Ceftazidime/Avibactam의 사용 적절성 및 유효성 평가

Abstract

Background: Antibiotic resistance is a critical global health challenge. Ceftazidime/avibactam (CZA) introduced in July 2023 targets resistant Gram-negative bacterial infections unresponsive to carbapenem antibiotics. Since its reimbursement inclusion in February 2024, CZA usage has steadily increased. This study aimed to assess CZA utilization and evaluate its appropriateness and clinical outcomes. Methods: A retrospective analysis of electronic medical records was conducted for adult patients treated with CZA for ≥ 3 days at a tertiary hospital from July 2023 to July 2024. Data on indications, dosages, and administration were collected and efficacy was assessed based on treatment success rates, 30-day mortality, and clinical laboratory improvements. Results: Among 229 CZA-treated patients, 175 met the inclusion criteria. Klebsiella pneumoniae was the most common identified pathogen. It was found in (159) 91% patients, Of the 175 patients, 101 (58%) received CZA for approved indications, while 74 (42%) were treated off-label primarily for bacteremia. Most (168, 96%) patients adhered to approved dosages. The overall treatment success rate was 63%, showing no significant differences by indication. Monotherapy demonstrated a significantly higher treatment success rate for patients with bacteremia than combination therapy (p<0.05). Among all patients, 40 (29%) were treated with combination therapy. Within 30 days of CZA discontinuation, 42 (24%) died. Mortality showed no significant differences by indication or concomitant antibiotic use. Conclusion: The treatment success rate of monotherapy with CZA was significantly higher than that of combination therapy for patients with bacteremia. Treatment success rates and 30-day mortality showed no significant differences by indications. Thus, for safe and effective treatment of multidrug-resistant infections, appropriate use and management of CZA as a restricted antibiotic should be continuously monitored.