2286. Evaluating the Impact of Ceftolozane/Tazobactam on Clinical Outcomes in Patients with Multi-Drug-resistant Pseudomonas aeruginosa Pneumonia

Abstract

BackgroundCeftolozane/tazobactam is a novel cephalosporin and β-lactamase inhibitor antibiotic that has shown to have potent activity against Pseudomonas aeruginosa including strains exhibiting multi-drug resistance (MDR). The purpose of this study was to evaluate ceftolozane/tazobactam efficacy in MDR P. aeruginosa pneumonia compared with historical standard of care.MethodsThis was a retrospective cohort study of patients hospitalized across AdventHealth Central Florida campuses with MDR P. aeruginosa pneumonia from January 1, 2017 through December 31, 2018. This study included patients ≥ 18 years of age with a diagnosis of pneumonia and a positive respiratory culture with MDR P. aeruginosa. The primary outcome of this study was the rate of clinical cure by day 14 of definitive therapy. Secondary outcomes included 30-day readmission rate, average hospital length of stay (LOS), cost of admission, average ICU LOS after initiation of definitive antibiotic, and total days of antibiotic exposure for pneumonia. Data were analyzed with statistical computer software utilizing independent samples t-test and chi square tests of independence as appropriate.ResultsA total of 115 patients were included in the final analysis, 62 patients treated with ceftolozane/tazobactam and 53 patients treated with historical standard of care. Rate of clinical cure was similar between patients treated with ceftolozane/tazobactam, 72.6% (n = 45), and those treated with historical standard of care, 67.9% (n = 36), {X2 (1) = 0.297, p = 0.683}. Other outcomes assessed were also similar between groups except for average hospital length of stay (42.7 days vs. 30.3 days t(113) = 2.054, p = 0.042), and cost of admission ($78,550 vs. $47,681, t(113) = 2.458, p = 0.016), which were significantly greater in the ceftolozane/tazobactam treatment group.ConclusionIn patients diagnosed with MDR P. aeruginosa pneumonia, clinical cure rates were not significantly different between those treated with ceftolozane/tazobactam compared with historical standard of care. Significantly greater hospital length of stay and cost of admission was associated with use of ceftolozane/tazobactam, although many patient factors may have influenced these results.Disclosures All authors: No reported disclosures.

Systematic Literature Review of Real-World Evidence of C Eftolozane/Tazobactam for the Treatment of Respiratory Infections

“…Of the 33 studies included in the SLR that included data on patients with RTIs (and presented outcomes for these patients), 28 were published as peer-reviewed publications, and ve were available as conference proceedings (either as abstracts or posters). [43][44][45][46][47] Including studies that included patients from multiple different countries, the most common study locations were the US (23 studies), 15,21,24-33,35−37,39-41,43−47 Spain (5), 20,22,23,36,42 and Italy (3). 15,18,19 There was a mix of study designs included: of nine non-comparative studies, eight were retrospective, 18,19,23,24,31,36,43,46 and one was prospective.…”

Real-world Use of Ceftolozane/tazobactam: a Systematic Literature Review

“…Five studies were identi ed that compared C/T with other treatment regimens (Table 4): three included aminoglycoside/polymyxin-based regimens as comparator; (23,27,80) two either used standard of care (SoC). (26,83) Each study included patients with P. aeruginosa infections, with four including patients with resistant P. aeruginosa. (23,27,80,83) In the three studies with aminoglycoside-/polymyxin-based comparators, all reported mortality rates, (23,27,80) two reported clinical cure rates, (23,27) and one reported microbiological cure rate.…”

“…Including studies that recruited patients from multiple countries, the most common study locations were the US (N = 50), (21, 22, 24, 27-29, 33, 34, 39-41, 43-45, 50, 51, 54, 56, 57, 59, 61, 62, 68-71, 73-77, 79-85, 87-92, 94, 95, 97-100) Spain (N = 15), (26, 28, 30-32, 35-37, 42, 47, 49, 58, 66, 79, 96) and Italy (N = 13). (18,20,23,25,48,52,53,55,64,67,72,79,86) A variety of study designs were captured: 27 were non-comparative retrospective studies, (18,19,22,24,25,28,32,33,40,41,79,81,(84)(85)(86)(87)(88)(89)(90)(91)(92)(94)(95)(96)(97)(98)(99) 14 were case series, (20, 21, 29, 31, 34-39, 42, 43, 82, 100) ve were comparative (including two cohort studies, (80,83) and three case-control studies, (23,…”

“…(26,83) Each study included patients with P. aeruginosa infections, with four including patients with resistant P. aeruginosa. (23,27,80,83) In the three studies with aminoglycoside-/polymyxin-based comparators, all reported mortality rates, (23,27,80) two reported clinical cure rates, (23,27) and one reported microbiological cure rate. (80) In Pogue et al, patients treated with C/T had signi cantly higher clinical cure rate (p = 0.002), but there was no difference in in-hospital mortality.…”

“…(80) In the two studies that compared patients treated with C/T with mixed SoC antibacterial agents, both reported clinical cure rates and mortality. (26,83) Both studies found that patients treated with C/T had numerically higher clinical cure rates than patients treated with other antibacterial agents. Fernández-Cruz et al additionally found that patients treated with C/T had signi cantly lower mortality rates (p < 0.05);…”