Ceftazidime-avibactam for the treatment of febrile neutropenia in HSCT recipients and acute leukemia patients post induction chemotherapy

Febrile neutropenia is a major complication in patients with acute leukemia or those undergoing hematopoietic stem cell transplantation (HSCT). Understanding patient characteristics and susceptibility patterns in febrile neutropenia is essential for appropriate antimicrobial therapy. First-line agents should have Pseudomonas aeruginosa coverage, but with the increase in multi-drug resistant organisms, ceftazidime-avibactam has emerged as a new therapeutic option. This retrospective case-control study included 300 admissions (143 patients) between January 2009 and December 2022. Patients with hematologic neoplasms and patients that underwent HSCT, satisfying the criteria of febrile neutropenia and treated with ceftazidime-avibactam (CAZAVI) were included and compared to controls who received the best available therapy (BAT). A bivariate regression model explored independent predictors of septic shock and mortality. Patients who received CAZAVI were more likely to have a microbiologically documented infection (59.0% vs. 28.3%). Complications were significantly more frequent in the CAZAVI group, with sepsis being the most common (59.0%). Multivariable logistic regression analysis showed that receiving CAZAVI was an independent risk factor for both sepsis and mortality (aOR 6.33 [95% CI 2.81-14.30] and 7.82 [2.63-23.26], respectively). Knowing common organisms and patterns of resistance, with an understanding of risk factors for morbidity and mortality, is crucial for the antimicrobial management of febrile neutropenia. Further studies on the effectiveness of CAZAVI in this population are needed.