{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:05:02Z","timestamp":1775145902372,"version":"3.50.1"},"reference-count":74,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Ventilator-associated pneumonia (VAP) in critically ill patients with COVID-19 represents a very huge global threat due to a higher incidence rate compared to non-COVID-19 patients and almost 50% of the 30-day mortality rate. Pseudomonas aeruginosa was the first pathogen involved but uncommon non-fermenter gram-negative organisms such as Burkholderia cepacea and Stenotrophomonas maltophilia have emerged as other potential etiological causes. Against carbapenem-resistant gram-negative microorganisms, Ceftazidime\/avibactam (CZA) is considered a first-line option, even more so in case of a ceftolozane\/tazobactam resistance or shortage. The aim of this report was to describe our experience with CZA in a case series of COVID-19 patients hospitalized in the ICU with VAP due to difficult-to-treat (DTT) P. aeruginosa, Burkholderia cepacea, and Stenotrophomonas maltophilia and to compare it with data published in the literature. A total of 23 patients were treated from February 2020 to March 2022: 19\/23 (82%) VAPs were caused by Pseudomonas spp. (16\/19 DTT), 2 by Burkholderia cepacea, and 6 by Stenotrophomonas maltophilia; 12\/23 (52.1%) were polymicrobial. Septic shock was diagnosed in 65.2% of the patients and VAP occurred after a median of 29 days from ICU admission. CZA was prescribed as a combination regimen in 86% of the cases, with either fosfomycin or inhaled amikacin or cotrimoxazole. Microbiological eradication was achieved in 52.3% of the cases and the 30-day overall mortality rate was 14\/23 (60.8%). Despite the high mortality of critically ill COVID-19 patients, CZA, especially in combination therapy, could represent a valid treatment option for VAP due to DTT non-fermenter gram-negative bacteria, including uncommon pathogens such as Burkholderia cepacea and Stenotrophomonas maltophilia.<\/jats:p>","DOI":"10.3390\/antibiotics11081007","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T22:03:42Z","timestamp":1658873022000},"page":"1007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Ceftazidime\/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature"],"prefix":"10.3390","volume":"11","author":[{"given":"Giulia Jole","family":"Burastero","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-9045","authenticated-orcid":false,"given":"Gabriella","family":"Orlando","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Santoro","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Menozzi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6922-5759","authenticated-orcid":false,"given":"Erica","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4041-1459","authenticated-orcid":false,"given":"Andrea","family":"Bedini","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Cervo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Faltoni","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7164-5293","authenticated-orcid":false,"given":"Erica","family":"Bacca","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuela","family":"Biagioni","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Coloretti","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Melegari","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Maccieri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-4967","authenticated-orcid":false,"given":"Stefano","family":"Busani","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Bertellini","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-0829","authenticated-orcid":false,"given":"Massimo","family":"Girardis","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Ferrarini","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit, AUSL, Modena, Via Giardini 1355, 41126 Baggiovara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Rofrano","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Unit, AUSL, Modena, Via Giardini 1355, 41126 Baggiovara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Sarti","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Mussini","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Infectious Diseases, University of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1254-9995","authenticated-orcid":false,"given":"Marianna","family":"Meschiari","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","unstructured":"Lastinger, L.M., Alvarez, C.R., Kofman, A., Konnor, R.Y., Kuhar, D.T., Nkwata, A., Patel, P.R., Pattabiraman, V., Xu, S.Y., and Dudeck, M.A. (2022). 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