A Questionnaire-based Survey to Understand the Role of Ceftazidime-avibactam in the Management of Carbapenem-Resistant Infections in Indian ICU Settings

INTRODUCTION: Antimicrobial resistance is serious and growing threat, with the increasing prevalence of MDR gram-negative bacteria worldwide, especially carbapenem-resistant Enterobacteriaceae (CRE). Ceftazidime-avibactam (CAZ-AVI) is a targeted first-line, and ICMR guideline recommended treatment option against CRE. OBJECTIVES: To understand the role of CEF-AVI in the management of carbapenem-resistant infections among specialists in India. MATERIALS AND METHODS: A questionnaire-based survey involving infectious disease specialists and intensivists was conducted in India. A digital questionnaire comprising 17 questions assessed the perception of CEF-AVI use in CRE infections among the survey participants. Data from completed questionnaires were retrieved and analyzed. RESULTS: A total of 102 participants completed the survey. Participants reported a 20–40% prevalence of carbapenem-resistant E. coli (40.20%), K. pneumoniae (46.08%), P. aeruginosa (46.08%), and Acinetobacter (49.02%) respectively, in their intensive care unit settings. More than half of the participants prescribed CEF-AVI either alone or in combination for HAP/VAP (52.94%) and 22.55% preferred in all approved indications (cUTI/cIAI/HAP/VAP/BSI). While in CRE suspected patients, 31.37% participants preferred CEF-AVI in combination with aztreonam as empirical therapy for complicated urinary tract infections, 35.29% preferred in hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and 42.16% preferred in blood stream infections. Interestingly, 91.18% participants reported upto 30% CEF-AVI resistance among CRE infections. 52.94% of participants reported that synergy of CEF-AVI + aztreonam was not observed in <10% of patients. Majority of participants (39.22%) rated the efficacy and safety (34.31%) of CEF-AVI at 6 on the 7-pont Likert scale (1 being low efficacy, while 7 being high efficacy). Nausea or vomiting (47.06%) were the most observed side effect with CEF-AVI + aztreonam. Some of the barriers reported in the management of CRE infections were unavailability of newer antibiotics (30.39%), high cost of newer antibiotics (26.47%), and absence of antibiotic stewardship policies (24.51%). 51.96% participants mentioned Aztreonam-avibactam, cefepime-zidebactam, and plazomicin as the drugs which will be used for the treatment of CRE infections. Participants primarily positioned CEF-AVI as ideal, targeted therapy for CRE infections (42.16%).(1) CONCLUSION: Ceftazidime-avibactam is effective and well-tolerated drug for the management of CRE infections in India.