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Use of Ceftazidime-Avibactam in Children Admitted to Pediatric Intensive Care Units
André Ricardo Araujo da Silva1,2, Rafael Quijada1
1Faculty of Medicine, Universidade Federal Fluminense, Niterói 24220-900, Brazil.
Insights
Ceftazidime-avibactam (CAZ-AVI) effectively treated carbapenem-resistant bacteria (CRB) in critically ill children. Microbiological clearance was high within 7 days for confirmed CRB infections, indicating CAZ-AVI
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Ceftazidime-avibactam (CAZ-AVI) is a crucial antibiotic for treating infections caused by carbapenem-resistant gram-negative bacteria (CRB).
- Pediatric intensive care units (PICUs) face challenges in managing CRB infections, necessitating effective therapeutic options.
Purpose of the Study:
- To describe the utilization and outcomes of CAZ-AVI in children admitted to PICUs with suspected or confirmed CRB infections.
- To evaluate the clinical effectiveness and safety of CAZ-AVI in a pediatric critical care setting.
Main Methods:
- A retrospective descriptive study was conducted in two PICUs in Rio de Janeiro, Brazil, from January 2020 to January 2024.
- Included were children aged 0-18 years receiving CAZ-AVI for over 24 hours.
- Data collected included patient demographics, comorbidities, prior antibiotic use, infection types, and treatment outcomes.
Main Results:
- CAZ-AVI was administered to 37 critically ill children (median age 28 months) with a high prevalence of comorbidities (91.9%) and prior carbapenem use (89.2%).
- In five patients with confirmed CRB infections, microbiological clearance was achieved in 80% within 7 days of CAZ-AVI treatment.
- The 30-day mortality rate was 37.8%.
Conclusions:
- CAZ-AVI was predominantly used in critically ill children with complex medical histories, including multiple comorbidities and prior carbapenem exposure.
- High rates of microbiological clearance were observed in CRB-confirmed infections, supporting the efficacy of CAZ-AVI in this challenging population.
Background:
Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant gram-negative bacteria (CRB). Our aim was to describe the use of CAZ-AVI in children admitted to pediatric intensive care units (PICUs), with suspected or proven CRB infections.
Methods:
A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included.
Results:
CAZ-AVI was used in 37 patients. The median age was 28 months (range 1-215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1-138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1-22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%.
Conclusion:
Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.
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