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Ceftolozane/tazobactam for the treatment of XDR Pseudomonas aeruginosa infections

Infection volume 46, pages 461–468 (2018)Cite this article

Abstract

Purpose

The aim of this study was to evaluate the effectiveness of ceftolozane/tazobactam (C/T) for treating extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) infections, and to analyze whether high C/T dosing (2 g ceftolozane and 1 g tazobactam every 8 h) and infection source control have an impact on outcome.

Methods

Retrospective study of all consecutive patients treated with C/T for XDR-PA infection at a tertiary referral hospital (November 2015–July 2017). Main clinical and microbiological variables were analyzed.

Results

Thirty-eight patients were included. Median age was 59.5 years and Charlson Comorbidity Index was 3.5. Fourteen (36.8%) patients had respiratory tract infection, six (15.8%) soft tissue, and six (15.8%) urinary tract infection. Twenty-three (60.5%) received high-dose C/T and in 24 (63.2%) C/T was combined with other antibiotics. At completion of treatment, 33 (86.8%) patients showed clinical response. At 90 days of follow-up, 26 (68.4%) achieved clinical cure, and 12 (31.6%) had clinical failure because of persistent infection in one patient, death attributable to the XDR-PA infection in four, and clinical recurrence in seven. All-cause mortality was 5 (13.2%). Lower C/T MIC and adequate infection source control were the only variables significantly associated with clinical cure.

Conclusions

C/T should be considered for treating XDR-PA infections, with infection source control being an important factor to avoid failure and resistance.

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Acknowledgements

We thank Celine Cavallo for English language support.

Funding

Supported by Plan Nacional de I + D+I 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)—co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020. MSD provided medical writing support but was not involved in the content of the manuscript.

Author information

Affiliations

  1. Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Laura Escolà-Vergé, Carles Pigrau, Ibai Los-Arcos, Oscar Len & Benito Almirante

  2. Pharmacy Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Ángel Arévalo & David Campany

  3. Microbiology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Belen Viñado & Nieves Larrosa

  4. Intensive Care Department and SODIR Research Group, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Xavier Nuvials & Ricard Ferrer

  5. Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain

    Laura Escolà-Vergé, Carles Pigrau, Belen Viñado, Nieves Larrosa & Benito Almirante

Authors
  1. Laura Escolà-Vergé
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  2. Carles Pigrau
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Corresponding author

Correspondence to Benito Almirante.

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Conflict of interest

CP. has received honoraria for talks on behalf of Angelini, MSD, Novartis, Pfizer, Salvat, and Zambon. O.L. has received honoraria for talks on behalf of Astellas, MSD and Pfizer. R.F. has received honoraria for talks on behalf of MSD, Pfizer, Estor and Orion. B.A. has received grant support from Gilead Sciences, Pfizer, and the Instituto de Salud Carlos III. He has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas Pharma, Novartis, and Angelini. The other authors have no declarations.

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Escolà-Vergé, L., Pigrau, C., Los-Arcos, I. et al. Ceftolozane/tazobactam for the treatment of XDR Pseudomonas aeruginosa infections. Infection 46, 461–468 (2018). https://doi.org/10.1007/s15010-018-1133-5

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Keywords

  • Pseudomonas aeruginosa
  • Extensively drug-resistant
  • Ceftolozane/tazobactam
  • Infection source control