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Text
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URL Address
<a href="http://doi.org/10.1093/cid/cix783" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/cid/cix783</a>
Pages
163–171
Issue
2
Volume
66
Dublin Core
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Title
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Colistin Versus Ceftazidime-Avibactam in the Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae.
Publisher
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Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Date
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2018
2018-01
Subject
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benefit-risk; carbapenem-resistant Enterobacteriaceae; Carbapenems; Ceftazidime – Therapeutic Use; ceftazidime-avibactam; colistin; Colistin – Therapeutic Use; Comparative Studies; Drug Resistance; Enterobacteriaceae Infections – Drug Therapy; Human; In Vitro Studies; Klebsiella Infections; Klebsiella pneumoniae
Creator
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van Duin David; Lok Judith J; Earley Michelle; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Doi Yohei; Kaye Keith S; Fowler Vance G Jr; Paterson David L; Bonomo Robert A; Evans Scott
Description
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Background: The efficacy of ceftazidime-avibactam-a cephalosporin-beta-lactamase inhibitor combination with in vitro activity against Klebsiella pneumoniae carbapenemase-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.
Identifier
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<a href="http://doi.org/10.1093/cid/cix783" target="_blank" rel="noreferrer noopener">10.1093/cid/cix783</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
benefit-risk
Bonomo Robert A
carbapenem-resistant Enterobacteriaceae
Carbapenems
Ceftazidime – Therapeutic Use
ceftazidime-avibactam
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Cober Eric
colistin
Colistin – Therapeutic Use
Comparative Studies
Department of Internal Medicine
Doi Yohei
Drug Resistance
Earley Michelle
Enterobacteriaceae Infections – Drug Therapy
Evans Scott
Fowler Vance G Jr
Human
In Vitro Studies
Kalayjian Robert C
Kaye Keith S
Klebsiella Infections
Klebsiella pneumoniae
Lok Judith J
NEOMED College of Medicine
Paterson David L
Perez Federico
Richter Sandra S
Salata Robert A
van Duin David
Watkins Richard R