{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T20:00:52Z","timestamp":1778616052835,"version":"3.51.4"},"reference-count":27,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Fund for VQR improvement assigned to the Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties of the University of Palermo"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Bone and joint infections (BJIs) caused by multidrug-resistant gram-negative bacteria are becoming a concern due to limited therapeutic options. Although not approved for these indications, an ever-growing amount of evidence supports the efficacy and safety of ceftazidime\u2013avibactam as a therapy for osteomyelitis and prosthetic joint infections. Here, we present three cases of difficult-to-treat resistant Pseudomonas aeruginosa osteomyelitis that were successfully treated with ceftazidime\u2013avibactam alone or in combination therapy with fosfomycin and amikacin. Ceftazidime\u2013avibactam was prescribed at a daily dose of 2.5 g every 8 h for 42 days in all cases. One potential drug-related adverse effect was observed, i.e., Clostridioides difficile infection, which occurred after fourteen days of treatment with ceftazidime\u2013avibactam.<\/jats:p>","DOI":"10.3390\/antibiotics12081328","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:15:48Z","timestamp":1692267348000},"page":"1328","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ceftazidime-Avibactam as Osteomyelitis Therapy: A Miniseries and Review of the Literature"],"prefix":"10.3390","volume":"12","author":[{"given":"Alessandro","family":"Mancuso","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2032Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"},{"name":"Infectious and Tropical Disease Unit, Sicilian Regional Reference Centre for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Pipit\u00f2","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2032Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"},{"name":"Infectious and Tropical Disease Unit, Sicilian Regional Reference Centre for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Rubino","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit, Sicilian Regional Reference Centre for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"},{"name":"Antimicrobial Stewardship Team, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore Antonino","family":"Distefano","sequence":"additional","affiliation":[{"name":"Microbiology and Virology Unit, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donatella","family":"Mangione","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2032Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1992-1796","authenticated-orcid":false,"given":"Antonio","family":"Cascio","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties \u201cG. D\u2032Alessandro\u201d, University of Palermo, 90127 Palermo, Italy"},{"name":"Infectious and Tropical Disease Unit, Sicilian Regional Reference Centre for the Fight against AIDS, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"},{"name":"Antimicrobial Stewardship Team, AOU Policlinico \u201cP. Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"publisher","first-page":"e00932-19","DOI":"10.1128\/IAI.00932-19","article-title":"Staphylococcus aureus Osteomyelitis: Bone, Bugs, and Surgery","volume":"88","author":"Urish","year":"2020","journal-title":"Infect. Immun."},{"key":"ref_2","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.otsr.2013.02.011","article-title":"Bacterial epidemiology of osteoarticular infections in a referent center: 10-year study","volume":"99","author":"Senneville","year":"2013","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_3","unstructured":"European Centre for Disease Prevention and Control and WHO Regional Office for Europe (2022). Surveillance of Antimicrobial Resistance in Europe, 2021 Data: Executive Summary, European Centre for Disease Prevention and Control."},{"key":"ref_4","doi-asserted-by":"publisher","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":"ref_5","doi-asserted-by":"publisher","first-page":"2376","DOI":"10.1093\/jac\/dkq306","article-title":"In vitro activity of ceftazidime+NXL104 against Pseudomonas aeruginosa and other non-fermenters","volume":"65","author":"Mushtaq","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_6","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1586\/eri.10.173","article-title":"Activity of a novel combination against multidrug-resistant nonfermenters: Ceftazidime plus NXL104","volume":"9","author":"Curcio","year":"2011","journal-title":"Expert. Rev. Anti-Infect. Ther."},{"key":"ref_7","unstructured":"Haesler, E. (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, Cambridge Media."},{"key":"ref_8","doi-asserted-by":"publisher","first-page":"e12837","DOI":"10.1111\/tid.12837","article-title":"Carbapenem-resistant Klebsiella pneumoniae vertebral osteomyelitis in a renal transplant recipient treated with ceftazidime-avibactam","volume":"20","author":"Cani","year":"2018","journal-title":"Transpl. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.recote.2018.02.005","article-title":"Lumbar arthrodesis infection by multi-resistant Klebsiella pneumoniae, successfully treated with implant retention and ceftazidime\/avibactam","volume":"62","year":"2018","journal-title":"Rev. Esp. Cir. Ortop. Traumatol."},{"key":"ref_10","first-page":"128","article-title":"Ceftazidime\/Avibactam for Refractory Bacteremia, Vertebral Diskitis\/Osteomyelitis with Pre-Vertebral Abscess and Bilateral Psoas Pyomyositis Secondary to Klebsiella Pneumoniae Carbapenemase-Producing Bacteria (KPC)","volume":"37","author":"Vidal","year":"2018","journal-title":"P. R. Health Sci. J."},{"key":"ref_11","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.jgar.2018.07.010","article-title":"Evaluation of ceftazidime\/avibactam for serious infections due to multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa","volume":"15","author":"Ripa","year":"2018","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_12","doi-asserted-by":"publisher","first-page":"bcr2018225440","DOI":"10.1136\/bcr-2018-225440","article-title":"Two for the price of one: Emerging carbapenemases in a returning traveller to New York City","volume":"2018","author":"Mittal","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_13","doi-asserted-by":"publisher","first-page":"1854805","DOI":"10.1155\/2018\/1854805","article-title":"Prosthetic Joint Infection from Carbapenemase-Resistant Klebsiella pneumoniae Successfully Treated with Ceftazidime-Avibactam","volume":"2018","author":"Schimmenti","year":"2018","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"publisher","first-page":"e01872-19","DOI":"10.1128\/AAC.01872-19","article-title":"Long-Term Compassionate Use of Cefiderocol To Treat Chronic Osteomyelitis Caused by Extensively Drug-Resistant Pseudomonas aeruginosa and Extended-Spectrum-\u03b2-Lactamase-Producing Klebsiella pneumoniae in a Pediatric Patient","volume":"64","author":"Alamarat","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_15","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1007\/s15010-020-01539-9","article-title":"Ceftazidime\/avibactam and ceftolozane\/tazobactam for the treatment of extensively drug-resistant Pseudomonas aeruginosa post-neurosurgical infections: Three cases and a review of the literature","volume":"49","author":"Meschiari","year":"2021","journal-title":"Infection"},{"key":"ref_16","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.ijid.2021.05.085","article-title":"Combination of aztreonam, ceftazidime-avibactam and amikacin in the treatment of VIM-1 Pseudomonas aeruginosa ST235 osteomyelitis","volume":"108","author":"Mularoni","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"publisher","first-page":"3109","DOI":"10.2147\/IDR.S320056","article-title":"Carbapenem-Resistant Klebsiella pneumoniae Osteomyelitis Treated with Ceftazidime-Avibactam in an Infant: A Case Report","volume":"14","author":"Ji","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1038\/s41467-021-27656-z","article-title":"Combination of pre-adapted bacteriophage therapy and antibiotics for treatment of fracture-related infection due to pandrug-resistant Klebsiella pneumoniae","volume":"13","author":"Eskenazi","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_19","doi-asserted-by":"publisher","first-page":"851310","DOI":"10.3389\/fmed.2022.851310","article-title":"Use of Phage Cocktail BFC 1.10 in Combination With Ceftazidime-Avibactam in the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Femur Osteomyelitis-A Case Report","volume":"9","author":"Racenis","year":"2022","journal-title":"Front. Med."},{"key":"ref_20","doi-asserted-by":"publisher","first-page":"e28855","DOI":"10.7759\/cureus.28855","article-title":"A Case of New Delhi Metallo-\u03b2-Lactamases (NDM) Citrobacter sedlakii Osteomyelitis Successfully Treated With Ceftazidime-Avibactam and Aztreonam","volume":"14","author":"Rubnitz","year":"2022","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.jgar.2021.04.003","article-title":"Treatment of bone and joint infections by ceftazidime\/avibactam and ceftolozane\/tazobactam: A cohort study","volume":"25","author":"Rempenault","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_22","doi-asserted-by":"publisher","first-page":"106702","DOI":"10.1016\/j.ijantimicag.2022.106702","article-title":"Efficacy of ceftazidime-avibactam in various combinations for the treatment of experimental osteomyelitis due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae","volume":"61","author":"Davido","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_23","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1093\/jac\/dkad070","article-title":"Efficacy of ceftazidime\/avibactam in various combinations for the treatment of experimental osteomyelitis in rabbits caused by OXA-48-\/ESBL-producing Escherichia coli","volume":"78","author":"Davido","year":"2023","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_24","doi-asserted-by":"publisher","first-page":"e0058521","DOI":"10.1128\/Spectrum.00585-21","article-title":"Time-Kill Evaluation of Antibiotic Combinations Containing Ceftazidime-Avibactam against Extensively Drug-Resistant Pseudomonas aeruginosa and Their Potential Role against Ceftazidime-Avibactam-Resistant Isolates","volume":"9","author":"Montero","year":"2021","journal-title":"Microbiol. Spectr."},{"key":"ref_25","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1093\/infdis\/jiz149","article-title":"Ceftazidime-Avibactam in Combination with Fosfomycin: A Novel Therapeutic Strategy Against Multidrug-Resistant Pseudomonas aeruginosa","volume":"220","author":"Zeiser","year":"2019","journal-title":"J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.ijantimicag.2018.07.004","article-title":"Evaluation of the efficacy and safety of ceftazidime\/avibactam in the treatment of Gram-negative bacterial infections: A systematic review and meta-analysis","volume":"52","author":"Zhong","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_27","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1093\/jac\/dky124","article-title":"Efficacy and safety of ceftazidime\/avibactam: A systematic review and meta-analysis","volume":"73","author":"Sternbach","year":"2018","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/8\/1328\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:36:10Z","timestamp":1760128570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/8\/1328"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,17]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["antibiotics12081328"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12081328","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,17]]}}}