Efficacy and safety of ceftazidime-avibactam versus standard antibiotic therapy for resistant Gram-negative bacterial infections: a systematic review and meta-analysis

Background: Drug-resistant Klebsiella pneumoniae infections pose a significant clinical challenge due to limited treatment options. Ceftazidime-avibactam (CAZ-AVI) is a novel β-lactam/β-lactamase inhibitor combination developed to address this need. The aim of this study is to assess the clinical effectiveness and safety of CAZ-AVI for these infections.

Methods: A comprehensive search and retrieval of academic sources pertaining to the treatment of drug-resistant Klebsiella pneumoniae infection using ceftazidime and avibactam was conducted across both domestic and international databases. The search time frame for each database was set up to February 2024. Following the initial screening process, the quality of the research literature was assessed using the Newcastle-Ottawa Scale (NOS). Subsequently, the odds ratio (OR) value was calculated utilizing either fixed or random effects models, and forest plots were generated. Additionally, a sensitivity analysis was performed by excluding studies with the highest weight, and the bias within the literature was evaluated through the construction of a funnel plot.

Results: A total of 2,203 publications were identified, and 8 studies were deemed eligible for analysis. The findings from the meta-analysis revealed that in comparison to the standard antibiotic treatment group, the CAZ-AVI group exhibited superior clinical efficacy and a higher rate of bacterial clearance. There was a decrease in adverse reactions and mortality in the CAZ-AVI group. Nevertheless, no statistically significant variances were observed in procalcitonin (PCT) and C-reactive protein (CRP) levels between the two groups. Sensitivity analysis indicated the stability and reliability of the combined effect size results.

Conclusions: Ceftazidime and avibactam show superior clinical effectiveness and safety in managing drug-resistant Klebsiella pneumoniae infections, making them a more favorable choice for clinical use.

Keywords: Ceftazidime-avibactam (CAZ-AVI); Klebsiella pneumoniae (KP); meta-analysis