ReviewAntibiotics (Basel, Switzerland)2026
Ceftazidime-Avibactam as Early Empiric Therapy for Gram-Negative Nosocomial Infections: A Risk-Stratified Empiric Use Informed by National AMR Surveillance Data 2024.
Review in Antibiotics (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundInternational evidence supports early initiation of ceftazidime-avibactam (CAZ-AVI) in carbapenem-resistant Enterobacterales (CRE) infections, with superior outcomes when therapy is initiated within 72 h. The applicability of this principle to the United Arab Emirates (UAE) requires contextualization against local antimicrobial resistance epidemiology.
methodsThis consensus narrative review integrates two evidence streams: (1) national AMR surveillance data from the UAE National Antimicrobial Resistance Surveillance Report 2024-encompassing 195,108 non-duplicate isolates from 318 surveillance sites across all seven Emirates-providing phenotypic susceptibility and resistance rates for key gram-negative pathogens; and (2) a structured review of the published international evidence base on CAZ-AVI clinical efficacy, outcome data, and timing, identified through PubMed searches using the terms "ceftazidime-avibactam", "empiric therapy", "carbapenem-resistant Enterobacterales", and "nosocomial infections". The risk-stratification framework was developed through expert consensus by the authoring group, informed by the integrated evidence synthesis and structured around established clinical risk factors for carbapenem-resistant gram-negative infection.
resultsNational carbapenem resistance among Enterobacterales remains low (imipenem 3.4%R; meropenem 1.4%R), with
conclusionsCAZ-AVI is not supported as a universal empiric therapy for all nosocomial pneumonia in the UAE. A risk-stratified approach is proposed: standard anti-pseudomonal beta-lactams for general nosocomial infections, and early CAZ-AVI for pre-defined high-risk CRE-suspected patients, where the timing benefit is operationally justified primarily by the international outcome evidence, given that UAE-specific CAZ-AVI phenotypic data are currently available only for P. aeruginosa. Investment in carbapenemase molecular surveillance and expanded CAZ-AVI susceptibility reporting is recommended as a national priority to enable precise empiric prescribing.
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