Backgrounds:

Carbapenem resistance rates in pediatric patients are increasing. New antibiotics such as ceftazidime-avibactam (CAZ-AVI) are potentially useful alternatives to antibiotic combinations including meropenem, but there is no consensus on its empirical use. CAZ-AVI has been approved for patients older than 3 months, with complicated intraabdominal infection, complicated urinary tract infection, hospital-acquired pneumonia, and other infections with limited therapeutic options.

The aim was to describe the current use of CAZ-AVI in our hospital.

Methods

Consecutive case series including patients treated with CAZ-AVI due to suspected or confirmed infection caused by carbapenemase producing microorganisms (CPM) in a tertiary care children’s hospital.

Results:

Twenty patients with CPM were included: 9(45%) in colonization and 11(55%) with clinical infection(pneumonia, sepsis, urinary tract infections). Isolated microorganisms were 12 K.pneumoniae, 6 E.coli, and 2 P.aeruginosa (VIM, OXA, NDM y KPC). Of the 11 patients with infection, 8(72%) were males with a median age of 3.84 (IQR 1.73-6.13). Four patients required admission to the Pediatric Intensive Care Unit due to severe infections.

Patients with clinical infection received meropenem as empirical treatment with unfavorable evolution. CAZ-AVI was used after CPM detection, in monotherapy, or in combination with aztreonam in infections due to metallobetalactamase PM. CAZ-AVI was used as first-line empirical therapy in patients with previously known colonization with suspected infection. CAZ-AVI was also indicated in one patient with cystic fibrosis. Considering new guidelines of CPM infections, and from our epidemiology, we could consider CAZ-AVI in patients with CPM: (1)invasive infections due to CPM(KPC, Oxa-48 y MBL); (2)patients who receive carbapenems because of BLEE infection and remain febrile >48 hours; (3)patients colonized with BLEE who develop septic shock.

Conclusions/Learning Points:

Further studies and consensus should be elaborated to homogenize CAZ-AVI use in the pediatric population.