{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:21:55Z","timestamp":1782321715356,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"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>Background: This study aimed to compare mortality rates and treatment efficacy between ceftazidime\u2013avibactam (CAZ\/AVI) and meropenem-based combination regimens in critically ill patients with carbapenem-resistant Gram-negative bacteria (CRGNB) infections. Methods: This retrospective study included 135 intensive care unit (ICU) patients diagnosed with CRGNB infections between 2020 and 2024. Patients were categorized on the basis of treatment: CAZ\/AVI or alternative combinations that included meropenem with either amikacin or polymyxin. The primary outcomes were 14-day, 30-day, and 90-day all-cause mortality rates. The secondary outcomes included the clinical response on day 14 and the total duration of ICU hospitalization. Results: Among the patients, 74 received CAZ\/AVI, whereas 61 were treated with meropenem-based regimens. No significant differences were observed in the baseline characteristics between the groups. There were no statistically significant differences in 14-day (27.0% vs. 31.1%), 30-day (41.9% vs. 47.5%), or 90-day mortality rates (62.2% vs. 65.6%) between the two groups (p = 0.738, 0.511, and 0.818, respectively), including within the pneumonia and bloodstream infection subgroups. Clinical success was observed in 64.9% of the CAZ\/AVI group and 65.6% of the other group (p = 0.931), with comparable ICU lengths of stay (44.0 \u00b1 29.1 vs. 41.5 \u00b1 26.4 days, p = 0.974). Multivariate analysis revealed that advanced age, higher Sequential Organ Failure Assessment (SOFA) scores, elevated procalcitonin levels, and prolonged time from culture collection to the initiation of appropriate antibiotic therapy were independent predictors of increased 30-day mortality. Conclusions: CAZ\/AVI demonstrated efficacy and mortality outcomes comparable to those of meropenem-based regimens in ICU patients with CRGNB infections. Prompt initiation of appropriate antimicrobial therapy remains critical.<\/jats:p>","DOI":"10.3390\/antibiotics14090863","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:31:12Z","timestamp":1756373472000},"page":"863","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Comparative Study of Ceftazidime\u2013Avibactam and Meropenem-Based Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in Intensive Care Units"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0167-0802","authenticated-orcid":false,"given":"Murat","family":"Ayd\u0131n","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, 25080 Erzurum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4138-2490","authenticated-orcid":false,"given":"Nurten Nur","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, 25080 Erzurum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehtap H\u00fclya","family":"Aslan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Erzurum Regional Training and Research Hospital, 25080 Erzurum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithat","family":"Kahramano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, 25080 Erzurum, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e169","DOI":"10.1093\/cid\/ciaa1478","article-title":"Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum \u03b2-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa)","volume":"72","author":"Tamma","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jointm.2023.11.007","article-title":"Risk factors and mortality rates of carbapenem-resistant gram-negative bacterial infections in intensive care units","volume":"4","author":"Kuloglu","year":"2024","journal-title":"J. Intensive Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5363","DOI":"10.2147\/IDR.S475679","article-title":"Ceftazidime-Avibactam for the Treatment of Carbapenem-Resistant Klebsiella Pneumoniae Infection: A Retrospective, Single Center Study","volume":"17","author":"Yu","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"106517","DOI":"10.1016\/j.ijantimicag.2021.106517","article-title":"Effectiveness of ceftazidime-avibactam for the treatment of infections due to Pseudomonas aeruginosa","volume":"59","author":"Corbella","year":"2022","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dumlu, R., and \u015eahin, M. (2024). Ceftazidime-Avibactam Versus Polymyxin-Based Combination Therapies: A Study on 30-Day Mortality in Carbapenem-Resistant Enterobacterales Bloodstream Infections in an OXA-48-Endemic Region. Antibiotics, 13.","DOI":"10.3390\/antibiotics13100990"},{"key":"ref_6","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_7","doi-asserted-by":"crossref","unstructured":"Tamma, P.D., Heil, E.L., Justo, J.A., Mathers, A.J., Satlin, M.J., and Bonomo, R.A. (Clin. Infect. Dis., 2024). Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections, Clin. Infect. Dis., online ahead of print.","DOI":"10.1093\/cid\/ciae403"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Huang, R.C., Chen, L.Y., Wang, Y.C., and Chiu, C.H. (J. Microbiol. Immunol. Infect., 2025). Effectiveness comparison between ceftazidime-avibactam and carbapenem-based regimens in nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections, J. Microbiol. Immunol. Infect., in press.","DOI":"10.1016\/j.jmii.2025.03.003"},{"key":"ref_9","first-page":"e70234","article-title":"Real-World Evidence on Use of Ceftazidime-Avibactam in the Management of Gram-Negative Infections: A Retrospective Analysis","volume":"16","author":"Todi","year":"2024","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Li, D., Fei, F., Yu, H., Huang, X., Long, S., Zhou, H., and Zhang, J. (2021). Ceftazidime-Avibactam Therapy Versus Ceftazidime-Avibactam-Based Combination Therapy in Patients With Carbapenem-Resistant Gram-Negative Pathogens: A Meta-Analysis. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.707499"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S565","DOI":"10.1093\/cid\/ciz830","article-title":"Treatment Options for Carbapenem-resistant gram-negative Bacterial Infections","volume":"69","author":"Doi","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chen, Y., Huang, H.B., Peng, J.M., Weng, L., and Du, B. (2022). Efficacy and Safety of Ceftazidime-Avibactam for the Treatment of Carbapenem-Resistant Enterobacterales Bloodstream Infection: A Systematic Review and Meta-Analysis. Microbiol. Spectr., 10.","DOI":"10.1128\/spectrum.02603-21"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.5455\/medscience.2022.03.060","article-title":"Evaluation of ceftazidime-avibactam efficacy in gram-negative bacteria","volume":"11","author":"Cetinkol","year":"2022","journal-title":"Med. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.47582\/jompac.1372443","article-title":"Evaluation of ceftazidime-avibactam susceptibility in carbapenem resistant Klebsiella pneumoniae and Pseudomonas aeruginosa isolates","volume":"4","author":"Koca","year":"2023","journal-title":"J. Med. Palliat. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"49182","DOI":"10.12775\/JEHS.2024.71.49182","article-title":"Effectiveness of Ceftazidime\/Avibactam treatment for infections caused by Klebsiella pneumoniae Carbapenemase (KPC), a 30-day mortality perspective. Comparison of results with control groups treated with other antibiotics","volume":"71","author":"Paschke","year":"2024","journal-title":"J. Educ. Health Sport"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Xiao, S., Fu, Q., Miao, Y., Zhao, M., Lu, S., Xu, J., and Zhao, W. (2023). Clinical efficacy and drug resistance of ceftazidime-avibactam in the treatment of Carbapenem-resistant gram-negative bacilli infection. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1198926"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/1120009X.2024.2349439","article-title":"A comparative study of ceftazidime\/avibactam-based and fosfomycin plus meropenem-based regimens for managing infections caused by carbapenem-resistant Klebsiella pneumoniae in critically ill patients","volume":"37","author":"Kahveci","year":"2025","journal-title":"J. Chemother."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Deng, S., Chen, J., Zhou, P., and Hu, Q. (2025). Mortality-related risk factors for carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: A real-world retrospective study in China. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10454-z"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1093\/jac\/dkac049","article-title":"Impact of ceftazidime\/avibactam versus best available therapy on mortality from infections caused by carbapenemase-producing Enterobacterales (CAVICOR study)","volume":"77","author":"Cano","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s41030-021-00175-4","article-title":"The Impact of Risk Factors on Treatment Outcomes of Nosocomial Pneumonia Due to Gram-Negative Bacteria in the Intensive Care Unit","volume":"7","author":"Nguyen","year":"2021","journal-title":"Pulm. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Stoian, M., Andone, A., B\u00e2ndil\u0103, S.R., Oni\u0219or, D., Laszlo, S.\u0218., Lupu, G., Danielescu, A., Baba, D.-F., V\u0103sie\u0219iu, A.M., and Manea, A. (2025). Mechanical Ventilator-Associated Pneumonia in the COVID-19 Pandemic Era: A Critical Challenge in the Intensive Care Units. Antibiotic, 14.","DOI":"10.3390\/antibiotics14010028"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1007\/s00134-020-05980-0","article-title":"Ventilator-associated pneumonia in adults: A narrative review","volume":"46","author":"Papazian","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.12816\/0039060","article-title":"Procalcitonin as a diagnostic and prognostic marker of sepsis in critically Ill patients in intensive care unit","volume":"68","author":"Ashour","year":"2017","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"dlac089","DOI":"10.1093\/jacamr\/dlac089","article-title":"Early appropriate diagnostics and treatment of MDR gram-negative infections","volume":"4","author":"Bassetti","year":"2022","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2018.06.002","article-title":"Rethinking the concept of sepsis and septic shock","volume":"54","author":"Cabrita","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: A severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit. Care Med."},{"key":"ref_27","unstructured":"Centres for Disease Control and Prevention (CDC) (2025, August 01). People Who Are Immunocompromised 2023 [Updated 11.05.2023; Cited 2025 07.04.2025], Available online: https:\/\/archive.cdc.gov\/www_cdc_gov\/coronavirus\/2019-ncov\/need-extra-precautions\/people-who-are-immunocompromised.html."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1038\/ki.2013.243","article-title":"Comments on \u2018KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease\u2019","volume":"84","author":"Andrassy","year":"2013","journal-title":"Kidney Int."},{"key":"ref_29","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2025, August 01). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Version 15.0 [Updated 01.01.2025; Cited 2025 07.04.2025]. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_15.0_Breakpoint_Tables.pdf."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/863\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:00Z","timestamp":1760034840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/9\/863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,27]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["antibiotics14090863"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14090863","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,27]]}}}