Clinical characteristics, microbiology and outcomes of a cohort of patients treated with ceftolozane/tazobactam in acute care inpatient facilities, Houston, Texas, USA.
Clinical characteristics, microbiology and outcomes of a cohort of patients treated with ceftolozane/tazobactam in acute care inpatient facilities, Houston, Texas, USA.
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DOI：
10.1093/jacamr/dlac131
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发表时间：
2023-02
影响因子：
3.4
通讯作者：
Arias, Cesar A.
中科院分区：
文献类型：
--
作者：
Tran, Truc T.;Cabrera, Nicolo L.;Gonzales-Luna, Anne J.;Carlson, Travis J.;Alnezary, Faris;Miller, William R.;Sakurai, Aki;Dinh, An Q.;Rydell, Kirsten;Rios, Rafael;Diaz, Lorena;Hanson, Blake M.;Munita, Jose M.;Pedroza, Claudia;Shelburne, Samuel A.;Aitken, Samuel L.;Garey, Kevin W.;Dillon, Ryan;Puzniak, Laura;Arias, Cesar A.
Ceftolozane/tazobactam是一种β-内酰胺/β-内酰胺酶抑制剂，具有抗多种革兰氏阴性菌的活性，包括耐多药铜绿假单胞菌。该药被批准用于医院获得性和呼吸机相关的细菌性肺炎。然而，大多数现实世界的结果数据来自小型观察队列。因此，我们试图评估在美国德克萨斯州休斯顿的多家三级医院头孢唑烷/他唑巴坦的使用情况。我们对2016年1月至2019年9月在休斯顿两家医院系统接受至少48小时头孢唑烷/他唑巴坦治疗的患者进行了一项多中心回顾性研究。收集人口统计学、临床和微生物学数据，包括可获得的感染细菌分离物。主要终点是出院时的综合临床成功。次要结局包括在头孢唑烷/他唑巴坦开始治疗后14天和30天的住院死亡率和临床处置情况。多变量logistic回归分析用于确定主要结局和死亡率的预测因子。对回收的分离株进行头孢唑烷/他唑巴坦药敏试验，并进行WGS试验。共纳入263例患者，185例患者（70.3%）获得综合临床成功。疾病的严重程度是临床成功的最一致的预测指标。头孢唑烷/他唑巴坦和另一种革兰氏阴性药物联合治疗与临床成功几率降低相关（OR 0.32, 95% CI 0.16-0.63）。15.4%的WGS菌株对头孢唑烷/他唑巴坦耐药；ampC和ftsI的突变是常见的，但没有聚集在特定的ST.。与以前的经验相比，在该患者队列中使用头孢唑烷/他唑巴坦治疗的临床成功率相似。头孢唑烷/他唑巴坦仍然是治疗铜绿假单胞菌敏感分离株的替代药物。
Ceftolozane/tazobactam is a β-lactam/β-lactamase inhibitor combination with activity against a variety of Gram-negative bacteria, including MDR Pseudomonas aeruginosa. This agent is approved for hospital-acquired and ventilator-associated bacterial pneumonia. However, most real-world outcome data come from small observational cohorts. Thus, we sought to evaluate the utilization of ceftolozane/tazobactam at multiple tertiary hospitals in Houston, TX, USA. We conducted a multicentre retrospective study of patients receiving at least 48 h of ceftolozane/tazobactam therapy from January 2016 through to September 2019 at two hospital systems in Houston. Demographic, clinical and microbiological data were collected, including the infecting bacterial isolate, when available. The primary outcome was composite clinical success at hospital discharge. Secondary outcomes included in-hospital mortality and clinical disposition at 14 and 30 days post ceftolozane/tazobactam initiation. Multivariable logistic regression analysis was used to identify predictors of the primary outcome and mortality. Recovered isolates were tested for susceptibility to ceftolozane/tazobactam and underwent WGS. A total of 263 patients were enrolled, and composite clinical success was achieved in 185 patients (70.3%). Severity of illness was the most consistent predictor of clinical success. Combination therapy with ceftolozane/tazobactam and another Gram-negative-active agent was associated with reduced odds of clinical success (OR 0.32, 95% CI 0.16–0.63). Resistance to ceftolozane/tazobactam was noted in 15.4% of isolates available for WGS; mutations in ampC and ftsI were common but did not cluster with a particular ST. Clinical success rate among this patient cohort treated with ceftolozane/tazobactam was similar compared with previous experiences. Ceftolozane/tazobactam remains an alternative agent for treatment of susceptible isolates of P. aeruginosa.
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