This study compared the efficacy and mortality rates of ceftazidime/avibactam (CAZ/AVI) and meropenem-based combination therapies in treating carbapenem-resistant Gram-negative bacterial (CRGNB) infections in ICU patients. It found no significant differences in 14-day, 30-day, or 90-day mortality rates, clinical success rates, or ICU length of stay between the two groups. The research emphasizes the importance of timely appropriate antibiotic initiation for patient outcomes and identifies age, SOFA score, procalcitonin levels, and treatment delay as independent predictors of 30-day mortality.
Literature Overview
This article, titled 'A Comparative Study of Ceftazidime–Avibactam and Meropenem-Based Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in Intensive Care Units,' published in the journal Antibiotics, retrospectively analyzed 135 ICU patients receiving CAZ/AVI or meropenem-based combination therapies for carbapenem-resistant Gram-negative bacterial (CRGNB) infections. The study demonstrates that while baseline characteristics between CAZ/AVI and meropenem combination groups showed no significant differences, both groups exhibited comparable outcomes in mortality rates, clinical success rates, and ICU length of stay, suggesting CAZ/AVI's potential as a first-line ICU treatment.
Background Knowledge
Carbapenem-resistant Gram-negative bacteria (CRGNB) represent major hospital-acquired pathogens globally, particularly in ICU settings. Organisms like Klebsiella pneumoniae and Pseudomonas aeruginosa can cause severe healthcare-associated infections, including ventilator-associated pneumonia and bloodstream infections. Treatment options remain limited, with high mortality rates creating significant clinical challenges. Recently, CAZ/AVI—a novel β-lactam and β-lactamase inhibitor combination—has demonstrated broad-spectrum antibacterial activity against CRGNB. However, meropenem combinations with polymyxins or amikacin remain standard therapeutic approaches. While previous studies have compared CAZ/AVI with other antibiotics, comparative data against meropenem-based regimens, particularly in real-world ICU settings, remain sparse. This study fills this critical gap by providing clinically relevant evidence to optimize treatment strategies.
Research Methods and Experiments
This retrospective cohort study analyzed 135 ICU patients diagnosed with CRGNB infections between 2020 and 2024, divided into a CAZ/AVI monotherapy group (n=74) and a meropenem-combination therapy group (n=61). Primary endpoints included all-cause mortality at 14, 30, and 90 days. Secondary endpoints evaluated clinical response at day 14 and ICU length of stay. Data were analyzed using Kaplan–Meier survival analysis and multivariable logistic regression models.
Key Conclusions and Perspectives
Research Significance and Prospects
This research provides critical clinical evidence for CRGNB treatment strategies, suggesting CAZ/AVI could serve as an effective alternative to meropenem-based combinations in ICU settings. However, as a single-center retrospective analysis, these findings require validation through multicenter prospective randomized controlled trials. Further investigations into genotypic profiles and antimicrobial resistance mechanisms may help optimize individualized treatment approaches.
Conclusion
This study systematically compared the efficacy and safety of ceftazidime/avibactam (CAZ/AVI) and meropenem-based combination therapies in ICU patients with carbapenem-resistant Gram-negative bacterial infections. Results showed no significant differences in mortality rates at 14, 30, or 90 days, clinical success rates, or ICU length of stay between the two treatment groups. The research reaffirms the critical importance of timely appropriate antibiotic initiation for improved outcomes and identifies advanced age, elevated SOFA scores, high procalcitonin levels, and treatment delays as independent risk factors for 30-day mortality. While findings support CAZ/AVI's utility in ICU settings, larger prospective trials are needed to confirm efficacy and refine individualized treatment strategies for specific patient subgroups.
