Ceftazidime-Avibactam versus Colistin for the Treatment of Infections Due to Carbapenem-Resistant Enterobacterales: A Multicenter Cohort Study

Thamer A Almangour,1 Leen Ghonem,2 Ahmad Aljabri,2 Alya Alruwaili,3 Mohammed Al Musawa,4 Nader Damfu,5 Mesfer S Almalki,6 Majda Alattas,4 Hossam Abed,4 Doaa Naeem,5 Nawaf Almalki,5 Abdullah A Alhifany7 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 2Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Infectious Diseases Services, King Fahad Medical City, Riyadh, Saudi Arabia; 4Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia; 5Pharmaceutical Care Department, King Abdul Aziz Medical City, Jeddah, Saudi Arabia; 6Pharmaceutical Services, Security Forces Hospital, Makkah, Saudi Arabia; 7Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Thamer A Almangour, Email talmangour@ksu.edu.sa.comBackground: The aim of this study was to compare the safety and effectiveness of ceftazidime-avibactam (CAZ-AVI) to colistin-based regimen in the treatment of infections caused by carbapenem-resistant Enterobacterales (CRE).Methods: This was a retrospective, multicenter, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Main study outcomes included in-hospital mortality, clinical cure at end of treatment, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to assess the independent impact of CAZ-AVI on the clinical outcome.Results: A total of 230 patients were included in this study: 149 patients received CAZ-AVI and 81 patients received colistin-based regimen. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31– 4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.75; 95% CI, 1.28– 5.91). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39– 1.16) was lower in patients who received CAZ-AVI but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19– 0.69) was significantly less common in patients who received CAZ-AVI.Conclusion: CAZ-AVI is associated with higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treating these infections.Keywords: ceftazidime-avibactam, colistin, colistimethate sodium, carbapenem-resistant Enterobacterales