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Abstract: PO2379

Efficacy of the Recommended Ceftazidime/Avibactam Dose in Treating Carbapenem-Resistant Enterobacteriaceae in Critically Ill Patients Using Renal Replacement Therapies

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • El Nekidy, Wasim, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Oyoun Alsoud, Leen, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Attallah, Nizar M., Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Rkieh, Laila, Trillium Health Partners, Mississauga, Ontario, Canada
  • Hijazi, Fadi A., Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Nusair, Ahmad Rakad, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Mallat, Jihad, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
  • Ghazi, Islam, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania, United States
Background

Ceftazidime/avibactam (CEF/AVI) is a novel antibiotic used to treat Multi-drug Resistant (MDR) and gram-negative bacteria, including Carbapenem-Resistant Enterobacteriaceae (CRE). Data on CEF/AVI dosing and outcomes in patients with Chronic Kidney Disease stage-5 utilizing hemodialysis are scarce. The purpose of this study was to assess the efficacy of the recommended dose of CEF/AVI in patients utilizing renal replacement therapies.

Methods

A retrospective cohort study was conducted at our quaternary care institution between May 2015 and December 2019. All hospitalized adults who had CRE Klebsiella Pneumoniae, E.coli, or MDR Pseudomonas Aeruginosa related infections, and received CEF/AVI while utilizing either continuous venovenous hemofiltration (CVVH) or intermittent hemodialysis (IHD) or both were included

Results

Of the 24 patients who met the inclusion criteria, 70.8% were males, mean age was 66.0 ± 15.7 years. Eleven patients had bacteremia, 8 had pneumonia, 3 had urinary tract infection (UTI), and 2 had wound infections. Fourteen patients received CVVH while 10 received IHD during time on therapy. CEF/AVI dose while on CVVH was 1.25 g intravenous every 8 hours while the dose was 0.94 to 1.25 g daily in patients who were treated with IHD. Twenty-two of those patients were admitted to the critical care unit and required mechanical ventilation and 20 of them received vasopressors. A total of 13 patients had microbiological cure, and 10 patients were clinically cured. Nine patients with bacteremia had microbiological cure. Four patients with pneumonia had clinical cure during the follow up periods up to 3 months, recurrence/relapse occurred in 9 of the 24 patients. Eight patients deceased within 30 days of follow up and 4 more within 90 days. Only one patient did not have relapse or recurrence within the 90 days of follow up.

Conclusion

The CEF/AVI recommended dose could achieve uncertain clinical outcomes. Pharmacokinetics and pharmacodynamics studies are urgently needed to determine the adequacy of CEF/AVI dosing in this population