A multicenter international prospective observational pharmacological study in adult patients (≥18 years) treated with ceftazidime/avibactam (CAZ/AVI) alone or with CAZ/AVI plus fosfomycin (FOS) for infection due to carbapenem-resistant Enterobacterales (CRE) (KPC and/or OXA-48).
Gram-negative infections, particularly those caused by carbapenem-resistant Enterobacterales (CRE), have a dramatic impact on patient survival. Despite the introduction of new drugs in the last years have improved the outcome of patients with CRE infections, mortality and relapse rates are still relevant, especially in patients with high-risk source as pneumonia, and those in which the attainment of optimal exposure could be reduced by underlying renal disease. The use of combination regimen in these scenarios has been proposed. However, a standardized approach is still missing. Since several in vitro studies have highlighted the synergistic effect of fosfomycin (FOS) with different antibiotic classes, including cephalosporins such drug could be an appealing option in combination therapy for the management of CRE infections. In particular, the primary aim of the study is to assess the probability of achieving a pre-defined target of efficacy in patients treated with ceftazidime/avibactam (CAZ/AVI) and/or FOS according to different modes of drug administration in patients with CRE infections. Secondary aim is to assess the association between plasma drug concentration of both CAZ/AVI and FOS and patient response.
Study Type
OBSERVATIONAL
Enrollment
60
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Bologna, Bologna, Italy
RECRUITINGInstituto de Biomedicina de Sevilla (IBiS), Hospital Virgen Macarena/CSIC/Universidad de Sevilla
Seville, Seville, Spain
RECRUITINGPK/PD efficacy targets for study drugs
The primary endpoint will be the attainment of the pre-defined PK/PD target of efficacy at 48 and 72 hours after starting treatment for Carbapenem-resistant Enterobacterales (CRE) infection
Time frame: From enrollment (treatment onset) to 48 and 72 hours after starting treatment
Difference in SOFA score
Difference in SOFA score between day 0 (day of treatment onset) and day 7
Time frame: From day 0 (day of index positive culture) and day 7
Trend of C-Reactive Protein (CRP) and Procalcitonin (PCT)
Trend of C-Reactive Protein (CRP) and Procalcitonin (PCT) from day 0 to day 7 after treatment onset
Time frame: From day 0 (day of index positive culture) and day 7
Microbiological eradication
Microbiological eradication defined as bacteraemia clearance or negativization of index diagnostic sample within 7 days from treatment onset
Time frame: From day 0 (day of index positive culture) and day 7
Relapse and/or reinfection
Relapse (new infection with the same pathogen emerging after treatment) and/or reinfection (new infection with a different pathogen emerging after treatment) rates at day 90
Time frame: From enrollment to the end of the follow-up at three months
All-cause mortality
All-cause mortality at day 30 and at day 90
Time frame: From enrollment to the end of the follow-up at three months
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