Sachin Suresh Jadhav1*, Amey C Panchal1, Nishit Ojha1, Sonu Tony1, Jyothi Goutham Kumar2, Anjali Matani3 ,Yesheswini N Naik4
Introduction: Infections due to Extended Spectrum Beta-Lactam (ESBL) positive, Carbapenemase Producing Enterobacteriaceae (CPE) and NDM1 resistance Enterobacteriaceae have significantly increased internationally and may account for up to 70% of infections in some geographies. Parallelly, high colistin resistance rates have also been reported. We are reporting the initial results of the first randomized-controlled trial addressing this issue of antibiotic resistant Gram-Negative Bacteremia (GNB).
Objectives: The objective of the study was to assess the efficacy of first-line Ceftazidime–Avibactam with or without Aztreonam in high-risk FN, versus Meropenem.
Methodology: Adult patients with high-risk FN were randomized to Meropenem, Ceftazidime-Avibactum or Ceftazidime-Avibactum with Aztreonam as the first line antibiotic regimen.
Results: Compared to meropenem, there was a trend towards reduced antibiotic failure, as defined by breakthrough fever within 7 days, with ceftazidime-avibactam, with or without aztreonam, although this wasn’t statistically significant, (p value=0.076). Besides this, antibiotic failure was significantly associated with blood culture positivity (p=0.015). Also, the presence of lung infiltrates was significantly associated with transfer to ICU (p=0.001).
Conclusion: In high-risk FN, there was a trend to a higher incidence of antibiotic failure with first-line therapy with meropenem, compared to ceftazidime-avibactam with or without aztreonam, (p=0.076).