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Peer-reviewedCC BY-NC-NDBMC infectious diseases

Ceftazidime-avibactam as a polymyxin-sparing option for multidrug-resistant Gram-negative infections in children: a real-world comparative cohort study.

  • Sevgi Aslan Tuncay1
  • Gulsen Akkoc2
  • Ezgi Celikboya3
  • Seyhan Yilmaz1
  • Burcu Parlak1
  • Pinar Canizci Erdemli1
  • Aylin Dizi Isik1
  • Didem Buyuktas Aytac1
  • Meryem Cagla Abaci Capar1
  • Ahmet Furkan Eser3
  • Makbule Nilufer Yalindag Ozturk3
  • Eda Kepenekli1,4
1 more authors
  • Sevliya Ocal Demir1
4 affiliations
  1. 1Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Marmara University, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, No:10, Floor 6, Pendik, Istanbul, Türkiye.
  2. 2Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Marmara University, Fevzi Çakmak, Muhsin Yazıcıoğlu Street, No:10, Floor 6, Pendik, Istanbul, Türkiye. [email protected].
  3. 3Division of Pediatric Intensive Care Unit,Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Türkiye.
  4. 4Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Biruni University, Istanbul, Türkiye.
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Abstract

Background

Multidrug-resistant (MDR) Gram-negative infections are challenging to treat in children, and polymyxin-based regimens are limited by toxicity. We evaluated the real-world use of ceftazidime-avibactam (CZA) as a potential polymyxin-sparing option for children with MDR Gram-negative infections.Methods

We conducted a single-center retrospective comparative cohort study at a tertiary hospital in Istanbul, Türkiye. Children aged < 18 years who received definitive therapy for microbiologically confirmed MDR Gram-negative infections between January 2022 and May 2024 were included. The primary outcome was 28-day all-cause mortality. Secondary outcomes included clinical response, documented microbiological clearance, acute kidney injury (AKI), drug-induced liver injury (DILI) and one-year all-cause mortality.Results

Forty-five children were included: 15 received CZA-based therapy and 30 received non-CZA regimens. Mechanical ventilation was required in 40/45 (88.9%) patients, reflecting a critically ill cohort. Steroid exposure within 30 days (46.7% vs. 6.7%; P = 0.003) and prior carbapenem exposure (93.3% versus 56.7%; P = 0.016) were more frequent in the CZA group. Clinical response (73.3% versus 73.3%; P = 1.000) and 28-day all-cause mortality (40.0% versus 40.0%; P = 1.000) were comparable between groups. Documented microbiological clearance, AKI and DILI did not differ significantly. Similar findings were observed in the CZA vs. meropenem plus colistin subgroup.Conclusions

CZA-based therapy showed similar observed outcomes and no clear excess toxicity signal compared with heterogeneous non-CZA regimens, despite preferential use in children with greater recent antimicrobial exposure and clinical complexity. These findings support CZA as a feasible polymyxin-sparing option in selected children.

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Cite

BibTeXRIS
BibTeX
@article{tuncay2026ceftazidimeavibactam,
  title = {{Ceftazidime-avibactam as a polymyxin-sparing option for multidrug-resistant Gram-negative infections in children: a real-world comparative cohort study.}},
  author = {Sevgi Aslan Tuncay and Gulsen Akkoc and Ezgi Celikboya and Seyhan Yilmaz and Burcu Parlak and Pinar Canizci Erdemli and Aylin Dizi Isik and Didem Buyuktas Aytac and Meryem Cagla Abaci Capar and Ahmet Furkan Eser and Makbule Nilufer Yalindag Ozturk and Eda Kepenekli and Sevliya Ocal Demir},
  journal = {BMC infectious diseases},
  year = {2026},
  month = jul,
  doi = {10.1186/s12879-026-14049-0},
  url = {https://europepmc.org/article/MED/42919204},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Ceftazidime-avibactam as a polymyxin-sparing option for multidrug-resistant Gram-negative infections in children: a real-world comparative cohort study.
AU  - Sevgi Aslan Tuncay
AU  - Gulsen Akkoc
AU  - Ezgi Celikboya
AU  - Seyhan Yilmaz
AU  - Burcu Parlak
AU  - Pinar Canizci Erdemli
AU  - Aylin Dizi Isik
AU  - Didem Buyuktas Aytac
AU  - Meryem Cagla Abaci Capar
AU  - Ahmet Furkan Eser
AU  - Makbule Nilufer Yalindag Ozturk
AU  - Eda Kepenekli
AU  - Sevliya Ocal Demir
PY  - 2026
DA  - 2026/07/01
JO  - BMC infectious diseases
DO  - 10.1186/s12879-026-14049-0
UR  - https://europepmc.org/article/MED/42919204
AB  - Background  Multidrug-resistant (MDR) Gram-negative infections are challenging to treat in children, and polymyxin-based regimens are limited by toxicity. We evaluated the real-world use of ceftazidime-avibactam (CZA) as a potential polymyxin-sparing option for children with MDR Gram-negative infections.Methods  We conducted a single-center retrospective comparative cohort study at a tertiary hospital in Istanbul, Türkiye. Children aged < 18 years who received definitive therapy for microbiologically confirmed MDR Gram-negative infections between January 2022 and May 2024 were included. The primary outcome was 28-day all-cause mortality. Secondary outcomes included clinical response, documented microbiological clearance, acute kidney injury (AKI), drug-induced liver injury (DILI) and one-year all-cause mortality.Results  Forty-five children were included: 15 received CZA-based therapy and 30 received non-CZA regimens. Mechanical ventilation was required in 40/45 (88.9%) patients, reflecting a critically ill cohort. Steroid exposure within 30 days (46.7% vs. 6.7%; P = 0.003) and prior carbapenem exposure (93.3% versus 56.7%; P = 0.016) were more frequent in the CZA group. Clinical response (73.3% versus 73.3%; P = 1.000) and 28-day all-cause mortality (40.0% versus 40.0%; P = 1.000) were comparable between groups. Documented microbiological clearance, AKI and DILI did not differ significantly. Similar findings were observed in the CZA vs. meropenem plus colistin subgroup.Conclusions  CZA-based therapy showed similar observed outcomes and no clear excess toxicity signal compared with heterogeneous non-CZA regimens, despite preferential use in children with greater recent antimicrobial exposure and clinical complexity. These findings support CZA as a feasible polymyxin-sparing option in selected children.
SN  - 1471-2334
ER  -