Objectives

Antimicrobial resistance is a major threat to public health. New drugs such as Ceftazidime/avibactam have been developed for the treatment of Multi-Drug resistant (MDR) pathogens. Susceptibility can be variable and inappropriate use can add a financial strain on the National Health Service (NHS). There is a pressing need to ensure these new and invaluable antimicrobials are preserved and used effectively.

Methods

We undertook a retrospective observational study to assess the use of Ceftazidime/avibactam and evaluated prescribing against applied standards.

Results

Between August 2017 and January 2019, 28 patients received 31 courses of Ceftazidime/avibactam. Prescribing according to the approved indications was observed for 68% of prescriptions (p<0.0001). Duration of therapy was often prolonged but improved with Antimicrobial stewardship interventions. We observed 56% susceptibility (15/27 isolates) of MDR organisms (Pseudomonas, Klebsiella, Burkholderia, Enterobacter aerogenes, Achromobacter). We also report first in vivo experience to treat pulmonary disease caused by Non-tuberculous mycobacteria (NTM). Ceftazidime/avibactam was well tolerated, with no evidence of development of resistance at six months follow-up.

Conclusions

Our study showed that Antimicrobial stewardship interventions led to a more appropriate use of Ceftazidime/avibactam (as measured by duration of therapy), preserving it as a treatment option for MDR infections.

中文翻译：

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头孢他啶/ avibactam在英国三级心肺专科中心的经验

目标

抗菌素耐药性是对公共卫生的主要威胁。已经开发出诸如头孢他啶/ avibactam的新药来治疗耐多药（MDR）病原体。易感性可能会有所不同，使用不当会给国家卫生局（NHS）造成财务压力。迫切需要确保这些新的和宝贵的抗菌药物得以保存和有效使用。

方法

我们进行了一项回顾性观察研究，以评估头孢他啶/ avibactam的使用并评估所应用标准的处方。

结果

在2017年8月至2019年1月之间，有28名患者接受了31疗程的头孢他啶/阿维巴坦治疗。68％的处方符合批准的适应症规定（p <0.0001）。治疗时间通常会延长，但通过抗菌素管理干预可以改善治疗时间。我们观察到MDR生物（假单胞菌，克雷伯菌，伯克霍尔德氏菌，产气肠杆菌，无色杆菌）的敏感性为56％（15/27个分离株）。我们还报告了治疗非结核分枝杆菌（NTM）引起的肺部疾病的首次体内经验。头孢他啶/ avibactam的耐受性良好，随访六个月没有证据显示耐药性的发展。

结论

我们的研究表明，抗菌药物管理干预导致头孢他啶/ avibactam的使用更加合适（按治疗持续时间衡量），将其保留为MDR感染的治疗选择。