(240) Ceftazidime-avibactam versus Colistin in the treatment of Carbapenem-Resistant Enterobacteriaceae infections

Background: Carbapenem Resistant Enterobacteriaceae (CRE) poses a significant public health challenge and is a leading cause of mortality. CREs have seen a substantial spread globally in recent years. Healthcare providers often turn to last-resort antibiotics such as Colistin and novel combinations like Ceftazidime-avibactam to address these difficult-to-treat infections.

Objectives: This review aims to compare clinical effectiveness and safety of Colistin and Ceftazidime-avibactam in treating CRE infections.

Methods: Design – Review
Setting (Data sources) - PubMed, Cochrane Library, and Google Scholar were searched systematically for publications in the English language, from database inception till December 2023. Clinical studies, comprising Randomized Controlled Trials and prospective/retrospective observational studies, involving adult patients with a sample size of more than 20, which reported outcomes like mortality, clinical cure, and adverse events were included in the review. Studies that reported only in-vitro data, or which had insufficient information and reviews were excluded from the review.
Interventions - Ceftazidime-avibactam and Colistin
Outcome measures - Primary outcome- Mortality, Secondary outcome- Clinical cure and Nephrotoxicity
Statistical analysis - The risk ratio was used for the statistical computation of clinical effectiveness and safety comparison between Ceftazidime-avibactam and Colistin.

Results: 14 observational studies (9 retrospective and 5 prospective) with a total of 2202 patients were included in this review based on the aforementioned inclusion and exclusion criteria. Study findings showed that CRE patients in the Ceftazidime-avibactam group were associated with lower rates of mortality risk (Risk ratio [RR] = 0.64, 95% CI of 0.581 to 0.706), higher clinical cure (Risk ratio [RR] = 1.51, 95% CI of 1.367 to 1.659), and reduced nephrotoxicity (Risk ratio [RR] = 0.541, 95% CI of 0.491 to 0.675) when compared to CRE patients in the Colistin group.

Conclusions: The findings from this review suggest that Ceftazidime-avibactam is superior to Colistin in terms of safety and clinical effectiveness while treating CRE infections. Clinicians must judiciously use Ceftazidime-avibactam based on susceptibility profiles and patient specific characteristics to prevent further dissemination of antimicrobial resistance