Impact of ceftazidime-avibactam on mortality in bloodstream infections: a cohort study in patients with acute leukemia.

Bloodstream infections (BSI) caused by carbapenemase-producing Enterobacterales (CPE) represent a significant threat to patients with acute leukemia due to their high mortality. Ceftazidime-avibactam (CAZ-AVI) has emerged as a therapeutic alternative against these infections; however, its efficacy in immunocompromised patients remains unclear. To determine the impact of ceftazidime-avibactam on mortality due to BSI caused by CPE in patients with acute leukemia. A retrospective cohort study was conducted at the Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru. We included patients diagnosed with acute leukemia who developed BSI due to CPE during their hospital stays. Mortality was assessed for up to 30 days after BSI onset. We evaluated 41 patients with a median age of 51 years; 56.1% had acute myeloid leukemia and 43.9% had acute lymphoblastic leukemia. Mortality at 30 days occurred in 60.9% of patients. The most frequent type of chemotherapy administered was induction (51.2%). Empiric antibiotic therapy with meropenem was administered to 97.6% of the patients, and ceftazidime-avibactam was prescribed as a targeted therapy to 48.8%. In the multivariate Cox regression model, the prescription of ceftazidime-avibactam reduced the risk of death (adjusted hazard ratio, 0.29; 95% CI: 0.09-0.92; p = 0.012) compared with those who received other antibiotic therapies, such as colistin. In patients with acute leukemia who developed bloodstream infections due to CPE during hospitalization, the prescription of ceftazidime-avibactam reduced 30-day mortality risk.