ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Real-world effectiveness and treatment costs of ceftazidime-avibactam versus colistin-meropenem for ICU-acquired MDR gram-negative infections in liver transplant recipients.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 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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Abstract
backgroundMultidrug-resistant (MDR) Gram-negative infections remain a threat after liver transplantation, yet comparative treatment data in critically ill recipients are scarce. Therapeutic decisions are complicated by immunosuppression, resistance mechanisms, and antimicrobial toxicity. We evaluated ceftazidime-avibactam (CAZ/AVI) versus colistin-meropenem for ICU-acquired MDR Gram-negative infections. MATERIALS AND
methodsThis retrospective single-center cohort included 190 liver transplant recipients treated between October 2021 and April 2025; 100 received CAZ/AVI-based therapy and 90 colistin-meropenem. Detailed data were available for 169 patients. The primary outcome was clinical response. Secondary outcomes were microbiological eradication, sepsis-related mortality, 30-day all-cause in-hospital mortality, and direct antimicrobial costs. Multivariable logistic regression adjusted for severity-related, transplant-related, and microbiological covariates.
resultsIn the 169-patient cohort, clinical response was higher with CAZ/AVI than colistin-meropenem (86.9% vs. 56.5%; p < 0.001), as was microbiological eradication (94.0% vs. 72.9%; p < 0.001). CAZ/AVI remained associated with clinical response (aOR, 4.83; 95% CI, 2.10-11.11) and lower sepsis-related mortality (11.9% vs. 43.5%; aOR, 0.19; 95% CI, 0.08-0.45), whereas 30-day all-cause mortality did not differ (41.7% vs. 47.1%; aOR, 1.02; 95% CI, 0.52-2.00). Mean treatment cost was higher with CAZ/AVI, yielding 48,571.76 TL per additional clinical response; this estimate was descriptive and did not represent formal cost-effectiveness.
conclusionsWhen microbiologically appropriate, CAZ/AVI was associated with better clinical and microbiological outcomes and lower sepsis-related mortality than colistin-meropenem, without lower 30-day all-cause mortality. Given the observational design, incomplete treatment-appropriateness data, and limited economic scope, these associations require prospective validation before causal conclusions are drawn.
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