Background: The aim of this study was to compare the safety and effectiveness of ceftazidime-avibactam (CAZ-AVI) to colistin-based regimen in the treatment of infections caused by carbapenem-resistant Enterobacterales (CRE). Methods: This was a retrospective, multicenter, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Main study outcomes included in-hospital mortality, clinical cure at end of treatment, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to assess the independent impact of CAZ-AVI on the clinical outcome. Results: A total of 230 patients were included in this study: 149 patients received CAZ-AVI and 81 patients received colistin-based regimen. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31– 4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.75; 95% CI, 1.28– 5.91). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39– 1.16) was lower in patients who received CAZ-AVI but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19– 0.69) was significantly less common in patients who received CAZ-AVI. Conclusion: CAZ-AVI is associated with higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treating these infections.

Purpose: To evaluate the real-world evidence of ceftazidime-avibactam (CAZ-AVI) compared to intravenous colistin for the treatment of multidrug-resistant (MDR) P. aeruginosa infections. Method: This is a multicenter, retrospective cohort study conducted in the period between 2017 and 2023 at five institutions for patients who received either CAZ-AVI or colistin-based regimens for treating MDR P. aeruginosa infections. Outcomes were compared using multivariate logistic regression analysis. Result: Among the screened patients, 203 patients were included: 89 in the CAZ-AVI group and 114 in the colistin group. A total of 57% presented with pneumonia, 21% with bacteremia, and 61% were in the intensive care unit. The rate of clinical cure was significantly higher among patients who received CAZ-AVI (67% vs. 50%; OR, 2.07; 95% CI, 1.16–3.68). The rate of in-hospital mortality was numerically lower among patients who received CAZ-AVI (40% vs. 49%; OR, 0.58; 95% CI, 0.33–1.03). The rate of AKI was significantly lower among patients who received CAZ-AVI (15% vs. 43%; OR, 0.23; 95% CI, 0.11–0.45). Conclusion: CAZ-AVI was more effective in treating MDR P. aeruginosa infections and showed a better safety profile compared to colistin. Thus, CAZ-AVI could be a better alternative for treating MDR P. aeruginosa infections.

Addressing global drug shortages demands proactive measures. Enhanced reporting, supply chain policies, and quality systems are crucial to minimize it. Notably, there’s a lack of systematic review on the reasons of drug shortage. To fill this gap, our study will adhere to PRISMA guidelines for systematic reviews, conducting a thorough literature search across various databases using specific descriptors related to drug shortages. Articles will be screened for relevance, with eligibility assessed by two independent reviewers and disagreements resolved through consensus. Duplicates will be removed, and data will be extracted using a standardized form. Quality assessment will employ the Mixed Methods Appraisal Tool, with appraisals conducted independently by two reviewers and discrepancies resolved through consensus. A narrative synthesis approach will be used to synthesize findings, initially presenting results in tabular form before discussing and structuring them into themes. Drug shortages are caused by a range of factors, including issues with drug supply, demand, and regulatory challenges. These factors interact in complex ways, requiring comprehensive solutions to effectively address the scarcity of medicines.

A primigravida at 26 weeks’ gestation visiting from Pakistan presented with fever, abdominal pain and hypotension suggestive of sepsis and required admission to the intensive care unit. Blood culture grew a multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolate that was resistant to cephalosporins but susceptible to carbapenems. Intravenous meropenem was commenced, resulting in a rapid clinical improvement within 48 hours. She completed a 14-day course of meropenem without maternal or fetal adverse effects, and repeat blood cultures were sterile. The remainder of her pregnancy was uncomplicated, and she delivered a healthy term infant. This case highlights the diagnostic and therapeutic challenges of MDR, cephalosporin-resistant Salmonella Typhi infection during pregnancy and supports meropenem as an effective and potentially life-saving treatment associated with favourable maternal and fetal outcomes.