Impact of ceftazidime–avibactam on mortality in bloodstream infections: a cohort study in patients with acute leukemia

Copaja-Corzo C.; Bazán-Ruiz S.; Fuentes-Yufra A.; Pizarro-Perea M.; Montiel-González M.; Pérez-Lazo G. · Therapeutic Advances in Infectious Disease (2025) · DOI: 10.1177/20499361251362955

Resumen

Background: Bloodstream infections (BSI) caused by carbapenemase-producing Enterobacterales (CPE) represent a significant threat to patients with acute leukemia due to their high mortality. Ceftazidime–avibactam (CAZ-AVI) has emerged as a therapeutic alternative against these infections; however, its efficacy in immunocompromised patients remains unclear. Objective: To determine the impact of ceftazidime–avibactam on mortality due to BSI caused by CPE in patients with acute leukemia. Design: A retrospective cohort study was conducted at the Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru. Methods: We included patients diagnosed with acute leukemia who developed BSI due to CPE during their hospital stays. Mortality was assessed for up to 30 days after BSI onset. Results: We evaluated 41 patients with a median age of 51 years; 56.1% had acute myeloid leukemia and 43.9% had acute lymphoblastic leukemia. Mortality at 30 days occurred in 60.9% of patients. The most frequent type of chemotherapy administered was induction (51.2%). Empiric antibiotic therapy with meropenem was administered to 97.6% of the patients, and ceftazidime–avibactam was prescribed as a targeted therapy to 48.8%. In the multivariate Cox regression model, the prescription of ceftazidime–avibactam reduced the risk of death (adjusted hazard ratio, 0.29; 95% CI: 0.09–0.92; p = 0.012) compared with those who received other antibiotic therapies, such as colistin. Conclusion: In patients with acute leukemia who developed bloodstream infections due to CPE during hospitalization, the prescription of ceftazidime–avibactam reduced 30-day mortality risk. © The Author(s), 2025. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Instituciones: Universidad Científica del Sur; Universidad San Ignacio de Loyola; Universidad Privada de Tacna