Effects of Sensititre-Reported Ceftazidime/Avibactam Susceptibility on Appropriate Antimicrobial Use and Clinical Outcomes among Patients with Carbapenem-Resistant Pseudomonas aeruginosa (CRPA) and Carbapenem-Resistant Enterobacteriaceae (CRE) Infections at Sisaket Hospital
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Abstract
Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-Resistant Enterobacteriaceae (CRE) are major antimicrobial-resistance problems associated with limited treatment options and high mortality. Ceftazidime/avibactam (CZA/AVI) is an important therapeutic option, but its effectiveness depends on accurate and timely reporting of the minimum inhibitory concentration (MIC).
Objective: To evaluate the effect of MIC-based CZA/AVI susceptibility reporting on appropriate antimicrobial use and clinical outcomes in patients with CRPA and CRE infections.
Methods: A retrospective comparative study of patients with CRPA/CRE infections before MIC reporting (1st. January-31st. December 2024; n = 96) and after MIC reporting using the Sensititre system (1st. January-31st. December 2025; n = 96). Data were analyzed using descriptive statistics, the chi-square/Fisher's exact test, and multivariable logistic regression.
Results: After implementation of MIC reporting, CZA/AVI use increased from 10.4% to 63.5% (a 53.1–percentage-point increase), and appropriate (MIC-guided) use increased from 0% to 59.4%. In-hospital mortality decreased from 29.2% to 11.5% (p = 0.004); the pre-reporting period was associated with significantly higher odds of death (OR 3.2, 95% CI 1.5–6.9) Mean length of stay decreased from 29.9 to 26.5 days, but the difference was not statistically significant. In multivariable logistic regression, the CZA/AVI MIC was significantly associated with infection control, with a higher MIC associated with lower odds of successful control (OR 0.9, 95% CI 0.8-0.9, p=0.031) This study could not confirm that the reduction in mortality was caused by the MIC-reporting system; however, MIC was associated with infection control, supporting MIC as a clinically meaningful quantitative parameter, and further study of additional factors related to mortality is warranted. Total mean cost did not differ significantly between the two years, although a downward trend was observed in 2025.
Conclusion: MIC-based susceptibility reporting for CZA/AVI using the Sensititre system is important for appropriate antimicrobial use and is associated with infection control in patients with drug-resistant CRPA and CRE infections
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เสาวรัตน์ ดีแก่. ความชุกและความหลากหลายของยีนดื้อยาคาร์บาพีเนมของเชื้อ Enterobacteriaceae ในโรงพยาบาลสุรินทร์. วารสารการแพทย์โรงพยาบาลศรีสะเกษ สุรินทร์ บุรีรัมย์ ปีที่ 39 ฉบับที่ 1 มกราคม-เมษายน (2567)