Real-World Use of Ceftazidime–Avibactam for Carbapenem-Resistant Enterobacterales Infections in Children: A 7-Year Cohort From a Latin American Referral Center

Abstract Background Pediatric data on ceftazidime-avibactam (CAZ-AVI) for carbapenem-resistant Enterobacterales (CRE) infections remain limited, particularly in Latin America, where KPC-producing organisms are endemic. We describe the clinical characteristics, microbiological profile, and outcomes of children with CRE infections treated with CAZ-AVI at a tertiary referral center in Colombia. Methods We conducted a retrospective cohort study of children younger than 18 years with clinically significant CRE infections treated with CAZ-AVI between January 2018 and June 2025. Clinical, microbiological, treatment, and outcome data were collected. The primary outcome was clinical response at the end of therapy. Results Forty-three patients were included (median age, 11 years [IQR, 6–15]); 25 patients (58%) were immunocompromised, 29 (67%) required PICU admission, and 16 (37%) presented with septic shock. Klebsiella pneumoniae was the predominant pathogen (33 patients, 77%), and KPC was the most common carbapenemase detected (39 patients, 91%). Clinical improvement within 72 hours occurred in 40 patients (93%), with a median time to response of 2 days (IQR, 2–3). Overall, 40 patients (93%) achieved clinical cure. The estimated 30-day survival probability was 95.3% (95% CI, 88.8–100), recurrence occurred in 3 patients (7%), and no treatment-related adverse events were documented. Conclusion In this real-world pediatric cohort from a KPC-endemic setting, CAZ-AVI was associated with favorable clinical outcomes and good tolerability. These findings support its role as an important therapeutic option for pediatric CRE infections and underscore the importance of mechanism-guided antimicrobial management.