Ceftazidime/Avibactam and Ceftolozane/Tazobactam for Multidrug-Resistant Gram Negatives in Patients with Hematological Malignancies: Current Experiences.

Marianna Criscuolo,Enrico Maria Trecarichi

doi:10.3390/antibiotics9020058

Abstract

Patients suffering from hematological malignancies are at high risk for severe infections, including in particular bloodstream infections, which represent one of the most frequent life-threatening complications for these patients, with reported mortality rates reaching 40%. Furthermore, a worrisome increase in antimicrobial resistance of Gram-negative bacteria (e.g., cephalosporin- and/or carbapenem-resistant Enterobacteriaceae and multidrug-resistant (MDR) Pseudomonas aeruginosa) involved in severe infectious complications among patients with hematological malignancies has been reported during the last years. The two novel combination of cephalosporins and β-lactamase inhibitors, ceftolozane/tazobactam and ceftazidime/avibactam, were recently approved for treatment of complicated intra-abdominal and urinary tract infections and nosocomial pneumonia and display activity against several MDR Gram-negative strains. Although not specifically approved for neutropenic and/or cancer patients, these drugs are used in this setting due to increasing rates of infections caused by MDR Gram-negative bacteria. The aim of this review is to describe the actual evidence from scientific literature about the “real-life” use of these two novel drugs in patients with hematological malignancies and infections caused by MDR Gram-negative bacteria.

Highlights

Among hematologic patients, those affected by acute leukemias and lymphoproliferative diseases are vulnerable
Considering the impairment of the immune system due to underlying malignancies and frequent neutropenia following chemotherapy, they are at high risk for severe infections, including in particular bloodstream infections (BSIs), which represent one of the most frequent life-threatening complications for these patients, with reported mortality rates reaching
The aim of the current review is to describe the actual evidence from scientific literature concerning the “real-life” use of these two novel drugs in patients suffering from hematological malignancies with infections caused by MDR Gram-negative bacteria

Summary

Introduction

Those affected by acute leukemias and lymphoproliferative diseases are vulnerable. Several studies have reported significantly higher mortality rates among patients suffering from hematological malignancies and BSIs due to MDR Gram-negative bacteria compared to those with BSIs due to susceptible strains, and often, antimicrobial resistance by bacterial isolates and/or the related inadequacy of empirical antimicrobial treatments have been demonstrated among the most important independent risk factors for mortality [1,2,3,4,5,6,12,13,14]. The aim of the current review is to describe the actual evidence from scientific literature concerning the “real-life” use of these two novel drugs in patients suffering from hematological malignancies with infections caused by MDR Gram-negative bacteria

Mechanism of Action

Acinetobacter baumannii

Morganella morganii

Findings

Conclusions