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

Naiju Zhang; Jinchun Liu

doi:doi:10.11648/j.jddmc.20210703.12

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

Naiju Zhang, Jinchun Liu

Published in Journal of Drug Design and Medicinal Chemistry (Volume 7, Issue 3)

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

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[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.
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[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.
[18]	Daikos G L, Markogiannakis A. Carbapenemase-producing Klebsiella pneumoniae: (When) might we still consider treating with carbapenems [J]. Clin Microbiol Infect, 2011, 17 (8): 1135-1141.

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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
AU  - Jinchun Liu
Y1  - 2021/10/15
PY  - 2021
N1  - https://doi.org/10.11648/j.jddmc.20210703.12
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
SP  - 50
EP  - 53
PB  - Science Publishing Group
SN  - 2472-3576
UR  - https://doi.org/10.11648/j.jddmc.20210703.12
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
IS  - 3
ER  -

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Author Information

Naiju Zhang

Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, P. R. China
Jinchun Liu

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

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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
AU  - Jinchun Liu
Y1  - 2021/10/15
PY  - 2021
N1  - https://doi.org/10.11648/j.jddmc.20210703.12
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
SP  - 50
EP  - 53
PB  - Science Publishing Group
SN  - 2472-3576
UR  - https://doi.org/10.11648/j.jddmc.20210703.12
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
IS  - 3
ER  -

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