INTRODUCTION A systematic literature review was undertaken to evaluate real-world use of ceftazidime-avibactam for infections due to aerobic Gram-negative organisms in adults with limited treatment options. METHODS Literature searches retrieved peer-reviewed publications and abstracts from major international infectious disease congresses from January 2015 to February 2021. Results were screened using pre-defined criteria to limit the dataset to relevant publications (notable exclusions were paediatric data and outcomes data for bacteria intrinsically resistant to ceftazidime-avibactam). Data for included publications were subjected to qualitative synthesis. RESULTS Seventy-three relevant publications (62 peer-reviewed articles; 10 abstracts) comprising 1926 patients treated with ceftazidime-avibactam (either alone or combined with other antimicrobials) and 1114 comparator/control patients were identified. All patients were hospitalised for serious illness and most had multiple comorbidities. The most common infections were pneumonia, bacteraemia, and skin/soft tissue, urinary tract, or abdominal infections; smaller numbers of patients with meningitis, febrile neutropenia, osteomyelitis, and cystic fibrosis were also included. Carbapenem-resistant or carbapenemase-producing Enterobacterales (CRE; n = 1718) and carbapenem-resistant, multidrug-resistant (MDR), and extensively drug-resistant Pseudomonas aeruginosa (n = 150) were the most common pathogens. Most publications reported positive outcomes for ceftazidime-avibactam treatment (clinical success rates ranged from 45 to 100% and reported 30-day mortality from 0 to 63%), which were statistically superior versus comparators in some studies. ceftazidime-avibactam resistance emergence occurred infrequently and mostly in Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae strains. CONCLUSION This review provides qualitative evidence of successful use of ceftazidime-avibactam for the treatment of hospitalised patients with CRE and MDR P. aeruginosa infections with limited treatment options.

中文翻译：

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头孢他啶-阿维巴坦治疗严重革兰氏阴性菌感染的治疗选择有限：系统文献综述。

引言 一项系统的文献综述旨在评估头孢他啶-阿维巴坦在治疗选择有限的成人中治疗由需氧革兰氏阴性菌引起的感染的真实世界使用情况。方法 文献检索检索 2015 年 1 月至 2021 年 2 月主要国际传染病大会的同行评审出版物和摘要。使用预先定义的标准筛选结果，将数据集限制为相关出版物（值得注意的排除是儿科数据和细菌的结果数据）对头孢他啶-阿维巴坦耐药）。纳入出版物的数据经过定性综合。结果 73 篇相关出版物（62 篇同行评审文章；10 个摘要）包括 1926 名接受头孢他啶-阿维巴坦（单独或与其他抗微生物药物联合治疗）的患者和 1114 名比较/对照患者。所有患者均因严重疾病住院，大多数患者有多种合并症。最常见的感染是肺炎、菌血症和皮肤/软组织、泌尿道或腹部感染；少数患有脑膜炎、发热性中性粒细胞减少症、骨髓炎和囊性纤维化的患者也包括在内。耐碳青霉烯或产碳青霉烯酶的肠杆菌 (CRE; n = 1718) 和耐碳青霉烯、多重耐药 (MDR) 和广泛耐药的铜绿假单胞菌 (n = 150) 是最常见的病原体。大多数出版物报告了头孢他啶-阿维巴坦治疗的阳性结果（临床成功率范围为 45% 至 100%，报告的 30 天死亡率为 0% 至 63%），在某些研究中，其在统计学上优于对照药。头孢他啶-阿维巴坦耐药性的出现很少发生，主要发生在产碳青霉烯酶（KPC）的肺炎克雷伯菌菌株中。结论 本综述提供了成功使用头孢他啶-阿维巴坦治疗 CRE 和 MDR 铜绿假单胞菌感染且治疗选择有限的住院患者的定性证据。头孢他啶-阿维巴坦耐药性的出现很少发生，主要发生在产碳青霉烯酶（KPC）的肺炎克雷伯菌菌株中。结论 本综述提供了成功使用头孢他啶-阿维巴坦治疗 CRE 和 MDR 铜绿假单胞菌感染且治疗选择有限的住院患者的定性证据。头孢他啶-阿维巴坦耐药性的出现很少发生，主要发生在产碳青霉烯酶（KPC）的肺炎克雷伯菌菌株中。结论 本综述提供了成功使用头孢他啶-阿维巴坦治疗 CRE 和 MDR 铜绿假单胞菌感染且治疗选择有限的住院患者的定性证据。