Head-to-head: meropenem/vaborbactam versus ceftazidime/avibactam in ICUs patients with KPC-producing K. pneumoniae infections– results from a retrospective multicentre study
Andrea Marıno, Alberto Enrico Maraolo, Maria Mazzitelli, Alessandra Oliva, Nicholas Geremia, Andrea De Vito, Chiara Gullotta, Vincenzo Scaglione, Eleonora Vania, Sara Lo Menzo, Paolo Navalesi, Lorenzo Volpicelli, Andrea Fiori, Pamela Prestifilippo, Annamaria Cattelan, Claudio Maria Mastroianni, Giordano Madeddu, Bruno Cacopardo, Giuseppe Nunnari
Abstract
PURPOSE: Meropenem/vaborbactam (M/V) and ceftazidime/avibactam (C/A) are considered key agents in treating KPC-producing Klebsiella pneumoniae (Kp) infections. We compared these two drugs in ICUs patients with BSI and/or pneumoniae due to KPC- Kp. METHODS: This retrospective multicentre study analysed ICU patients with bloodstream infections (BSI) and/or pneumonia caused by KPC-Kp across five Italian ICUs from January 2021 to December 2023. Propensity-score matching (PSM) was applied to mitigate the impact of confounding factors. The primary outcome was 30-day all-cause mortality. Secondary outcomes included early clinical improvement at 72 h, computing the odds ratio (OR) as effect size, and infection-related events. Subgroup analyses were performed based on relevant prognostic factors. RESULTS: The study included 177 patients, with 88 subjects paired after-matching (52 treated with C/A and 36 with M/V). As for primary outcome, after PSM, no statistically significant differences in 30-day mortality were observed between the two groups: in the Kaplan-Meier survival log-rank test was p = 0.38, and PSM-adjusted HR of M/V on mortality was 0.65 (95% CI 0.55–1.68). As for secondary outcomes, M/V significantly improved early clinical response post-PSM (OR: 2.19, 95% CI: 1.35–3.55). CONCLUSIONS: M/V showed no statistically significant difference in 30-day mortality compared to C/A but demonstrated significantly improved in early clinical response for patients with KPC-Kp. These findings were consistent between unmatched and matched patients. Further prospective studies are warranted to validate these observations.