Use of Ceftazidime-Avibactam for Suspected or Confirmed Carbapenem-Resistant Organisms in Children: A Retrospective Study

Haiyang Meng,1,2 Yongmei Zhao,1,2 Qi An,1,2 Baoling Zhu,3 Zhe Cao,4 Jingli Lu1,2 1Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China; 3Department of pharmacy, Xiangcheng Hospital of Chinese Medicine, Xiangcheng, People’s Republic of China; 4Department of pharmacy, Zhenping People’s Hospital, Zhenping, People’s Republic of ChinaCorrespondence: Jingli Lu, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, People’s Republic of China, Tel +86 371 66913047, Email lujingli123@163.comBackground: The incidence of carbapenem-resistant organism (CRO) infections is increasing in children. However, pediatric-specific treatment strategies present unique challenges. Ceftazidime/avibactam is a β-lactam/β-lactamase inhibitor combination, showing adequate efficiency against CRO isolates. However, clinical data on the efficacy of ceftazidime/avibactam in children are still lacking.Methods: This was a retrospective study of children (aged < 18 years) infected with confirmed or suspected carbapenem-resistant pathogens and treated with ceftazidime-avibactam at the First Affiliated Hospital of Zhengzhou University between 2020 and 2022.Results: We identified 38 children aged 14 (5.0– 16.3) years; 20 (52.6%) had hematologic malignancies. 25 children with confirmed CRO infections were administered ceftazidime-avibactam as targeted therapy. The median treatment was 10 (6.0– 16.5) days. Among them, 24 had infections caused by carbapenem-resistant Enterobacterales (CRE) (18 carbapenem-resistant Klebsiella pneumoniae and six carbapenem-resistant Escherichia coli species) and one with carbapenem-resistant Pseudomonas aeruginosa strains. The source of infection was the bloodstream in 60.0% of the cases (15/25). The clinical response rate was 84.0% (21/25), and 30-day mortality rate was 20% (5/25). 13 children were administered ceftazidime-avibactam as empiric therapy for suspected infections. The median treatment was 8 (6.0– 13.0) days. No deaths occurred and clinical response was achieved in 12 of the 13 patients (92.3%) who empirically treated with ceftazidime-avibactam.Conclusion: Ceftazidime-avibactam is important for improving survival, and clinical response in children with infections caused by CRO.Keywords: ceftazidime-avibactam, carbapenem-resistant organisms, children