Ventilator-associated pneumonia (VAP) in critically ill patients with COVID-19 represents a very huge global threat due to a higher incidence rate compared to non-COVID-19 patients and almost 50% of the 30-day mortality rate. Pseudomonas aeruginosa was the first pathogen involved but uncommon non-fermenter gram-negative organisms such as Burkholderia cepacea and Stenotrophomonas maltophilia have emerged as other potential etiological causes. Against carbapenem-resistant gram-negative microorganisms, Ceftazidime/avibactam (CZA) is considered a first-line option, even more so in case of a ceftolozane/tazobactam resistance or shortage. The aim of this report was to describe our experience with CZA in a case series of COVID-19 patients hospitalized in the ICU with VAP due to difficult-to-treat (DTT) P. aeruginosa, Burkholderia cepacea, and Stenotrophomonas maltophilia and to compare it with data published in the literature. A total of 23 patients were treated from February 2020 to March 2022: 19/23 (82%) VAPs were caused by Pseudomonas spp. (16/19 DTT), 2 by Burkholderia cepacea, and 6 by Stenotrophomonas maltophilia; 12/23 (52.1%) were polymicrobial. Septic shock was diagnosed in 65.2% of the patients and VAP occurred after a median of 29 days from ICU admission. CZA was prescribed as a combination regimen in 86% of the cases, with either fosfomycin or inhaled amikacin or cotrimoxazole. Microbiological eradication was achieved in 52.3% of the cases and the 30-day overall mortality rate was 14/23 (60.8%). Despite the high mortality of critically ill COVID-19 patients, CZA, especially in combination therapy, could represent a valid treatment option for VAP due to DTT non-fermenter gram-negative bacteria, including uncommon pathogens such as Burkholderia cepacea and Stenotrophomonas maltophilia.

Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature / Burastero, Giulia Jole; Orlando, Gabriella; Santoro, Antonella; Menozzi, Marianna; Franceschini, Erica; Bedini, Andrea; Cervo, Adriana; Faltoni, Matteo; Bacca, Erica; Biagioni, Emanuela; Coloretti, Irene; Melegari, Gabriele; Maccieri, Jessica; Busani, Stefano; Bertellini, Elisabetta; Girardis, Massimo; Ferrarini, Giulia; Rofrano, Laura; Sarti, Mario; Mussini, Cristina; Meschiari, Marianna. - In: ANTIBIOTICS. - ISSN 2079-6382. - 11:8(2022), pp. 1007-1022. [10.3390/antibiotics11081007]

Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature

Orlando, Gabriella;Santoro, Antonella;Franceschini, Erica;Bedini, Andrea;Faltoni, Matteo;Bacca, Erica;Biagioni, Emanuela;Coloretti, Irene;Melegari, Gabriele;Maccieri, Jessica;Busani, Stefano;Girardis, Massimo;Mussini, Cristina;Meschiari, Marianna
2022

Abstract

Ventilator-associated pneumonia (VAP) in critically ill patients with COVID-19 represents a very huge global threat due to a higher incidence rate compared to non-COVID-19 patients and almost 50% of the 30-day mortality rate. Pseudomonas aeruginosa was the first pathogen involved but uncommon non-fermenter gram-negative organisms such as Burkholderia cepacea and Stenotrophomonas maltophilia have emerged as other potential etiological causes. Against carbapenem-resistant gram-negative microorganisms, Ceftazidime/avibactam (CZA) is considered a first-line option, even more so in case of a ceftolozane/tazobactam resistance or shortage. The aim of this report was to describe our experience with CZA in a case series of COVID-19 patients hospitalized in the ICU with VAP due to difficult-to-treat (DTT) P. aeruginosa, Burkholderia cepacea, and Stenotrophomonas maltophilia and to compare it with data published in the literature. A total of 23 patients were treated from February 2020 to March 2022: 19/23 (82%) VAPs were caused by Pseudomonas spp. (16/19 DTT), 2 by Burkholderia cepacea, and 6 by Stenotrophomonas maltophilia; 12/23 (52.1%) were polymicrobial. Septic shock was diagnosed in 65.2% of the patients and VAP occurred after a median of 29 days from ICU admission. CZA was prescribed as a combination regimen in 86% of the cases, with either fosfomycin or inhaled amikacin or cotrimoxazole. Microbiological eradication was achieved in 52.3% of the cases and the 30-day overall mortality rate was 14/23 (60.8%). Despite the high mortality of critically ill COVID-19 patients, CZA, especially in combination therapy, could represent a valid treatment option for VAP due to DTT non-fermenter gram-negative bacteria, including uncommon pathogens such as Burkholderia cepacea and Stenotrophomonas maltophilia.
2022
11
8
1007
1022
Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature / Burastero, Giulia Jole; Orlando, Gabriella; Santoro, Antonella; Menozzi, Marianna; Franceschini, Erica; Bedini, Andrea; Cervo, Adriana; Faltoni, Matteo; Bacca, Erica; Biagioni, Emanuela; Coloretti, Irene; Melegari, Gabriele; Maccieri, Jessica; Busani, Stefano; Bertellini, Elisabetta; Girardis, Massimo; Ferrarini, Giulia; Rofrano, Laura; Sarti, Mario; Mussini, Cristina; Meschiari, Marianna. - In: ANTIBIOTICS. - ISSN 2079-6382. - 11:8(2022), pp. 1007-1022. [10.3390/antibiotics11081007]
Burastero, Giulia Jole; Orlando, Gabriella; Santoro, Antonella; Menozzi, Marianna; Franceschini, Erica; Bedini, Andrea; Cervo, Adriana; Faltoni, Matte...espandi
File in questo prodotto:
File Dimensione Formato  
antibiotics-11-01007.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 487.09 kB
Formato Adobe PDF
487.09 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1289207
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 12
social impact