{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:10:04Z","timestamp":1776730204697,"version":"3.51.2"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:00:00Z","timestamp":1707868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Multidrug-resistant (MDR) infections are challenging to treat due to underlying patient conditions, pathogen characteristics, and high antibiotic resistance rates. As newer antibiotic therapies come to market, limited data exist about their real-world utilization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a national retrospective cohort study of ceftazidime\/avibactam (approved in 2015) utilization among inpatients from the Veterans Affairs (VA) Healthcare System, from 2015 through 2021. Joinpoint regression was used to estimate time trends in utilization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ceftazidime\/avibactam use increased by 52.3% each year (days of therapy per 1,000 bed days; 95% confidence interval, 12.4%-106.4%). We identified 1,048 unique predominantly male (98.3%) and white (66.2%; Black, 27.7%) patients treated with ceftazidime\/avibactam, with a mean (SD) age of 71.5 (11.9) years. The most commonly isolated organisms were Pseudomonas aeruginosa (36.3%; carbapenem resistant, 80.6%; MDR, 65.0%) and Klebsiella species (34.1%; carbapenem resistant, 78.4%; extended-spectrum cephalosporin resistant, 90.7%). Common comorbid conditions included hypertension (74.8%), nervous system disorders (60.2%), diabetes mellitus (48.7%), and cancer (45.1%). Median time to ceftazidime\/avibactam initiation from admission was 6 days, with a median of 3 changes in therapy before ceftazidime\/avibactam initiation and a subsequent median length of inpatient stay of 14 days (median of 8 days of ceftazidime\/avibactam therapy). Treatment heterogeneity was high, both before ceftazidime\/avibactam initiation (89.6%) and during ceftazidime\/avibactam treatment (85.6%), and common concomitant antibiotics included vancomycin (41.4%), meropenem (24.1%), cefepime (15.2%), and piperacillin\/tazobactam (15.2%). The inpatient mortality rate was 23.6%, and 20.8% of patients had a subsequent admission with ceftazidime\/avibactam treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Utilization of ceftazidime\/avibactam increased from 2015 to 2021 in the national VA Healthcare System. Ceftazidime\/avibactam was utilized in complex, difficult-to-treat patients, with substantial treatment heterogeneity and variation in the causative organism and culture sites.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxae038","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T01:10:15Z","timestamp":1708132215000},"page":"509-520","source":"Crossref","is-referenced-by-count":2,"title":["Real-world utilization of ceftazidime\/avibactam among inpatients in the national Veterans Affairs Healthcare System"],"prefix":"10.1093","volume":"81","author":[{"given":"Aisling R","family":"Caffrey","sequence":"first","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center , Providence, RI"},{"name":"College of Pharmacy, University of Rhode Island , Kingston, RI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haley J","family":"Appaneal","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center , Providence, RI"},{"name":"College of Pharmacy, University of Rhode Island , Kingston, RI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vrishali V","family":"Lopes","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center , Providence, RI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd A","family":"Riccobene","sequence":"additional","affiliation":[{"name":"AbbVie, Inc. , Florham Park, NJ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry L","family":"LaPlante","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Program, Providence Veterans Affairs Medical Center , Providence, RI"},{"name":"College of Pharmacy, University of Rhode Island , Kingston, RI , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"2024061112413244600_CIT0001","article-title":"Gram-negative bacteria","volume-title":"StatPearls","author":"Oliveira","year":"2022"},{"issue":"5","key":"2024061112413244600_CIT0002","doi-asserted-by":"crossref","first-page":"PH29","DOI":"10.12659\/MSM.881750","article-title":"Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: a prospective cohort study","volume":"17","author":"Ak","year":"2011","journal-title":"Med Sci Monit"},{"issue":"11","key":"2024061112413244600_CIT0003","doi-asserted-by":"crossref","first-page":"ofaa461","DOI":"10.1093\/ofid\/ofaa461","article-title":"Epidemiology and risk factors associated with mortality in consecutive patients with bacterial bloodstream infection: impact of MDR and XDR bacteria","volume":"7","author":"Santoro","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"2024061112413244600_CIT0004","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.mib.2017.10.028","article-title":"Global antimicrobial resistance in gram-negative pathogens and clinical need","volume":"39","author":"Theuretzbacher","year":"2017","journal-title":"Curr Opin Microbiol"},{"issue":"5","key":"2024061112413244600_CIT0005","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.3390\/jcm10051068","article-title":"An update on eight \u201cnew\u201d antibiotics against multidrug-resistant gram-negative bacteria","volume":"10","author":"Yusuf","year":"2021","journal-title":"J Clin Med"},{"issue":"1","key":"2024061112413244600_CIT0006","first-page":"15","article-title":"Carbapenem resistance: overview of the problem and future perspectives","volume":"3","author":"Meletis","year":"2016","journal-title":"Ther Adv Infect Dis"},{"issue":"3","key":"2024061112413244600_CIT0007","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect Dis."},{"key":"2024061112413244600_CIT0008","volume-title":"COVID-19: U.S. Impact on Antimicrobial Resistance","author":"Centers for Disease Control and Prevention","year":"2022"},{"issue":"4","key":"2024061112413244600_CIT0009","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/cid\/ciaa061","article-title":"Pharmacoepidemiology of ceftazidime-avibactam use: a retrospective cohort analysis of 210 US hospitals","volume":"72","author":"Strich","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"12","key":"2024061112413244600_CIT0010","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.3390\/antibiotics10121475","article-title":"Place in therapy of the newly available armamentarium for multi-drug-resistant gram-negative pathogens: proposal of a prescription algorithm","volume":"10","author":"Volpicelli","year":"2021","journal-title":"Antibiotics"},{"issue":"9","key":"2024061112413244600_CIT0011","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1002\/phar.2449","article-title":"Approach to the treatment of patients with serious multidrug-resistant Pseudomonas aeruginosa infections","volume":"40","author":"O\u2019Donnell","year":"2020","journal-title":"Pharmacotherapy"},{"issue":"2","key":"2024061112413244600_CIT0012","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/cid\/ciw243","article-title":"Ceftazidime\/avibactam and ceftolozane\/tazobactam: second-generation \u03b2-lactam\/\u03b2-lactamase inhibitor combinations","volume":"63","author":"van Duin","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"2","key":"2024061112413244600_CIT0013","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s40265-013-0013-7","article-title":"Ceftazidime-avibactam: a novel cephalosporin\/\u03b2-lactamase inhibitor combination","volume":"73","author":"Zhanel","year":"2013","journal-title":"Drugs"},{"key":"2024061112413244600_CIT0014","author":"Department of Veterans Affairs"},{"key":"2024061112413244600_CIT0015","article-title":"Offce of Inspector General","volume-title":"Review of VHA Community Living Centers and Corresponding Star Ratings","author":"Veterans Health Administration","year":"2020"},{"key":"2024061112413244600_CIT0016","article-title":"Healthcare Cost and Utilization Project (HCUP)","author":"Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses"},{"issue":"2","key":"2024061112413244600_CIT0017","doi-asserted-by":"crossref","first-page":"e01964","DOI":"10.1128\/AAC.01964-16","article-title":"Ceftazidime-avibactam as salvage therapy for infections caused by carbapenem-resistant organisms","volume":"61","author":"Temkin","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"2024061112413244600_CIT0018","doi-asserted-by":"crossref","first-page":"e0197521","DOI":"10.1128\/aac.01975-21","article-title":"Treatment, clinical outcomes, and predictors of mortality among a national cohort of admitted patients with Acinetobacter baumannii Infection","volume":"66","author":"Appaneal","year":"2022","journal-title":"Antimicrob Agents Chemother"},{"key":"2024061112413244600_CIT0019","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement M100-S20","author":"Clinical and Laboratory Standards Institute","year":"2020"},{"issue":"4","key":"2024061112413244600_CIT0020","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.diagmicrobio.2017.11.022","article-title":"Antibiotic resistance rates for Pseudomonas aeruginosa clinical respiratory and bloodstream isolates among the Veterans Affairs Healthcare System from 2009 to 2013","volume":"90","author":"Appaneal","year":"2018","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"5","key":"2024061112413244600_CIT0021","doi-asserted-by":"crossref","first-page":"e02236","DOI":"10.1128\/AAC.02236-16","article-title":"Antimicrobial resistance of Escherichia coli urinary isolates in the Veterans Affairs Health Care System","volume":"61","author":"Morrill","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2024061112413244600_CIT0022","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"2024061112413244600_CIT0023","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciad428","article-title":"Infectious Diseases Society of America 2023 Guidance on the treatment of antimicrobial resistant gram-negative infections","volume-title":"Clin Infect Dis","author":"Tamma"},{"issue":"5","key":"2024061112413244600_CIT0024","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2024061112413244600_CIT0025","doi-asserted-by":"crossref","first-page":"1700582","DOI":"10.1183\/13993003.00582-2017","article-title":"International ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)\/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociaci\u00f3n Latinoamericana del T\u00f3rax (ALAT)","volume":"50","author":"Torres","year":"2017","journal-title":"Eur Respir J"},{"issue":"4","key":"2024061112413244600_CIT0026","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.cmi.2021.11.025","article-title":"European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant gram-negative bacilli (endorsed by European Society of Intensive Care Medicine)","volume":"28","author":"Paul","year":"2022","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"2024061112413244600_CIT0027","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s40121-021-00507-6","article-title":"Ceftazidime-avibactam for the treatment of serious gram-negative infections with limited treatment options: a systematic literature review","volume":"10","author":"Soriano","year":"2021","journal-title":"Infect Dis Ther"},{"issue":"6","key":"2024061112413244600_CIT0028","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s40265-018-0902-x","article-title":"Ceftazidime-avibactam: a review in the treatment of serious gram-negative bacterial infections","volume":"78","author":"Shirley","year":"2018","journal-title":"Drugs"},{"key":"2024061112413244600_CIT0029","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2147\/IDR.S349004","article-title":"Ceftazidime-avibactam versus colistin for the treatment of infections due to carbapenem-resistant Enterobacterales: a multicenter cohort study","volume":"15","author":"Almangour","year":"2022","journal-title":"Infect Drug Resist"},{"issue":"12","key":"2024061112413244600_CIT0030","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1093\/cid\/ciad100","article-title":"Mortality attributable to bloodstream infections caused by different carbapenem-resistant gram negative bacilli: results from a nationwide study in Italy (ALARICO Network)","volume":"76","author":"Falcone","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2024061112413244600_CIT0031","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/S2666-5247(22)00329-9","article-title":"Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study","volume":"4","author":"Reyes","year":"2023","journal-title":"Lancet Microbe"},{"issue":"11","key":"2024061112413244600_CIT0032","doi-asserted-by":"crossref","first-page":"3170","DOI":"10.1093\/jac\/dky295","article-title":"Effectiveness of ceftazidime\/avibactam as salvage therapy for treatment of infections due to OXA-48 carbapenemase-producing Enterobacteriaceae","volume":"73","author":"Sousa","year":"2018","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"2024061112413244600_CIT0033","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/cid\/cix783","article-title":"Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae","volume":"66","author":"van Duin","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"12","key":"2024061112413244600_CIT0034","doi-asserted-by":"crossref","first-page":"ofz522","DOI":"10.1093\/ofid\/ofz522","article-title":"Real-world experience with ceftazidime-avibactam for multidrug-resistant gram-negative bacterial infections","volume":"6","author":"Jorgensen","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"2","key":"2024061112413244600_CIT0035","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.cmi.2020.10.016","article-title":"Risk factors for carbapenem-resistant gram-negative bacterial infections: a systematic review","volume":"27","author":"Palacios-Baena","year":"2021","journal-title":"Clin Microbiol Infect"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxae038\/56817709\/zxae038.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/81\/12\/509\/58196480\/zxae038.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/article-pdf\/81\/12\/509\/58196480\/zxae038.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T21:46:37Z","timestamp":1718142397000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/81\/12\/509\/7607915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,14]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,2,14]]},"published-print":{"date-parts":[[2024,6,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxae038","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,6,15]]},"published":{"date-parts":[[2024,2,14]]}}}