4CPS-005 Real-life use of ceftazidime-avibactam

<h3>Background and Importance</h3> Ceftazidime-avibactam is a novel synthetic beta-lactam/beta-lactamase inhibitor combination active against Ambler class A, including extended-spectrum β-lactamases (ESBLs) and KPC, some class D enzymes (OXA-48 carbapenemases) and AmpC enzymes producing bacteria. Pharmacy and therapeutics (PyT) committee protocol includes its use in targeted treatment in severe infections with KPC-or-OXA 48-producing bacteria and combined with aztreonam in metallo-beta-lactamase-producing bacteria (VIM). Empiric treatment in severe infections and risk of colonisation by carbapenemase-producing bacteria without bacterial culture results. <h3>Aim and Objectives</h3> Analyse the degree of protocol compliance established by the PyT committee on the use of ceftazidime-avibactam. <h3>Material and Methods</h3> A retrospective observational study was carried out in all patients treated with ceftazidime-avibactam from January 2020 to June 2024. Collected data: demographics (age, sex), prescription service, indication, dosage, duration of treatment, isolated microorganism, adverse drug reactions. Data sources: electronic prescription programme and electronic medical records. <h3>Results</h3> 31 patients were included, 64.5% male; median age 63 years (IQR=77–55). Prescribing services were ICU and infectious diseases. In five patients the prescribed dose was adjusted according to renal function. The median duration of treatment was 7 days (IQR: 3–11). 71% patients received targeted treatment and 29% empiric treatment. <h3>Indications for targeted treatment were</h3> sepsis (27.3%), complicated urinary tract infections (22.7%), complicated intra-abdominal infections (13.6%), vascular lesions/amputations (9.1%), pneumonia (9.1%), colonisation (9.1%) (one patient colonised at intra-abdominal level and another at skin and soft tissue level), infections due to fractures (4.5%) and infections due to surgery (4.5%). Isolated microorganisms in targeted treatment were: VIM-producing <i>Klebsiella pneumoniae</i> (22.7%), OXA 48-producing <i>Escherichia coli</i> (22.7%), VIM-producing<i> Enterobacter cloacae</i> (13.6%), KPC-producing<i> Klebsiella pneumoniae</i> (13.6%), OXA 48-producing <i>Klebsiella pneumoniae</i> (9.1%), KPC-producing <i>Klebsiella aerogenes</i> (9.1%), multidrug-resistant <i>Pseudomonas aeruginosa</i> (4.5%), and VIM-producing <i>Enterobacter aerogenes</i> (4.5%). Regarding indications for empiric treatment group were: pneumonia (33.3%), gastrointestinal tract involvement (22.2%), sepsis (33.3%) and complicated urinary tract infections (11.1%). Isolated microorganisms in empiric treatment were: 77.7% were multidrug-resistant <i>Pseudomonas aeruginosa</i>, one patient with COVID and another with <i>Klebsiella pneumoniae</i> ESBL. Treatment antibiotic was de-escalated when laboratory testing became available. Adverse drug reactions observed: betalactamic encephalopathy (one patient). <h3>Conclusion and Relevance</h3> The degree of compliance with the protocol established by the PyT committee was high. In our case, ceftazidime-avibactam was used for targeted treatment of complicated urinary tract infections and sepsis in most cases. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest