai Road, Beitou District, Taipei 11217, Taiwan.School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanBackground: Ceftazidime-avibactam (CZA) is the preferred treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). This study aimed to investigate the prognostic factors of 28-day mortality and 14-day clinical failure in patients treated with CZA for CZA-susceptible CRKP bacteremia. Methods: Patients with CZA-susceptible CRKP bacteremia who received CZA for a minimum of 5 days at our hospital from February 2020 to September 2023 were enrolled. The resistance mechanisms of the CRKP isolates were determined. Cox regression analysis was used to analyze the factors associated with 28-day mortality, and logistic regression was used to study 14-day clinical failure. Results: A total of 135 adults who received CZA for CRKP bacteremia were identified. Among the CRKP isolates, 85 (63.0 %) were KPC-2 producers and 17 (12.6 %) were OXA-48 producers. Monotherapy with CZA was identified in 98 cases (72.5 %). The 28-day mortality rate was 28.1 %, and the 14-day clinical failure rate was 41.5 %. In multivariate analysis, 28-day mortality was positively associated with older age, malignancy, and INCREMENT score ≥8. Charlson comorbidity index and the SOFA score were independent predictors of 14-day clinical failure. Among patients with SOFA score >6, malignancy was an independent risk factor for 28-day mortality, and early initiation of CZA therapy within 4 days was a protective factor against 28-day mortality. Conclusion: Older age, malignancy, and INCREMENT score ≥8 are predictors for mortality in CZA-susceptible CRKP bacteremia treated with CZA. Early treatment with CZA is associated with survival in patients with high disease severity.http://www.sciencedirect.com/science/article/pii/S1876034125001856Ceftazidime-avibactamBacteremiaMortalityRisk factors |
| spellingShingle | Yi-Tsung Lin Shih-Neng Lin Chien Chuang Szu-Yu Liu Yu-Chien Ho Chih-Han Juan Hsiang-Ling Ho Sheng-Hua Chou Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia Journal of Infection and Public Health Ceftazidime-avibactam Bacteremia Mortality Risk factors |
| title | Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia |
| title_full | Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia |
| title_fullStr | Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia |
| title_full_unstemmed | Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia |
| title_short | Risk factors for mortality in patients treated with ceftazidime-avibactam for ceftazidime-avibactam susceptible carbapenem-resistant Klebsiella pneumoniae bacteremia |
| title_sort | risk factors for mortality in patients treated with ceftazidime avibactam for ceftazidime avibactam susceptible carbapenem resistant klebsiella pneumoniae bacteremia |
| topic | Ceftazidime-avibactam Bacteremia Mortality Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S1876034125001856 |
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