Clinical Experience with Ceftazidime/Avibactam for the Treatment of Extensively Drug-Resistant or Pandrug-Resistant Klebsiella pneumoniae in Neonates and Children

Abstract Purpose:Klebsiella pneumoniaeis a significant cause of healthcare-associated infections, resulting in high morbidity and mortality rates due to limited treatment options. In this study, we aimed to evaluate the treatment outcomes and the safety of Ceftazidime-avibactam in infections caused by extensively drug-resistant or pandrug-resistantKlebsiella pneumoniaein pediatric patients.Methods:This study included pediatric patients who received ceftazidime-avibactam treatment due to extensively drug-resistant or pandrug-resistantKlebsiella pneumoniaeinfections, monitored in the pediatric intensive care, neonatal intensive care, and pediatric wards of Cukurova University Faculty of Medicine between 2022 and 2023. Patients' microbiological responses, clinical responses, medication side effects, and 30-day survival rates were evaluated.Results:Eleven pediatric patients were included in the study, of whom nine were male (81.8%). The median age of the patients was 15 months (min: 1 day - max: 183 months). Sepsis was diagnosed in 9 patients (81.8%). Two premature infants (27 and 35 weeks) were admitted to the neonatal ICU. Regarding theKlebsiella pneumoniaestrains, 10 (91%) were extensively drug-resistant (XDR), and 1 (9%) was pandrug-resistant (PDR). Eight strains (72.7%) were carbapenem-resistant, and 9 (81.8%) were colistin-resistant. Microbiological response was noted in 8 patients (72.7%), clinical response was evident in 6 patients (54.5%). The 30-day survival rate was 54.5%, with six patients surviving.Conclusion:In our study, ceftazidime-avibactam has been identified as a significant treatment option for resistantKlebsiella pneumoniaeinfection in critically ill children and premature infants with sepsis and organ failure, and it has been found to be well tolerated.