Prognosis and Outcome of Carbapenem-Resistant Enterobacterales Bacteremia Managed With Ceftazidime-Avibactam and Aztreonam Combination Therapy in Tawam Hospital, UAE: A Retrospective Study

TL;DR

This study examines the outcomes of treating carbapenem-resistant Enterobacterales infections in UAE hospitals using a combination of two antibiotics, finding high mortality and long hospital stays.

Contribution

The study provides regional insights into CRE treatment outcomes in the UAE using CAZ-AVI and ATM combination therapy.

Findings

In-hospital mortality rate was 29.4%, with four-year mortality reaching 53%.

Patients with immunosuppression, prior hospitalizations, and comorbidities had worse outcomes.

CRE bacteremia incidence treated with the combination therapy increased over the study period.

Abstract

Introduction

In recent years, the medical community has grown increasingly alarmed by the escalating rates of carbapenem resistance - a global concern that is also affecting the United Arab Emirates (UAE). This rise in antibiotic resistance poses a significant challenge to healthcare systems and necessitates urgent and comprehensive research. The primary objective of this study is to investigate the factors that influence the prognosis and outcomes of bacteremia caused by carbapenem-resistant Enterobacterales (CRE), managed with a combination of ceftazidime-avibactam (CAZ-AVI) and aztreonam (ATM). Understanding the determinants of treatment success may provide valuable insights into improving patient care and outcomes.

Methods

This retrospective observational chart review was conducted at Tawam Hospital, Al Ain, from 2020 to 2023. Seventeen adult patients (aged >18 years) with confirmed CRE bacteremia who received combination therapy with CAZ-AVI and ATM were included. Data were extracted from the SEHA electronic medical records, including demographics, clinical features, laboratory findings, and outcomes such as ICU admission, in-hospital mortality, and length of stay. Statistical analyses were performed using Excel, Meta-Chart, and SkyBlue Statistics. Given the small sample size, descriptive statistics were prioritized, and chi-square and unpaired t-tests were used to explore associations, recognizing limitations in statistical power.

Results

The incidence of CRE bacteremia treated with CAZ-AVI and ATM increased over the study period, with the highest number of cases recorded in 2023. Antimicrobial resistance remained consistently high across both beta-lactam and non-beta-lactam classes. The overall in-hospital mortality rate was 29.4%, with long-term four-year mortality reaching 53%. The median length of hospital stay was 19 days, and 17.6% of patients required intensive care. Poor outcomes were primarily associated with immunosuppression, prior hospitalizations, and multiple comorbidities.

Conclusion

This study highlights the increasing clinical burden of CRE bacteremia in the UAE. By identifying key prognostic factors and reporting high mortality and prolonged hospital stays despite combination therapy, it underscores the urgent need for timely intervention, improved antimicrobial stewardship, and enhanced diagnostic capacity. These findings contribute valuable regional data to the global effort to curb antimicrobial resistance.

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