Ceftolozane/Tazobactam vs Polymyxin or Aminoglycoside-based Regimens for the Treatment of Drug-resistant Pseudomonas aeruginosa
Ceftolozane/Tazobactam vs Polymyxin or Aminoglycoside-based Regimens for the Treatment of Drug-resistant Pseudomonas aeruginosa
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DOI：
10.1093/cid/ciz816
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发表时间：
2020-07-15
影响因子：
11.8
通讯作者：
Perez, Federico
中科院分区：
文献类型：
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作者：
Pogue, Jason M.;Kaye, Keith S.;Perez, Federico
背景。头孢唑烷/他唑巴坦是一种新型头孢菌素/ β -内酰胺酶抑制剂组合，通常对耐药铜绿假单胞菌保持活性。在这种情况下，与多粘菌素或氨基糖苷相比，其安全性和有效性的比较尚不清楚。进行了一项回顾性、多中心、观察性队列研究。接受头孢唑烷/他唑巴坦治疗的患者与接受多粘菌素或氨基糖苷类药物治疗的患者进行比较，以治疗耐药铜绿假单胞菌感染。采用多因素logistic回归控制与治疗相关的因素，以评估头孢洛桑/他唑巴坦对临床治愈、急性肾损伤（AKI）和住院死亡率的独立影响。共纳入200例患者（每个治疗组100例）。该队列代表了患病人群，其中69%在重症监护室，63%在机械通气，42%在感染发作时发生严重败血症或感染性休克。最常见的感染类型为呼吸机相关性肺炎（52%）；7%的患者为菌血症。在多粘菌素/氨基糖苷类患者中，联合治疗比头孢唑嗪/他唑巴坦更常见（72% vs 15%, P < 0.001）。在校正组间差异后，头孢唑烷/他唑巴坦与临床治愈（校正优势比[aOR]， 2.63； 95%可信区间[CI]， 1.31-5.30）和预防AKI （aOR, 0.08; 95% CI, 0.03-0.22）独立相关。住院死亡率没有差异。头孢唑烷/他唑巴坦临床治愈所需治疗人数为5人，多粘菌素/氨基糖苷治疗AKI所需治疗人数为4人。这些数据支持在耐药铜绿假单胞菌感染中优先使用头孢唑烷/他唑巴坦而不是多粘菌素或氨基糖苷类药物。
Background. Ceftolozane/tazobactam is a novel cephalosporin/beta-lactamase inhibitor combination that often retains activity against resistant Pseudomonas aeruginosa. The comparative safety and efficacy vs polymyxins or aminoglycosides in this setting remains unknown.Methods. A retrospective, multicenter, observational cohort study was performed. Patients who received ceftolozane/tazobactam were compared with those treated with either polymyxin or aminoglycoside-based regimens for infections due to drug-resistant P. aeruginosa. Multivariate logistic regression was performed controlling for factors associated with treatment to assess the independent impact of ceftolozane/tazobactam on clinical cure, acute kidney injury (AKI), and in-hospital mortality.Results. A total of 200 patients were included (100 in each treatment arm). The cohort represented an ill population with 69% in the intensive care unit, 63% mechanically ventilated, and 42% in severe sepsis or septic shock at infection onset. The most common infection type was ventilator-associated pneumonia (52%); 7% of patients were bacteremic. Combination therapy was more commonly used in polymyxin/aminoglycoside patients than those who received ceftolozane/tazobactam (72% vs 15%, P < .001). After adjusting for differences between groups, receipt of ceftolozane/tazobactam was independently associated with clinical cure (adjusted odds ratio [aOR], 2.63; 95% confidence interval [CI], 1.31-5.30) and protective against AKI (aOR, 0.08; 95% CI, 0.03-0.22). There was no difference in in-hospital mortality. The number needed to treat for a clinical cure with ceftolozane/tazobactam was 5, and the number needed to harm with AKI with a polymyxin/aminoglycoside was 4.Conclusions. These data support the preferential use of ceftolozane/tazobactam over polymyxins or aminoglycosides for drug-resistant P. aeruginosa infections.