Clinical Outcomes And Cost-Effectiveness Of Ceftazidim-Avibactam In The Treatment of Ventilator-Associated Pneumonia
A Narrative Review
Abstract
A high rate of morbidity, mortality, and medical expenses has been observed in cases of ventilator-associated pneumonia (VAP), particularly when it is associated with carbapenem-resistant Enterobacteriaceae (CRE). Conventional medicines such as meropenem and colistin have been the standard of care. However, there is growing interest in ceftazidime-avibactam (CAZ-AVI) as a potential alternative. This review aims to evaluate the clinical outcomes and economic implications of CAZ-AVI in the management of VAP. A literature search was conducted across PubMed, ScienceDirect, Google Scholar, and Scopus from 2015 until July 2025. Studies were included if they reported clinical outcomes and cost-effectiveness of CAZ-AVI in patients with VAP. Data were extracted regarding interventions, comparators, outcomes, and economic evaluations. Seven studies met the inclusion criteria. The administration of CAZ-AVI has been demonstrated to be associated with enhanced clinical outcomes, including a reduction in mortality and nephrotoxicity, particularly when compared to colistin-based regimens. Economic evaluations consistently showed that CAZ-AVI was cost-effective, with ICERs ranging from $3,317 to $35,328 per QALY, depending on country-specific thresholds. CAZ-AVI has shown positive clinical results and is a cost-effective treatment for VAP, especially in cases of CRE infections.
Keywords:
VAP, Cost-effectiveness, clinical outcome, ceftazidim, avibactam
References
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[22] H. A. Hakeam, H. Alsahli, L. Albabtain, S. Alassaf, Z. Al Duhailib, and S. Althawadi, “Effectiveness of ceftazidime–avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia,” International Journal of Infectious Diseases, vol. 109, pp. 1–7, Aug. 2021, doi: 10.1016/j.ijid.2021.05.079.
[23] Y. Cai et al., “Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial,” Lancet Glob Health, vol. 12, no. 12, pp. e2059–e2067, Dec. 2024, doi: 10.1016/S2214-109X(24)00327-9.
[2] M. I. Restrepo et al., “Economic Burden of Ventilator‐Associated Pneumonia Based on Total Resource Utilization,” Infect Control Hosp Epidemiol, vol. 31, no. 5, pp. 509–515, May 2010, doi: 10.1086/651669.
[3] F. Howroyd, C. Chacko, A. MacDuff, N. Gautam, B. Pouchet, and B. Tunnicliffe, “Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges,” Dec. 01, 2024, Nature Research. doi: 10.1038/s41467-024-50805-z.
[4] Y. Mo, S. Booraphun, A. Y. Li, P. Domthong, G. Kayastha, and Y. H. Lau, “Individualised, Short-Course Antibiotic Treatment Versus Usual Long-Course Treatment for Ventilator-Associated Pneumonia (REGARD-VAP): A Multicentre, Individually Randomised, Open-Label, Non-Inferiority Trial,” Lancet Respir Med, vol. 12, no. 5, pp. 399–408, May 2024, doi: 10.1016/S2213-2600(23)00418-6.
[5] X. Xie, J. Lyu, T. Hussain, and M. Li, “Drug prevention and control of ventilator-associated pneumonia,” Front Pharmacol, vol. 10, no. MAR, 2019, doi: 10.3389/fphar.2019.00298.
[6] N. M. Joseph, S. Sistla, T. K. Dutta, A. S. Badhe, D. Rasitha, and S. C. Parija, “Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors,” Australasian Medical Journal, vol. 5, no. 2, pp. 135–140, 2012, doi: 10.4066/AMJ.2012.1004.
[7] A. Tariq et al., “Risk factors and outcomes of inadequate empirical antibiotic therapy in ventilator-associated pneumonia: a systematic review and meta-analysis,” Annals of Medicine & Surgery, vol. 87, no. 6, pp. 3786–3793, Jun. 2025, doi: 10.1097/ms9.0000000000003289.
[8] M. Bassetti, A. Mularoni, D. R. Giacobbe, N. Castaldo, and A. Vena, “New Antibiotics for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia,” Semin Respir Crit Care Med, vol. 43, no. 2, pp. 280–294, Apr. 2022, doi: 10.1055/s-0041-1740605.
[9] K. Tompkins and D. van Duin, “Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions,” Oct. 01, 2021, Springer Science and Business Media Deutschland GmbH. doi: 10.1007/s10096-021-04296-1.
[10] P. Gaibani et al., “Resistance to Ceftazidime/Avibactam, Meropenem/Vaborbactam and Imipenem/Relebactam in Gram-Negative MDR Bacilli: Molecular Mechanisms and Susceptibility Testing,” May 01, 2022, MDPI. doi: 10.3390/antibiotics11050628.
[11] J. Matuoka, D. V. Pachito, F. Piastrelli, L. Cristina, C. Fehlberg, and H. Alves De Oliveira Junior, “Economic evaluation of ceftazidime-avibactam vs. polymyxin B for treatment of hospital-acquired and ventilator-associated bacterial pneumonia,” 2025, doi: 10.17605/OSF.IO/SP2EJ.
[12] N. Alhamed, M. Hashhoush, R. Al-Omari, M. Alomani, and R. S. AlOmar, “Mortality and clinical outcomes of ceftazidime/avibactam vs best available therapy in treating carbapenem-resistant enterobacterales infections: A retrospective cohort study,” Clin Epidemiol Glob Health, vol. 34, Jul. 2025, doi: 10.1016/j.cegh.2025.102061.
[13] E. Tichy et al., “Cost-effectiveness Comparison of Ceftazidime/Avibactam Versus Meropenem in the Empirical Treatment of Hospital-acquired Pneumonia, Including Ventilator-associated Pneumonia, in Italy,” Clin Ther, vol. 42, no. 5, pp. 802–817, May 2020, doi: 10.1016/j.clinthera.2020.03.014.
[14] F. A. Varón-Vega, E. Lemos, G. N. Castaño, and J. M. Reyes, “Cost-utility analysis of ceftazidime-avibactam versus colistin-meropenem in the treatment of infections due to Carbapenem-resistant Klebsiella pneumoniae in Colombia,” Expert Rev Pharmacoecon Outcomes Res, vol. 22, no. 2, pp. 235–240, 2022, doi: 10.1080/14737167.2021.1964960.
[15] M. Zolfaghari et al., “Burden of nosocomial infections in intensive care units: Cost of antibiotics, the extra length of stay and mortality rate,” Caspian J Intern Med, vol. 15, no. 3, pp. 478–483, Jun. 2024, doi: 10.22088/cjim.15.3.478.
[16] H. Mai, Y. Liang, A. Feng, Y. Fu, J. Lyu, and L. Su, “A Cost-Effectiveness Analysis Comparing Ceftazidime-Avibactam with Meropenem for the Treatment of Hospital-Acquired Pneumonia (Including Ventilator-Associated Pneumonia),” Mar. 19, 2024. doi: 10.21203/rs.3.rs-4082842/v1.
[17] A. Torres et al., “Randomized trial of ceftazidime-avibactam vs meropenem for treatment of hospital-acquired and ventilator-associated bacterial pneumonia (REPROVE): Analyses per US FDA-specified end points,” Open Forum Infect Dis, vol. 6, no. 4, Apr. 2019, doi: 10.1093/ofid/ofz149.
[18] M. Yuan, K. Briscese, T. S. Hong, and L. Brunetti, “Natural products for the prevention of antibiotic-associated kidney injury,” Dec. 01, 2022, Elsevier B.V. doi: 10.1016/j.cotox.2022.100363.
[19] R. K. Shields, J. P. Horcajada, S. Kamat, P. M. Irani, M. Tawadrous, and T. Welte, “Ceftazidime-Avibactam in the Treatment of Patients with Bacteremia or Nosocomial Pneumonia: A Systematic Review and Meta-analysis,” Infect Dis Ther, vol. 13, no. 7, pp. 1639–1664, Jul. 2024, doi: 10.1007/s40121-024-00999-y.
[20] A. Marino et al., “Ceftazidime/Avibactam and Meropenem/Vaborbactam for the Management of Enterobacterales Infections: A Narrative Review, Clinical Considerations, and Expert Opinion,” Oct. 01, 2023, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/antibiotics12101521.
[21] J. Chen et al., “Clinical outcomes and safety of polymyxin B versus tigecycline combination therapy for pneumonia of carbapenem-resistant Klebsiella pneumoniae: a retrospective cohort study,” Ann Med, vol. 56, no. 1, 2024, doi: 10.1080/07853890.2024.2397087.
[22] H. A. Hakeam, H. Alsahli, L. Albabtain, S. Alassaf, Z. Al Duhailib, and S. Althawadi, “Effectiveness of ceftazidime–avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia,” International Journal of Infectious Diseases, vol. 109, pp. 1–7, Aug. 2021, doi: 10.1016/j.ijid.2021.05.079.
[23] Y. Cai et al., “Cost-effectiveness of a short-course antibiotic treatment strategy for the treatment of ventilator-associated pneumonia: an economic analysis of the REGARD-VAP trial,” Lancet Glob Health, vol. 12, no. 12, pp. e2059–e2067, Dec. 2024, doi: 10.1016/S2214-109X(24)00327-9.
Published
2026-05-31
Section
Articles
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