Avaliação do uso de Ceftazidima-avbactam em hospital de ensino no Brasil

Abstract

Antimicrobial resistance is a global public health problem, making it necessary to develop new drugs and carefully manage the use of antimicrobials to reduce rates of microbial resistance and optimize therapy. Ceftazidime-Avibactam (CAZ-AVI) is a new drug, approved in Brazil in 2018, aimed at Gram-negative producers of serine-β-lactamases, considered “last option” in therapy against multidrug-resistant microorganisms. Therefore, it is necessary to evaluate its use in hospitals to ensure the best targeting of this antimicrobial agent. The aim of this study was to analyze the use of CAZ-AVI in a university hospital through pharmacoepidemiological, clinical and microbiological parameters and to verify the main outcome of patients after treatment. This is a retrospective and descriptive study, carried out from July 2019 to December 2021, through the Infection Control Service and Antimicrobial Stewardship Program of the hospital, collecting data such as age, gender, isolated microorganism, profile of resistance, type of clinical sample, clinical outcome, type of infection, neutropenia, antimicrobial therapy, use of vasoactive drugs and duration of treatment with CAZ-AVI. The data obtained through the electronic medical record were compiled in an electronic spreadsheet and the statistical analysis was performed using the Chi-Square test, through the Excel® program. 72 patients were identified, which the clinical outcomes after the use of CAZ-AVI were 33 (45.8%) discharges and 39 (54.2%) deaths. CAZAVI was dispensed for 76 treatments, for which 35 (46.1%) were for ICU patients, followed by 10 (13.2%) in the medical clinic, nine (11.8%) for kidney/liver transplant patients and eight (10.5%) patients in hematology. Of the 91 cultures analyzed, tracheal aspirate (N=32) and blood cultures (N=31) make up 69.2% of all clinical samples used, with their complete results released within five days. Among the microorganisms isolated, 67 (73.6%) were K. pneumoniae, 17 (18.7%) P. aeruginosa, two (2.2%) A. baumannii and one B. cepacia, E. coli, K. oxytoca, P. mirabilis and S. marcescens, where 90 (98.9%) of these microorganisms were resistant to carbapenems. For the 67 K. pneumoniae isolates, 46 (68.7%) were sensitive to amikacin, 16 (23.9%) to gentamicin, 38 (56.7%) to colistin and 57 (85%) to CAZ-AVI. In addition, 14 (24.6%) were sensitive only to CAZ-AVI. As for the P. aeruginosa found, all 17 were sensitive to colistin, while 13 (76.5%) were sensitive to CAZ-AVI. Six metallo-β- lactamase-producing microorganisms were isolated, guiding the therapy for the off-label use of CAZ-AVI in association with the monobactam aztreonam. Regarding the complicating factors, the neutropenia identified in five patients statistically contributed to the speed at which the patients died. For the 25 (64.1%) patients who used vasoactive drugs due to sepsis, there was no relationship between this factor and 30-day mortality. Thus, CAZ-AVI proved to be a valuable tool for the treatment of infections caused by multidrug-resistant microorganisms, however, due to the high number of deaths, further studies are needed on its use in the hospital environment to optimize its use within the Brazilian reality