さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense a ID pharmacist. Another face is an investor.

Colistin Versus Ceftazidime-Avibactam in the Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae

CREに対する、コリスチン vs Ceftazidime-Avibactamの CID 論文

 

Abstract

Background

The efficacy of ceftazidime-avibactam—a cephalosporin–β-lactamase inhibitor combination with in vitro activity against Klebsiella pneumoniaecarbapenemase–producing carbapenem-resistant Enterobacteriaceae (CRE)—compared with colistin remains unknown.

Methods

Patients initially treated with either ceftazidime-avibactam or colistin for CRE infections were selected from the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), a prospective, multicenter, observational study. Efficacy, safety, and benefit-risk analyses were performed using intent-to-treat analyses with partial credit and the desirability of outcome ranking approaches. The ordinal efficacy outcome was based on disposition at day 30 after starting treatment (home vs not home but not observed to die in the hospital vs hospital death). All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW).

Results

Thirty-eight patients were treated first with ceftazidime-avibactam and 99 with colistin. Most patients received additional anti-CRE agents as part of their treatment. Bloodstream (n = 63; 46%) and respiratory (n = 30; 22%) infections were most common. In patients treated with ceftazidime-avibactam versus colistin, IPTW-adjusted all-cause hospital mortality 30 days after starting treatment was 9% versus 32%, respectively (difference, 23%; 95% bootstrap confidence interval, 9%–35%; P = .001). In an analysis of disposition at 30 days, patients treated with ceftazidime-avibactam, compared with those treated within colistin, had an IPTW-adjusted probability of a better outcome of 64% (95% confidence interval, 57%-71%). Partial credit analyses indicated uniform superiority of ceftazidime-avibactam to colistin.

Conclusions

Ceftazidime-avibactam may be a reasonable alternative to colistin in the treatment of K. pneumoniae carbapenemase–producing CRE infections. These findings require confirmation in a randomized controlled trial.

 

どうでしょうか? 

 

P:CRE infections

E : ceftazidime-avibactam

C : colistin

O : IPTW-adjusted all-cause hospital mortality 30 days after starting treatment was 9% versus 32%, respectively (difference, 23%; 95% bootstrap confidence interval, 9%–35%; P = .001)

T : prospective, multicenter, observational study

 

驚異のCRE。選択肢が増えて欲しいです。

と言っても、万能ではないので、予防に全力を尽くすスタンスは変わりませんが、

 

研究デザインの向上は困難ですが、RCTデータも期待したいです。