Ceftazidime-Avibactam Use in Children Admitted in Pediatric Intensive Care Units

Purpose: Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant Gram-negative bacteria. Our aim was to describe CAZ-AVI treatments in children admitted in pediatric intensive care units (PICUs). Methods: We conducted a retrospective descriptive study in two PICUS of Rio de Janeiro city, Brazil, between January 2020 and January 2024. We included children between 0 and 18 years that used CAZ-AVI for more than 24 hours. Duration of CAZ-AVI therapy, previous healthcare-associated infections and carbapenem use, length of stay and outcomes in 30 days. All treatments were previously discussed with an infectious disease specialist. Results: CAZ-AVI was used in 37 patients. Median of age was 28 months, 17 (45.9%) were male. Median time from admission until the initial presciption of CAZ-AVI was 39.9 days (variation between 1-138 days). Thirty-four (91.9%) children had at least one comorbidity at admission, 34/37 (91.9%) used at least one invasive device previously CAZ-AVI prescription, 33/37 (89.2%) used carbapenem before and 15 (40.5%) had a HAI before CAZ-AVI use. The mean time of use was 11 days (variation 1 to 22 days). Gram-negative bacteria were isolated in cultures of 12/37 (32.4%) patients, in the 24h before presciption or on the day of prescription. Mortality in 30 days was 14/37 (37.8%). Conclusion: We concluded that almost all patients that used CAZ-AVI were critically ill children, with multiple comorbidities, previous use of carbapenem and high rate of mortality.