Assessment of clinical effectiveness and safety of ceftazidime-avibactam in ‐treating multi-drug-resistant infections – A retrospective analysis at a tertiary care hospital in Saudi Arabia

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BACKGROUND: The present study investigated the, effectiveness, safety and appropriateness of prescribing Ceftazidime-Avibactam (CAZ-AVI) to facilitate optimal clinical use and improve patient outcomes. METHODS: The retrospective study included 77 patients who received CAZ-AVI between June 2022 and October 2023. Data was extracted from the hospital's electronic records, and a questionnaire was used to gather information on care setting, medication history, therapies, dosage, treatment duration, adverse effects, culture site, microbiological response and appropriateness of CAZ-AVI prescriptions. Chi-squared analysis was performed, with p ≤ 0.05 considered statistically significant. RESULTS: Males comprised 53.2 % of the study population. A substantial number of patients were in the ICU, with 84.4 % requiring mechanical ventilation. Carbapenem-resistant Klebsiella pneumoniae was the primary pathogen in 87 % of patients. A significant association was observed between the genotype and clinical improvement (χ² = 9.78, P = 0.024), with the Oxa-48 +NDM genotype (44.2 %) being the most prevalent. Clinical improvement was significantly associated with the duration of therapy (P = 0.001), with improvement seen in 46.8 % of patients after treatment for 8-14 days. Adding a second antibiotic to CAZ-AVI did not significantly improve clinical outcomes statistically (P = 0.054), with aztreonam being the frequently co-administered agent (36.4 %). However, its use did not result in superior efficacy or outcomes compared to other second-line antibiotics (P = 0.18). Microbiological assays showed no growth of organisms in 70.1 % of patients after seven days and no recurrence in 77.9 % of patients within 15-30 days of treatment. Adverse effects were absent in most patients, and Infectious Diseases specialists appropriately filled out 97.4 % of the prescription order forms. CONCLUSIONS: CAZ-AVI use was associated with clinical improvement in carbapenem-resistant Klebsiella pneumonia infections. The low incidence of adverse effects and frequent prescriptions filled by ID specialists support the appropriateness of its use.