Purpose: The clinical efficacy of ceftazidime-avibactam (CAZ-AVI) in treating carbapenem-resistant Klebsiella pneumoniae  (CRKP)-infected recipients after kidney transplantation (KT) has not been well evaluated. We aimed to assess its efficacy in a single-center cohort of KT recipients infected with CRKP.
Materials and Methods: We retrospectively observed KT recipients diagnosed with CRKP infection from June 2019 to July 2021. The primary outcome was 30-day mortality and secondary outcomes were 14-day clinical cure and 14-day microbiological cure. Logistic regression analysis was used to evaluate the relationship between CAZ-AVI treatment and prognosis.
Results: A total of 54 CRKP-infected KT recipients were recorded in this study. Twenty-two recipients received CAZ-AVI and 32 received other antibiotic regimens. Recipients in both groups had similar baseline characteristics, with the most common site of infection being surgical site infections (n=27; 50.0%) and bloodstream infections (n=23; 42.6%). Recipients treated with CAZ-AVI had significantly lower 30-day mortality (3/22 vs 14/32, P=0.019), significantly higher 14-day clinical cure (18/22 vs 17/32, P=0.030) and 14-day microbiological cure (19/22 vs 15/32, P=0.003) compared with recipients receiving other treatment regimens. Kaplan–Meier survival curves for 30-day mortality confirmed the findings (log-rank=0.014). In a multivariate logistic regression model, receiving CAZ-AVI was found to be an independent protective factor for 30-day mortality (odds ratio=0.148, 95% confidence interval, 0.027– 0.800; P=0.026). No significant side effects were recorded.
Conclusion: CAZ-AVI may be more valuable than other antibiotic regimens for the treatment of CRKP infection after kidney transplantation, and further large randomized controlled trials are needed to assess its efficacy.
Keywords: ceftazidime-avibactam, carbapenem-resistant Klebsiella pneumoniae , kidney transplantation, infections