Summary

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• Ceftazidime-avibactam (Avycaz) demonstrated superior clinical efficacy compared to polymyxins in treating carbapenem-resistant Enterobacteriaceae (CRE) infections, with significantly lower 30-day mortality rates, higher clinical cure rates, and higher microbial clearance rates.
• The safety profile of ceftazidime-avibactam is comparable to that of polymyxin regarding renal toxicity, as the incidence rate for acute kidney injury was similar between patients receiving both drugs.
• In treating complicated intra-abdominal infections (cIAI), cefepime plus metronidazole showed optimal empirical treatment effectiveness. While different beta-lactam/beta-lactamase inhibitor combinations including ceftazidime-avibactam present potential benefits, choices should consider specific patient risk profiles and microbial susceptibilities.
• For complicated urinary tract infections (cUTIs), Avycaz, along with other novel antibiotics, offered higher clinical cure rates and microbiological eradication at test-of-cure compared to conventional antibiotics despite having similar adverse event rates.
• Comparative studies between novel antibiotics like Avycaz and carbapenems for cIAIs did not exhibit significant differences in terms of clinical cure rates or adverse events, positioning it as a competitive alternative which can help reduce reliance on carbapenems thereby aiding antimicrobial stewardship efforts.
• In renal patients, there's an indication that using ceftazidime-avibactam might lead to a slightly increased risk of mortality when dosage adjustments are made due to impaired kidney function, but this requires further investigation since baseline conditions could influence outcomes.
• The use of Avycaz has been successful in real-world settings, especially when dealing with serious gram-negative bacterial infections such as CRE where options are limited; however, resistance emergence, while infrequent, is notable, particularly among KPC-producing Klebsiella pneumoniae strains, necessitating vigilant monitoring.
• When compared with other beta-lactam/beta-lactamase inhibitors like ceftolozane-tazobactam, Avycaz did not show significant differences in treating cIAIs, but nuanced differences might emerge when dealing with specific pathogens or patient subgroups. These findings are based on a review of 13 systematic reviews and meta-analyses.