Ceftolozane/tazobactam versus colistin in the treatment of ventilator-associated pneumonia due to extensively drug-resistant Pseudomonas aeruginosa

Bence Mogyoródi,András B Csékó,Zsolt D Iványi,János Gál,Csaba Hermann

doi:10.1038/s41598-022-08307-9

Bence Mogyoródi, András B Csékó + Show 3 more

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https://doi.org/10.1038/s41598-022-08307-9

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Journal: Scientific Reports	Publication Date: Mar 15, 2022
Citations: 8	License type: open-access

Affiliation: Semmelweis University

Abstract

Resistant strains of Pseudomonas aeruginosa are common pathogens in the intensive care unit (ICU), limiting available therapeutic options. We aimed to compare ceftolozane/tazobactam (C/T) with colistimethate sodium (CMS) in the treatment of ventilator-associated pneumonia (VAP) due to extensively drug-resistant (XDR) Pseudomonas aeruginosa. A retrospective, observational study was performed at a tertiary care ICU. Clinical and microbiological success rate, 28-day all-cause mortality, and adverse events were compared in patients who received C/T with those treated with systemic CMS. A total of 51 patients were included (18 in the C/T and 33 in the CMS group). Clinical success rates in the C/T and CMS groups were 13 (72.2%) and 10 (30.3%), respectively. On multivariate regression analysis, treatment with C/T was independently associated with clinical success (odds ratio 4.47, 95% CI 1.17–17.08). There was no difference in 28-day all-cause mortality (27.8% and 33.3% in the C/T and CMS group, p = 0.76). Acute kidney injury was more common in patients who received CMS (48.5% vs 11.1%, p = 0.01). In our study, ceftolozane/tazobactam was more efficacious in the treatment of XDR Pseudomonas aeruginosa VAP and showed a better safety profile compared to CMS.

Highlights

Abbreviations adverse events (AEs) Adverse event AKI Acute kidney injury APACHE II Acute Physiology and Chronic Health Evaluation II score CCI Charlson Comorbidity Index C/T Ceftolozane/tazobactam complicated intraabdominal infections (cIAI) Complicated intraabdominal infection complicated urinary tract infections (cUTI) Complicated urinary tract infection extended-spectrum beta-lactamase (ESBL) Extended-spectrum beta-lactamase hospital-acquired pneumonia (HAP) Hospital-acquired pneumonia intensive care unit (ICU) Intensive care unit MDR Multidrug-resistant SOFA Sequential Organ Failure Assessment score ventilator-associated pneumonia (VAP) Ventilator-associated pneumonia XDR Extensively drug-resistant
MDR and XDR strains of Pseudomonas aeruginosa are frequent in ICU-acquired pneumonia, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)[3,4]
The aim of the present work is to report our experience with C/T and to evaluate its efficacy and safety compared to colistimethate sodium (CMS) in the treatment of ventilator-associated pneumonia due to extensively drug-resistant Pseudomonas aeruginosa

Summary

Introduction

Abbreviations AE Adverse event AKI Acute kidney injury APACHE II Acute Physiology and Chronic Health Evaluation II score CCI Charlson Comorbidity Index C/T Ceftolozane/tazobactam cIAI Complicated intraabdominal infection cUTI Complicated urinary tract infection ESBL Extended-spectrum beta-lactamase HAP Hospital-acquired pneumonia ICU Intensive care unit MDR Multidrug-resistant SOFA Sequential Organ Failure Assessment score VAP Ventilator-associated pneumonia XDR Extensively drug-resistant. Acquired resistance profiles of Pseudomonas aeruginosa were described by a group of international e xperts[2]: Multidrug-resistant (MDR) was defined as non-susceptible to at least one agent in three or more antimicrobial categories; XDR was defined as non-susceptible to at least one agent in all but 2. MDR and XDR strains of Pseudomonas aeruginosa are frequent in ICU-acquired pneumonia, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)[3,4]. The clinical effectiveness of C/T is reportedly between 54 and 86.8% in the treatment of serious Pseudomonas aeruginosa infections[18,20–23]

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