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Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection

Received: 7 September 2021     Accepted: 22 September 2021     Published: 15 October 2021
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Abstract

Background: The literature of ceftazidime-avibactam for bloodstream infections is limited, and whether meropenem (MIC ≥ 16 mg/L) can be used is also a perplexing issue for clinicians. Aim: To observe the clinical efficacy and safety of ceftazidime-avibactam combined with high dose meropenem in the treatment of extensively drug-resistant (XDR) klebsiella pneumonia (Kp) bacteremia. Methods: In 1 critically ill patient with XDR-Kp diagnosed through blood culture, tigecycline combined with cefoperazone-sulbactam and tigecycline combined with polymyxin B were successively given, and both showed poor anti-infection effects. The clinical pharmacists recommend ceftazidime-avibactam combined with high dose meropenem for anti-infection therapy. Through literature review, clinical pharmacists dynamically adjusted the dose according to the creatinine clearance rate of patients. Clinical pharmacists analyzed whether meropenem (MIC ≥ 16 mg/L) could be combined with ceftazidine-avibactam for XDR-Kp and recommended the dose of meropenem for 2g q8h and intravenous pumping for 4 hours. Results: Ceftazidime-avibactam combined with a large dose of meropenem pumped into the vein for a long time made XDR-Kp rapidly negative conversion, with clinical symptoms, signs and inflammatory indicators such as body temperature, PCT, and CRP significantly improved, without adverse reactions such as liver and kidney function. Conclusion: Ceftazidime-avibactam combined with high dose meropenem has a significant therapeutic effect on XDR-Kp and the efficacy is safe and reliable.

Published in Journal of Drug Design and Medicinal Chemistry (Volume 7, Issue 3)
DOI 10.11648/j.jddmc.20210703.12
Page(s) 50-53
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Ceftazidime-avibactam, Meropenem, XDR Klebsiella Pneumonia Bacteremia, Clinical Pharmacists, Treatment, Case Report

References
[1] Giacobbe DR, Del Bono V, Trecarichi EM, et al; ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva). Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case-controlcontrol study. Clin Microbiol Infect, 2015; 21: 1106. e1-8.
[2] European Centre for Disease Prevention and Control (ECDC). Summary of the latest data on antibiotic resistance in EU: 2016. Available at: https://ecdc.europa.eu/en/publicationsdata/summary-latest-data-antibiotic-resistance-eu-2016. Accessed 19 March 2018.
[3] Rojas LJ, Salim M, Cober E, et al; Antibacterial Resistance Leadership Group. Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality. Clin Infect Dis, 2017; 64: 711-718.
[4] Lin Huizhen, Fang Songbai, Zhao Hongwei, et al. Ceftazidime-avibactam, a new antibacterial agent for Gram-negative bacterial infection [J]. Herald of Medicine, 2016, 35 (7): 735-739.
[5] Shields RK, Clancy CJ, Hao B et al. Effects of Klebsiella pneumoniae carbapenemase subtypes, extended-spectrum b-lactamases, and porin mutations on the in vitro activity of ceftazidime-avibactam against carbapenemresistant K. pneumoniae. Antimicrob Agents Chemother 2015; 59: 5793-7.
[6] Castanheira M, Farrell SE, Krause et al. Contemporary diversity of b-lactamases among Enterobacteriaceae in the nine U.S. census regions and ceftazidime-avibactam activity tested against isolates producing the most prevalent b-lactamase groups. Antimicrob Agents Chemother 2014; 58: 833-8.
[7] Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-Second Informational Supplement M100-ED28. CLSI, Wayne, PA, USA, 2018.
[8] EUCAST. Breakpoint Tables for Interpretation of MICs and Zone Diameters, Version 8.0, 2018. http://www.eucast.org.
[9] King M, Heil E, Kuriakose S et al. Multicenter study of outcomes with ceftazidime-avibactam in patients with carbapenem-resistant Enterobacteriaceae infections. Antimicrob Agents Chemother 2017; 61: e00449-17.
[10] Temkin E, Torre-Cisneros J, Beovic B et al. Ceftazidime-avibactam as salvage therapy for infections caused by carbapenem-resistant organisms.
[11] Antimicrob Agents Chemother 2017; 61: e01964-16.36 van Duin D, Lok JJ, Earley M et al. Colistin versus ceftazidime/avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2017; 66: 163–71.
[12] Katie E. Barber, Jason M. Pogue, Henderson D. et al. Ceftazidime/avibactam versus standard-of-care agents against carbapenem-resistant Enterobacteriaceae harbouring blaKPC in a one-compartment pharmacokinetic/pharmacodynamic model [J]. J Antimicrob Chemother. 2018 Sep 1; 73 (9): 2405-2410.
[13] Tumbarello M, Trecarichi EM, Corona A, et al. Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae. Clin Infect Dis. 2019 Jan 18; 68 (3): 355-364.
[14] Shields RK, Potoski BA, Haidar G, et al. Clinical Outcomes, Drug Toxicity, and Emergence of Ceftazidime-Avibactam Resistance Among Patients Treated for Carbapenem-Resistant Enterobacteriaceae Infections. Clin Infect Dis, 2016; 63: 1615-1618.
[15] Shields RK, Nguyen MH, Chen L, et al. Pneumonia and Renal Replacement Therapy Are Risk Factors for Ceftazidime-Avibactam Treatment Failures and Resistance among Patients with Carbapenem-Resistant Enterobacteriaceae Infections [J]. Antimicrob Agents Chemother. 2018 Apr 26; 62 (5). pii: e02497-17.
[16] Expert consensus on clinical application of pharmacokinetic/pharmacodynamic theory of antibacterial drugs, Chin J Tuberc Respir Dis, 2018, 41 (6): 409-446.
[17] Petrosillo N, Giannella M, Lewis R, et al. Treatment of carbapenem-resistant Klebsiella pneumoniae: The state of the art [J]. Expert Rev Anti Infect Ther, 2013, 11 (2): 159-177.
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Cite This Article
  • APA Style

    Naiju Zhang, Jinchun Liu. (2021). Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection. Journal of Drug Design and Medicinal Chemistry, 7(3), 50-53. https://doi.org/10.11648/j.jddmc.20210703.12

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    ACS Style

    Naiju Zhang; Jinchun Liu. Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection. J. Drug Des. Med. Chem. 2021, 7(3), 50-53. doi: 10.11648/j.jddmc.20210703.12

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    AMA Style

    Naiju Zhang, Jinchun Liu. Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection. J Drug Des Med Chem. 2021;7(3):50-53. doi: 10.11648/j.jddmc.20210703.12

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  • @article{10.11648/j.jddmc.20210703.12,
      author = {Naiju Zhang and Jinchun Liu},
      title = {Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection},
      journal = {Journal of Drug Design and Medicinal Chemistry},
      volume = {7},
      number = {3},
      pages = {50-53},
      doi = {10.11648/j.jddmc.20210703.12},
      url = {https://doi.org/10.11648/j.jddmc.20210703.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jddmc.20210703.12},
      abstract = {Background: The literature of ceftazidime-avibactam for bloodstream infections is limited, and whether meropenem (MIC ≥ 16 mg/L) can be used is also a perplexing issue for clinicians. Aim: To observe the clinical efficacy and safety of ceftazidime-avibactam combined with high dose meropenem in the treatment of extensively drug-resistant (XDR) klebsiella pneumonia (Kp) bacteremia. Methods: In 1 critically ill patient with XDR-Kp diagnosed through blood culture, tigecycline combined with cefoperazone-sulbactam and tigecycline combined with polymyxin B were successively given, and both showed poor anti-infection effects. The clinical pharmacists recommend ceftazidime-avibactam combined with high dose meropenem for anti-infection therapy. Through literature review, clinical pharmacists dynamically adjusted the dose according to the creatinine clearance rate of patients. Clinical pharmacists analyzed whether meropenem (MIC ≥ 16 mg/L) could be combined with ceftazidine-avibactam for XDR-Kp and recommended the dose of meropenem for 2g q8h and intravenous pumping for 4 hours. Results: Ceftazidime-avibactam combined with a large dose of meropenem pumped into the vein for a long time made XDR-Kp rapidly negative conversion, with clinical symptoms, signs and inflammatory indicators such as body temperature, PCT, and CRP significantly improved, without adverse reactions such as liver and kidney function. Conclusion: Ceftazidime-avibactam combined with high dose meropenem has a significant therapeutic effect on XDR-Kp and the efficacy is safe and reliable.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Pharmaceutical Practice of Ceftazidime-avibactam Combined with High Dose Meropenem in XDR-Klebsiella Pneumoniae Bloodstream Infection
    AU  - Naiju Zhang
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    DO  - 10.11648/j.jddmc.20210703.12
    T2  - Journal of Drug Design and Medicinal Chemistry
    JF  - Journal of Drug Design and Medicinal Chemistry
    JO  - Journal of Drug Design and Medicinal Chemistry
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    PB  - Science Publishing Group
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    AB  - Background: The literature of ceftazidime-avibactam for bloodstream infections is limited, and whether meropenem (MIC ≥ 16 mg/L) can be used is also a perplexing issue for clinicians. Aim: To observe the clinical efficacy and safety of ceftazidime-avibactam combined with high dose meropenem in the treatment of extensively drug-resistant (XDR) klebsiella pneumonia (Kp) bacteremia. Methods: In 1 critically ill patient with XDR-Kp diagnosed through blood culture, tigecycline combined with cefoperazone-sulbactam and tigecycline combined with polymyxin B were successively given, and both showed poor anti-infection effects. The clinical pharmacists recommend ceftazidime-avibactam combined with high dose meropenem for anti-infection therapy. Through literature review, clinical pharmacists dynamically adjusted the dose according to the creatinine clearance rate of patients. Clinical pharmacists analyzed whether meropenem (MIC ≥ 16 mg/L) could be combined with ceftazidine-avibactam for XDR-Kp and recommended the dose of meropenem for 2g q8h and intravenous pumping for 4 hours. Results: Ceftazidime-avibactam combined with a large dose of meropenem pumped into the vein for a long time made XDR-Kp rapidly negative conversion, with clinical symptoms, signs and inflammatory indicators such as body temperature, PCT, and CRP significantly improved, without adverse reactions such as liver and kidney function. Conclusion: Ceftazidime-avibactam combined with high dose meropenem has a significant therapeutic effect on XDR-Kp and the efficacy is safe and reliable.
    VL  - 7
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Author Information
  • Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, P. R. China

  • Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China

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