{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:57:43Z","timestamp":1792789063364,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T00:00:00Z","timestamp":1735862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Melinta Therapeutics, Parsippany, NJ, USA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Meropenem\u2013vaborbactam (MEV) and ceftazidime\u2013avibactam (CZA) are active against \u201curgent threat\u201d pathogens like carbapenem-resistant Enterobacterales (CRE). However, few studies have compared outcomes between them. Methods: To explore comparative outcomes of MEV vs. CZA, we conducted a multicenter retrospective cohort study of all adult hospitalized patients with a serious infection (sepsis, urinary tract infection [UTI], complicated intraabdominal [cIAI] infection, or pneumonia) within the PINC AI Database, 2019\u20132021. Descriptive statistics compared the two groups along demographic and clinical characteristics, and multiple regression derived adjusted outcomes. Results: Among 1,989,765 patients who met enrollment criteria, 455 received MEV and 2320 CZA. Compared to CZA, patients on MEV were more commonly Caucasian (68.1% vs. 63.6%, p = 0.032) or Hispanic (21.8% vs. 12.8%, p &lt; 0.001). Their mean [SD] Charlson comorbidity scores did not differ (3.6 [2.5] vs. 3.5 [2.5], p = 0.403). The most common index infection in both groups was pneumonia, though it was less prevalent in the MEV- than the CZA-treated group (48.1% vs. 56.8%, p = 0.001). Fewer than one-third of all patients received the respective drug within 2 days of the onset of the index infection (30.6% MEV vs. 33.0% CZA, p = 0.313). Fewer patients on MEV than CZA required mechanical ventilation (35.0% vs. 41.4%, p = 0.010). MEV treatment was associated with lower adjusted mortality (17.0% [95% CI 13.6%, 20.3%] vs. 20.6% [95% CI 19.0%, 22.2%], p = 0.048) relative to CZA. Conclusions: In this cohort of hospitalized patients treated with either MEV or CZA for their infectious syndrome, MEV was associated with lower adjusted hospital mortality, although the confidence intervals around the values overlapped.<\/jats:p>","DOI":"10.3390\/antibiotics14010029","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T05:02:02Z","timestamp":1735880522000},"page":"29","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparative Outcomes of Meropenem\u2013Vaborbactam vs. Ceftazidime\u2013Avibactam Among Adults Hospitalized with an Infectious Syndrome in the US, 2019\u20132021"],"prefix":"10.3390","volume":"14","author":[{"given":"Marya D.","family":"Zilberberg","sequence":"first","affiliation":[{"name":"EviMed Research Group, LLC, Goshen, MA 01032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian H.","family":"Nathanson","sequence":"additional","affiliation":[{"name":"OptiStatim, LLC, Longmeadow, MA 01116, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Redell","sequence":"additional","affiliation":[{"name":"Melinta Therapeutics, Parsippany, NJ 07054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Sulham","sequence":"additional","affiliation":[{"name":"Melinta Therapeutics, Parsippany, NJ 07054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4537-8328","authenticated-orcid":false,"given":"Andrew F.","family":"Shorr","sequence":"additional","affiliation":[{"name":"Washington Hospital Center, Washington, DC 20010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,3]]},"reference":[{"key":"ref_1","unstructured":"CDC (2022, August 13). Antibiotic Resistance Threats in the United States, 2019, Available online: https:\/\/www.cdc.gov\/antimicrobial-resistance\/data-research\/threats\/?CDC_AAref_Val."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3601","DOI":"10.1128\/AAC.03007-15","article-title":"Combination Regimens for Treatment of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections","volume":"60","author":"Nelson","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lee, G.C., and Burgess, D.S. (2012). Treatment of Klebsiella pneumoniae carbapenemase (KPC) infections: A review of published case series and case reports. Ann. Clin. Microbiol. Antimicrob., 11.","DOI":"10.1186\/1476-0711-11-32"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.ijantimicag.2017.08.019","article-title":"Italian Study Group on Resistant Infections of the Societ\u00e0 Italiana Terapia Antinfettiva (ISGRI-SITA). Effect of combination therapy containing a high-dose carbapenem on mortality in patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection","volume":"51","author":"Giannella","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1093\/jac\/dkq390","article-title":"Polymyxin B versus other antimicrobials for the treatment of pseudomonas aeruginosa bacteraemia","volume":"66","author":"Kvitko","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jinf.2012.01.015","article-title":"Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy","volume":"65","author":"Kubin","year":"2012","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4625","DOI":"10.1128\/AAC.00280-12","article-title":"Characterization of polymyxin B-induced nephrotoxicity: Implications for dosing regimen design","volume":"56","author":"Abdelraouf","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"ciad428","DOI":"10.1093\/cid\/ciad428","article-title":"Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections","volume":"2023","author":"Tamma","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e02323","DOI":"10.1128\/AAC.02313-19","article-title":"Meropenem-vaborbactam vs. ceftazidime-avibactam for treatment of carbapenem-resistant infections","volume":"64","author":"Ackley","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/aac.01406-22","article-title":"Epidemiology of Resistance Determinants Identified in Meropenem-Nonsusceptible Enterobacterales Collected as Part of a Global Surveillance Study, 2018 to 2019","volume":"67","author":"Estabrook","year":"2023","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e01105","DOI":"10.1128\/AAC.01105-21","article-title":"Detection and characterization of targeted carbapenem-resistant health care-associated threats: Findings from the Antibiotic Resistance Laboratory Network, 2017 to 2019","volume":"65","author":"Sabour","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6907","DOI":"10.2147\/IDR.S390635","article-title":"Mortality-related risk factors and novel antimicrobial regimens for carbapenem-resistant Enterobacteriaceae infections: A systematic review","volume":"15","author":"Hu","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s40121-018-0214-1","article-title":"Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections: The TANGO II randomized clinical trial","volume":"7","author":"Wunderink","year":"2018","journal-title":"Infect. Dis. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ofz344","DOI":"10.1093\/ofid\/ofz344","article-title":"Estimating the treatment of carbapenem-resistant Enterobacterales infections in the United States using antibiotic prescription data","volume":"6","author":"Clancy","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e0213021","DOI":"10.1128\/aac.02130-21","article-title":"Pharmacokinetic-pharmacodynamic target attainment analyses as support for meropenem-vaborbactam dosing regimens and susceptibility breakpoints","volume":"66","author":"Bhavnani","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/cid\/ciy576","article-title":"Ceftazidime\/avibactam, meropenem\/vaborbactam, or both? Clinical and formulary considerations","volume":"68","author":"Pogue","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bucataru, A., Turcu-Stiolica, A., Calina, D., Balasoiu, A.T., Zlatian, O.M., Osman, A., Balasoiu, M., and Ghenea, A.E. (2024). Systematic review and meta-analysis of clinical efficacy and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25179574"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2403724","DOI":"10.1080\/07853890.2024.2403724","article-title":"A systematic review of efficacy and safety of newer drugs approved from 2016 to 2023 for the treatment of complicated urinary tract infections","volume":"56","author":"Sivanandy","year":"2024","journal-title":"Ann. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1007\/s40121-024-00999-y","article-title":"Ceftazidime-avibactam in the treatment of patients with bacteremia or nosocomial pneumonia: A systematic review and meta-analysis","volume":"13","author":"Shields","year":"2024","journal-title":"Infect. Dis. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s15010-023-02108-6","article-title":"Ceftazidime-avibactam versus polymyxins in treating patients with carbapenem-resistant Enterobacteriaceae infections: A systematic review and meta-analysis","volume":"52","author":"Chen","year":"2024","journal-title":"Infection"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"ofz504","DOI":"10.1093\/ofid\/ofz504","article-title":"Carbapenem treatment and outcomes among patients with culture-positive complicated intra-abdominal infections in US hospitals: A retrospective cohort study","volume":"6","author":"Zilberberg","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zilberberg, M.D., Nathanson, B.H., Sulham, K., Fan, W., and Shorr, A.F. (2017). Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2383-z"},{"key":"ref_23","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."},{"key":"ref_24","unstructured":"Sulham, K., and Fan, W. (2018, January 8\u201310). Budget impact and cost-effectiveness of meropenem-vaborbactam compared with ceftazidime-avibactam in US hospitals. Proceedings of the ASM Microbe Meeting in 2018, Atlanta, GA, USA."},{"key":"ref_25","unstructured":"US Department of Health and Human Services Office for Human Research Protections (2022, February 03). Human Subject Regulations Decision Charts, Available online: https:\/\/www.hhs.gov\/ohrp\/regulations-and-policy\/decision-charts\/index.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/QCO.0000000000000490","article-title":"The ideal patient profile for new beta-lactam\/beta-lactamase inhibitors","volume":"31","author":"Montravers","year":"2018","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin","year":"2015","journal-title":"Stat. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/ckj\/sfab158","article-title":"An introduction to inverse probability of treatment weighting in observational research","volume":"15","author":"Chesnaye","year":"2022","journal-title":"Clin. Kidney J."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/1\/29\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:22:21Z","timestamp":1759918941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/1\/29"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,3]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["antibiotics14010029"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14010029","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,3]]}}}