Rational evaluation of the clinical application of ceftazidime-avibactam for the treatment of carbapenem-resistant Klebsiella pneumoniae infections: A real-world retrospective study

Objectives: To evaluate the rationality of the clinical use of ceftazidime-avibactam (CAZ-AVI) for carbapenemresistant Klebsiella pneumoniae (CRKP) infections in a real-world setting. Methods: We established the rational evaluation criteria based on drug instructions and relevant guidelines to retrospectively evaluate the use of CAZ-AVI to treat CRKP infections from June 2020 to June 2023 in a tertiary hospital in China. Patients were divided into the rational use group and irrational use group. The differences in clinical efficacy, 14- and 28-day mortality, microbiological response and side effects between these two groups were analyzed. Results: Seventy-five adult patients were enrolled. The clinical application of CAZ-AVI was rational in 32 (42.7 %) patients. Irrational dosage and irrational treatment regimens were observed in 19 (25.3 %) and 31 (41.3 %) patients, respectively. The clinical treatment success rate of the rational use group was higher than that of the irrational use group, whereas the 28-day mortality rate was slightly lower. However, the microbial clearance rate was significantly higher in the irrational use group, probably due to the high percentage of microbial replacement. The rational use group had a lower incidence of acute kidney injury and acute drug-induced liver injury. Multivariate logistic regression analysis showed that continuous renal replacement therapy (CRRT) negatively impacted rational CAZ-AVI use (OR 0.13, 95 % CI 0.03-0.72, P = 0.019). Conclusions: To optimize clinical outcomes and reduce side effects of CAZ-AVI, unnecessary combination therapy should be avoided, and dose adjustments should be made according to the drug instructions.