The Use of Ceftazidime-Avibactam in a Pediatric Intensive Care Unit-An Observational Prospective Study

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Resistance
• Critical Care Medicine

Background:

• Carbapenem-resistant Enterobacterales (CRE) infections are a growing concern in Pediatric Intensive Care Units (PICUs).
• Limited pediatric data exists for treating CRE infections, which are associated with poor patient outcomes.
• Ceftazidime-avibactam (CAZ-AVI) has emerged as a potential treatment option.

Purpose of the Study:

• To describe the utilization and clinical outcomes of ceftazidime-avibactam (CAZ-AVI) in a PICU setting.
• To evaluate CAZ-AVI's effectiveness in treating multidrug-resistant (MDR) bacterial infections in critically ill children.

Main Methods:

• An observational prospective study was conducted in a tertiary hospital's PICU during 2022.
• Data collected included epidemiological, clinical, microbiological, and outcome information for children treated with CAZ-AVI.
• Ten patients with 12 episodes of suspected or confirmed MDR bacterial infections were analyzed.

Main Results:

• CAZ-AVI was used for various indications including surgical prophylaxis, suspected sepsis, pneumonia, and surgical wound infections.
• Eighty percent of patients received empirical treatment due to prior MDR colonization; 60% received combination therapy with aztreonam for Metallo-β-Lactamases (MBL) strains.
• No bacterial resistance to CAZ-AVI was observed. Average treatment duration was 3 days for negative cultures and 7 days for positive MDR isolates.

Conclusions:

• Short-term empirical CAZ-AVI treatment is a frequent approach in PICUs for patients with MDR colonization and suspected bacteremia/sepsis.
• Combining CAZ-AVI with aztreonam may enhance efficacy against CRE, particularly Ambler class B MBL strains.
• Further research is warranted to establish optimal CAZ-AVI regimens in pediatric critical care.