The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study
IntroductionCarbapenem-resistant Pseudomonas aeruginosa (CRPA) infections pose a critical clinical challenge. Although ceftazidime/avibactam (CAZ/AVI) and polymyxin B (PMB) are frontline therapies, their comparative effectiveness in terms of 30-day survival, renal safety profiles, and clinical succe...
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Frontiers Media S.A.
2025-03-01
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| author | Wen-Ming Long Wen-Ming Long Wei-Xin Xu Qin Hu Qiang Qu Xiao-Li Wu Ying Chen Qing Wan Tian-Tian Xu Yue Luo Jian Qu Jian Qu |
| author_facet | Wen-Ming Long Wen-Ming Long Wei-Xin Xu Qin Hu Qiang Qu Xiao-Li Wu Ying Chen Qing Wan Tian-Tian Xu Yue Luo Jian Qu Jian Qu |
| author_sort | Wen-Ming Long |
| collection | DOAJ |
| description | IntroductionCarbapenem-resistant Pseudomonas aeruginosa (CRPA) infections pose a critical clinical challenge. Although ceftazidime/avibactam (CAZ/AVI) and polymyxin B (PMB) are frontline therapies, their comparative effectiveness in terms of 30-day survival, renal safety profiles, and clinical success rates remains poorly characterized. To address this knowledge gap, a multicenter real-world study was conducted.MethodsCRPA-infected patients treated with PMB or CAZ/AVI-based regimens were enrolled from five hospitals between January 1, 2021, to July 31, 2023. Propensity score matching (PSM) and binary logistic regression analysis were performed to evaluate efficacy and acute renal injury (AKI) occurrence, and a multivariable COX proportional hazards regression of the 30-day all-cause mortality was performed.Results170 CRPA-infected patients were enrolled, among whom 124 (72.9%) had difficult-to-treat resistant P. aeruginosa (DTR-PA) infections and 77 (45.3%) received CAZ/AVI-based regimens. After 1:1 PSM, the results demonstrated that the CRPA clearance rate was significantly higher in the CAZ/AVI group compared to the PMB group (61.0% vs. 24.4%, p = 0.001); however, no significant differences were observed in clinical success rates (55.6% vs. 44.4%), incidence of AKI (26.8% vs. 39.0%), or 30-day all-cause mortality (7.3% vs. 12.2%) between the two groups (all p > 0.05). Compared with the PMB-based regimens, CAZ/AVI-based regimens were significantly associated with CRPA clearance success (OR 0.185, 95%CI 0.061–0.564, p < 0.001); additionally, multi-site infection (OR 0.295, 95%CI 0.097–0.899, p = 0.032) and the number of combined anti-PA antibiotics (OR 0.435, 95%CI 0.213–0.888, p = 0.022) were associated with enhanced CRPA clearance. The occurrence of AKI in patients with CRPA infection was associated with underlying diseases, including sepsis/septic shock (OR 3.405, 95%CI 1.007–11.520, p = 0.049), and diabetes mellitus (OR 3.600, 95%CI 1.018–12.733, p = 0.047). In addition, other CREs infection (HR 40.849, 95%CI 3.323–502.170, p = 0.004), APACHE II score (HR 1.072, 95%CI 1.032–1.114, p < 0.001) were found to be independent predictors of 30-day all-cause mortality.ConclusionIn conclusion, CAZ/AVI-based regimens demonstrated superior efficacy in clearing CRPA compared to PMB-based regimens. Furthermore, several factors associated with AKI and mortality in CRPA-infected patients were identified, highlighting the need for further research to optimize treatment strategies. |
| format | Article |
| id | doaj-art-990943b561bf4e39bee9fc89efa77fa4 |
| institution | DOAJ |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-990943b561bf4e39bee9fc89efa77fa42025-08-20T02:49:59ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-03-011610.3389/fphar.2025.15339521533952The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched studyWen-Ming Long0Wen-Ming Long1Wei-Xin Xu2Qin Hu3Qiang Qu4Xiao-Li Wu5Ying Chen6Qing Wan7Tian-Tian Xu8Yue Luo9Jian Qu10Jian Qu11Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second People’s Hospital of Huaihua City (The Central Hospital of Huaihua City), Huaihua, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Pharmacy, Renmin Hospital, Wuhan University, Wuhan, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Pharmacy, The People’s Hospital of Liuyang, Liuyang, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaHunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, ChinaIntroductionCarbapenem-resistant Pseudomonas aeruginosa (CRPA) infections pose a critical clinical challenge. Although ceftazidime/avibactam (CAZ/AVI) and polymyxin B (PMB) are frontline therapies, their comparative effectiveness in terms of 30-day survival, renal safety profiles, and clinical success rates remains poorly characterized. To address this knowledge gap, a multicenter real-world study was conducted.MethodsCRPA-infected patients treated with PMB or CAZ/AVI-based regimens were enrolled from five hospitals between January 1, 2021, to July 31, 2023. Propensity score matching (PSM) and binary logistic regression analysis were performed to evaluate efficacy and acute renal injury (AKI) occurrence, and a multivariable COX proportional hazards regression of the 30-day all-cause mortality was performed.Results170 CRPA-infected patients were enrolled, among whom 124 (72.9%) had difficult-to-treat resistant P. aeruginosa (DTR-PA) infections and 77 (45.3%) received CAZ/AVI-based regimens. After 1:1 PSM, the results demonstrated that the CRPA clearance rate was significantly higher in the CAZ/AVI group compared to the PMB group (61.0% vs. 24.4%, p = 0.001); however, no significant differences were observed in clinical success rates (55.6% vs. 44.4%), incidence of AKI (26.8% vs. 39.0%), or 30-day all-cause mortality (7.3% vs. 12.2%) between the two groups (all p > 0.05). Compared with the PMB-based regimens, CAZ/AVI-based regimens were significantly associated with CRPA clearance success (OR 0.185, 95%CI 0.061–0.564, p < 0.001); additionally, multi-site infection (OR 0.295, 95%CI 0.097–0.899, p = 0.032) and the number of combined anti-PA antibiotics (OR 0.435, 95%CI 0.213–0.888, p = 0.022) were associated with enhanced CRPA clearance. The occurrence of AKI in patients with CRPA infection was associated with underlying diseases, including sepsis/septic shock (OR 3.405, 95%CI 1.007–11.520, p = 0.049), and diabetes mellitus (OR 3.600, 95%CI 1.018–12.733, p = 0.047). In addition, other CREs infection (HR 40.849, 95%CI 3.323–502.170, p = 0.004), APACHE II score (HR 1.072, 95%CI 1.032–1.114, p < 0.001) were found to be independent predictors of 30-day all-cause mortality.ConclusionIn conclusion, CAZ/AVI-based regimens demonstrated superior efficacy in clearing CRPA compared to PMB-based regimens. Furthermore, several factors associated with AKI and mortality in CRPA-infected patients were identified, highlighting the need for further research to optimize treatment strategies.https://www.frontiersin.org/articles/10.3389/fphar.2025.1533952/fullceftazidime/avibactampolymyxin Bcarbapenem-resistant Pseudomonas aeruginosareal-world studypropensity score-matchedmicrobiological efficacy |
| spellingShingle | Wen-Ming Long Wen-Ming Long Wei-Xin Xu Qin Hu Qiang Qu Xiao-Li Wu Ying Chen Qing Wan Tian-Tian Xu Yue Luo Jian Qu Jian Qu The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study Frontiers in Pharmacology ceftazidime/avibactam polymyxin B carbapenem-resistant Pseudomonas aeruginosa real-world study propensity score-matched microbiological efficacy |
| title | The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study |
| title_full | The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study |
| title_fullStr | The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study |
| title_full_unstemmed | The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study |
| title_short | The efficacy and safety of ceftazidime/avibactam or polymyxin B based regimens for carbapenem-resistant Pseudomonas aeruginosa infection: a multicenter real-world and propensity score-matched study |
| title_sort | efficacy and safety of ceftazidime avibactam or polymyxin b based regimens for carbapenem resistant pseudomonas aeruginosa infection a multicenter real world and propensity score matched study |
| topic | ceftazidime/avibactam polymyxin B carbapenem-resistant Pseudomonas aeruginosa real-world study propensity score-matched microbiological efficacy |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1533952/full |
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