Comparison of the Efficacy and Prognosis of Ceftazidime-avibactam and Polymyxin E in Patients with Renal Insufficiency

OBJECTIVE To compare the efficacy, safety and prognosis of ceftazidime-avibactam(CAZ-AVI) and polymyxin E in the treatment of carbapenem resistant gram-negative bacilli(CR-GNB) pulmonary infection in patients with renal insufficiency.

METHODS Patients with CR-GNB pulmonary infection and renal insufficiency admitted to Suzhou Municipal Hospital were selected and divided into the CAZ-AVI group and polymyxin E methane sulfonate sodium(CMS) group. Basic indicators such as gender, age, comorbidities, SOFA score, APACHE Ⅱ score, infection type and infection site were compared between the 2 groups. The treatment course for CR-GNB, whether combined treatment was used, combined treatment drugs, bacterial clearance rate, clinical cure rate, 30-day mortality rate and adverse reactions were recorded.

RESULTS A total of 161 patients with CR-GNB pulmonary infection and renal insufficiency were included, including 73 in the CAZ-AVI group and 88 in the CMS group. The proportion of combined drug treatment in the CAZ-AVI group was lower than that in the CMS group(76.70% vs 97.73%, P<0.001). The clinical cure rate and pathogen clearance rate in the CAZ-AVI group were higher than those in the CMS group(56.10% vs 36.40%, P=0.012; 71.23% vs 47.72%, P=0.003). The 30-day mortality rate in the CAZ-AVI group was 39.73%, which was lower than 60.22% in the CMS group, and the difference was statistically significant(P=0.010). The adverse reaction rate in the CMS group was higher than that in the CAZ-AVI group(60.23% vs 24.66%, P<0.001).

CONCLUSION Both CAZ-AVI and polymyxin E have good therapeutic effects on CR-GNB pulmonary infection in patients with renal insufficiency. Compared with polymyxin E, CAZ-AVI has a higher clinical cure rate and bacterial clearance rate, and better safety and prognosis.