单位：[1]Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China[2]China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Capital Medical University, Beijing 100029, China[3]Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China[4]Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China[5]National Clinical Research Center for Respiratory Diseases, Beijing 100730, China[6]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China[7]Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China[8]WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing 100029, China
Background: Infections produced by extensively drug-resistant (XDR) gram-negative bacilli (GNB) in solid organ transplant (SOT) are an important cause of morbidity and mortality. Ceftazidime/ avibactam (CAZ-AVI) is a novel beta-lactam/beta-lactamase combination antibiotic with anti-GNB activity, but experience in real clinical practice with CAZ-AVI in lung transplant (LT) recipients is limited. Methods: We conducted a retrospective study of patients with XDR-GNB infection who received at least 3 days of CAZ-AVI in the Department of Lung Transplantation Between December 2017 and December 2018 at China-Japan friendship hospital (CJFH). The general information, clinical manifestations, laboratory examinations, treatment course, and outcomes were summarized. Results: A total of 10 patients who underwent LT at our center were included. They were all males with a mean age 51 years. Infections after LT included pneumonia and/or tracheobronchitis [n=9; 90% (9/10)], cholecystitis and blood stream infection (BSI) (n=1, patient 8). In these 10 LT recipients, the incidence of various airway complications was 70% (7/10). Carbapenem-resistant Klebsialla pneumoniae (CRKP) was the predominant pathogen, being detected in 9 patients. Multilocus sequence typing (MLST) analysis showed that all 9 CRKP isolates belonged to ST11. Six patients (6/10, 60%) started CAZ-AVI as salvage therapy after a first- line treatment with other antimicrobials. CAZ-AVI was administered as monotherapy or in combination regimens in 20% (2/ 10) and 80% (8/10) of patients respectively. There were no difference in temperature before and after CAZ-AVI treatment (P>0.05). White blood cell (WBC) at 7 days, and procalcitonin (PCT) at 7 days and 14 days significantly dropped (P<0.05). After 7-14 days of CAZ-AVI treatment, the PaO2/FiO(2)ratio (P/F ratio) significantly improved (P<0.05). Nine patients (9/10, 90%) obtained negative microbiologic culture of CRKP/CRPA, with a median time to was 6.7 days (range, 1-15 days). However, 5 patients (5/10, 50%) had relapse of CRKP/CRPA infections in the respiratory tract regardless of whether negative microbiologic culture was obtained or not. The 30-day survival rate was 100%, and the 90-day survival rate was 90% (1/10). No severe adverse events related to CAZ-AVI occurred. Conclusions: CAZ-AVI treatment of CRKP/ CRPA infection in LT recipients was associated with high rates of clinical success, survival, and safety, but recurrent CRKP/CRPA infections in the respiratory tract did occur.
基金：
Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences [2019PT320020]
第一作者单位：[1]Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China[4]Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China[5]National Clinical Research Center for Respiratory Diseases, Beijing 100730, China[6]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China[7]Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China[8]WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing 100029, China[*1]No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, China.
推荐引用方式(GB/T 7714)：
Chen Wenhui,Sun Lingxiao,Guo Lijuan,et al.Clinical outcomes of ceftazidime-avibactam in lung transplant recipients with infections caused by extensively drug-resistant gram-negative bacilli[J].ANNALS of TRANSLATIONAL MEDICINE.2020,8(3):doi:10.21037/atm.2019.10.40.
APA：
Chen, Wenhui,Sun, Lingxiao,Guo, Lijuan,Cao, Bin,Liu, Yingmei...&Wang, Chen.(2020).Clinical outcomes of ceftazidime-avibactam in lung transplant recipients with infections caused by extensively drug-resistant gram-negative bacilli.ANNALS of TRANSLATIONAL MEDICINE,8,(3)
MLA：
Chen, Wenhui,et al."Clinical outcomes of ceftazidime-avibactam in lung transplant recipients with infections caused by extensively drug-resistant gram-negative bacilli".ANNALS of TRANSLATIONAL MEDICINE 8..3(2020)
