Evidence map›Paper›PMID 42084701›Full record

Observational studyEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026

Ceftazidime-avibactam as monotherapy or in combination for targeted treatment of KPC-producing Klebsiella pneumoniae infections in ICUs: a comparative analysis through counterfactual framework and desirability of outcome ranking.

Andrea Marino, Alberto Enrico Maraolo, Maria Mazzitelli, Alessandra Oliva, Nicholas Geremia, Andrea De Vito, Federica Cosentino, Chiara Gullotta, Vincenzo Scaglione, Eleonora Vania and 10 more

Abstract readMulticenter StudyObservational StudyComparative Study
In one paragraph

Observational study 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.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Andrea Marino *Department of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy. andrea.marino@unict.it.
Alberto Enrico Maraolo *Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. albertomaraolo@mail.com.
Maria MazzitelliDipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
Alessandra OlivaDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Nicholas GeremiaUnit of Infectious Diseases, Department of Clinical Medicine, Ospedale "dell'Angelo", Venice, Italy.
Andrea De VitoUnit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Federica CosentinoDepartment of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.
Chiara GullottaDepartment of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.
Vincenzo ScaglioneInfectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
Eleonora VaniaInfectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
Sara Lo MenzoInfectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
Paolo NavalesiDepartment of Medicine (DIMED), Institute of Anesthesia and Intensive Care, University of Padua, Padua University Hospital, Padua, Italy.
Lorenzo VolpicelliDepartment of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Andrea FioriSchool of Medicine, University of Sassari, Sassari, Italy.
Pamela PrestifilippoIntensive Care Unit, ARNAS Garibaldi Hospital, Catania, Italy.
Annamaria CattelanInfectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy.
Claudio Maria MastroianniDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Giordano MadedduUnit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
Bruno CacopardoDepartment of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.
Giuseppe NunnariDepartment of Clinical and Experimental Medicine, Infectious Diseases Unit, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the causal effect of ceftazidime/avibactam (C/A) combination therapy versus monotherapy on mortality and clinical success in patients with KPC-producing Klebsiella pneumoniae (KPC-Kp) infections in intensive care unit.

methodsThis multi-centre, retrospective observational study (2021-2023) included adults with KPC-Kp bloodstream infections or pneumonia treated with C/A-based regimens. We employed a counterfactual framework using inverse probability of treatment weighting (IPTW) to estimate the average treatment effect on 30-day mortality. Clinical success was further assessed using Desirability of Outcome Ranking (DOOR) analysis and partial credit scoring based on patient-perspective scenarios.

resultsAmong 123 included patients, 77 (62.6%) received monotherapy and 46 (37.4%) received combination therapy. The combination group presented with significantly higher baseline severity, including higher APACHE II scores and rates of septic shock. In the IPTW-adjusted analysis, 30-day survival was 73.8% (95% CI: 56-92%) with combination therapy compared with 60.8% (95% CI: 46.8-77%) with monotherapy. The survival probability ratio was 1.21 (95% CI: 0.80-1.45), indicating no statistically significant survival benefit. The DOOR analysis showed a 54.7% (95% CI: 48.9%-60.4%) probability of a more favourable outcome with combination therapy, which was not statistically significant. Mean partial credit scores did not differ significantly across scenarios prioritizing survival or adverse event avoidance.

conclusionsIn this cohort, C/A-based combination therapy did not provide a significant survival advantage or an improved clinical desirability ranking compared with monotherapy, after adjusting for confounding factors.

Indexed as

Anti-Bacterial AgentsAzabicyclo CompoundsCeftazidimeKlebsiella InfectionsKlebsiella pneumoniaeAgedbeta-LactamasesDrug CombinationsDrug Therapy, CombinationFemaleHumansIntensive Care UnitsMaleMiddle AgedRetrospective StudiesTreatment OutcomeAnti-Bacterial Agentsavibactam, ceftazidime drug combinationAzabicyclo Compoundsbeta-LactamasesCeftazidimeDrug CombinationsBloodstream infectionsCeftazidime-avibactamCREDOORInverse probability of treatment weightingPneumoniaPropensity score

Identifiers

PMID42084701
PMCPMC13428722

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.