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Purpose <p>Meropenem/vaborbactam (M/V) and ceftazidime/avibactam (C/A) are considered key agents in treating KPC-producing <i>Klebsiella pneumoniae (Kp)</i> infections. We compared these two drugs in ICUs patients with BSI and/or pneumoniae due to KPC- Kp.</p> Methods <p>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&#xa0;h, computing the odds ratio (OR) as effect size, and infection-related events. Subgroup analyses were performed based on relevant prognostic factors.</p> Results <p>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 <i>p</i> = 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).</p> Conclusions <p>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.</p>

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Head-to-head: meropenem/vaborbactam versus ceftazidime/avibactam in ICUs patients with KPC-producing K. pneumoniae infections– results from a retrospective multicentre study

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  • 发表日期：

    2025年7月16日

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  • Andrea Marino,
  • 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

摘要

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.