Клиническая эффективность цефтазидима–авибактама при инфекциях, вызванных карбапенеморезистентными грамотрицательными бактериями

Широкое распространение в стационарах мира, в том числе России, карбапенемаз среди грамотрицательных бактерий порядка Enterobacterales создаёт большие сложности эффективного применения антибиотиков при этих инфекциях в ОРИТ. Цефтазидим–авибактам является первым антибиотиком, разработанным и изученным для лечения инфекций, вызванных карбапенеморезистентными энтеробактериями. Цефтазидим–авибактам проявляет высокую активность против продуцентов сериновых карбапенемаз классов А и D — KPC и OXA-48, а в комбинации с азтреонамом эффективен при инфекциях, вызванных продуцентами металло-беталактамаз класса В — NDM и VIM. В обзоре проанализированы результаты 19 несравнительных и 10 сравнительных исследований цефтазидима–авибактама при инфекциях, вызванных карбапенеморезистентными Enterobacterales, а также отдельные клинические наблюдения. По данным несравнительных исследований клиническая эффективность цефтазидима–авибактама составила от 45,0 до 87,2%, в среднем 71,7±11,3%, а эрадикация продуцентов KPC или OXA-48 карбапенемаз — от 40,0 до 100%, в среднем 65,5±18,6%. Эффективность цефтазидима–авибактама в сравнительных исследованиях составила в среднем 67,9±17,3%, что было достоверно выше по сравнению с другими антибиотиками сравнения (в среднем 44,3±14,4%, р=0,012). Лечение цефтазидимом–авибактамом сопровождалось существенно меньшей 30-дневной летальностью по сравнению с другими антибиотиками, соответственно, 23,8±13,5% и 41,0±13,6%, р=0,001. Развитие резистентности Enterobacterales к цефтазидиму–авибактаму во время терапии наблюдается редко, в среднем 5,4±4,4%, что характеризует достаточно низкий потенциал антибиотика в селекции устойчивости. Раннее назначение цефтазидима–авибактама сопровождается лучшими результатами лечения по сравнению с отсроченной терапией. Лечение цефтазидимом–авибактамом инфекций, вызванных карбапенеморезистентными энтеробактериями, ассоциируется с достоверно более высоким шансом выздоровления пациентов и меньшим риском летального исхода по сравнению с другими режимами антибактериальной терапии.

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