Real World Treatment of Serious Infections with Ceftolozane/Tazobactam Interview with:

Thomas P. Lodise Jr., PharmD, PhD Clinical Pharmacist at the Stratton VA Medical Center in Albany, NY Albany College of Pharmacy and Health Sciences Albany, NY

Dr. Lodise

Thomas P. Lodise Jr., PharmD, PhD
Clinical Pharmacist at the Stratton
VA Medical Center in Albany, NY
Albany College of Pharmacy and Health Sciences
Albany, NY What is the background for this study? How does Ceftolozane/Tazobactam differ from other antibiotics for serious Gram-negative infections including Pseudomonas aeruginosa?

Response: Treatment of patients with Gram-negative infections is increasingly difficult due to rising resistance to commonly used agents. Ceftolozane/tazobactam (C/T) is a potent anti-pseudomonal agent with broad Gram-negative coverage that is indicated for complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) and is currently being studied for ventilated nosocomial pneumonia. C/T differs from other antibiotics in terms of its potency against multi-drug resistant Pseudomonas aeruginosa, one of the most concerning and difficult-to-treat Gram-negative pathogens. This study evaluates C/T in a large database of US hospitals to better understand treatment patterns and associated outcomes. What are the main findings?

Response: This study involved 1,490 patients across 253 U.S. hospitals. The mean age was 59.1 ± 17.5 years, 57% were male, and 65% were Caucasian. The most common comorbidities were chronic pulmonary disease (36%), renal disease (34%), and congestive heart failure (25%); 27% of patients had a prior hospitalization within 30 days. The mean Charlson score was 3 ± 2.4. Over half (55%) of patients were in the ICU, 49% were mechanically ventilated, and 15% were on dialysis.

Within the 259 patients with microbiology data, the most prevalent pathogen was P. aeruginosa (78%). More than 50% of isolates were from a respiratory source. The median number of days from admission to first day of C/T was six (2-15). Patients received a median seven (4-11) days of C/T. The median length of stay after the first dose of C/T was 10 (6-18) days. The 30-day mortality rate was 9%. All cause and infection related readmissions were 17% and 9%, respectively. What should readers take away from your report? 

Response: Although a comparator is lacking among patients with positive P. aeruginosa cultures, data indicate that C/T is a promising agent to treat these challenging patients. Further study in a comparative fashion is needed to put these results in proper context, but the 10% mortality, low length of stay post start of C/T and low readmission rates suggest that use of C/T should be considered as an early targeted treatment agent in appropriate patients. What recommendations do you have for future research as a result of this work? 

Response: Most of C/T’s usage was among critically ill, complex patients treated in the intensive care unit with P. aeruginosa. In spite of the complex nature of these patients, the outcomes among patients treated with C/T were positive and provides needed real-world evidence. Further studies with a comparator group will allow further interpretation. Is there anything else you would like to add? 

Response: Physicians and pharmacists need to be aware of local ecology in their institutions; intensive care patients, who are the sickest, can often be exposed to some of the most resistant and toughest-to-treat bacteria. It is important to keep in mind that not all beta-lactamase inhibitors are the same in treating these, and this study shows that C/T has particular efficacy against P. aeruginosa.

Disclosures: Motif BioSciences: Board Member, Consulting fee. 

Citation: IDWeek 2018 

Session: Poster Abstract Session: Treatment of AMR Infections

Real World Evaluation of Patient Characteristics and Outcomes of Patients Treated with Ceftolozane/Tazobactam across 253 US hospitals
Saturday, October 6, 2018 

Oct 9, 2018 @ 8:42 pm 

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