Efficacy of the Recommended Ceftazidime/Avibactam Dose in Treating Carbapenem-Resistant Enterobacteriaceae in Critically Ill Patients Using Renal Replacement Therapies
Bibliographic record
Abstract
Background: Ceftazidime/avibactam (CEF/AVI) is a novel antibiotic used to treat Multi-drug Resistant (MDR) and gram-negative bacteria, including Carbapenem-Resistant Enterobacteriaceae (CRE). Data on CEF/AVI dosing and outcomes in patients with Chronic Kidney Disease stage-5 utilizing hemodialysis are scarce. The purpose of this study was to assess the efficacy of the recommended dose of CEF/AVI in patients utilizing renal replacement therapies. Methods: A retrospective cohort study was conducted at our quaternary care institution between May 2015 and December 2019. All hospitalized adults who had CRE Klebsiella Pneumoniae, E.coli, or MDR Pseudomonas Aeruginosa related infections, and received CEF/AVI while utilizing either continuous venovenous hemofiltration (CVVH) or intermittent hemodialysis (IHD) or both were included Results: Of the 24 patients who met the inclusion criteria, 70.8% were males, mean age was 66.0 ± 15.7 years. Eleven patients had bacteremia, 8 had pneumonia, 3 had urinary tract infection (UTI), and 2 had wound infections. Fourteen patients received CVVH while 10 received IHD during time on therapy. CEF/AVI dose while on CVVH was 1.25 g intravenous every 8 hours while the dose was 0.94 to 1.25 g daily in patients who were treated with IHD. Twenty-two of those patients were admitted to the critical care unit and required mechanical ventilation and 20 of them received vasopressors. A total of 13 patients had microbiological cure, and 10 patients were clinically cured. Nine patients with bacteremia had microbiological cure. Four patients with pneumonia had clinical cure during the follow up periods up to 3 months, recurrence/relapse occurred in 9 of the 24 patients. Eight patients deceased within 30 days of follow up and 4 more within 90 days. Only one patient did not have relapse or recurrence within the 90 days of follow up. Conclusions: The CEF/AVI recommended dose could achieve uncertain clinical outcomes. Pharmacokinetics and pharmacodynamics studies are urgently needed to determine the adequacy of CEF/AVI dosing in this population
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".