Treatment of multidrug-resistant Pseudomonas aeruginosa bacteremia using ceftolozane-tazobactam-based or colistin-based antibiotic regimens: A multicenter retrospective study. Issue 10 (October 2022)

• Record Type: Journal Article
• Authors: Hakeam, Hakeam A.; Askar, Ghadi; Al Sulaiman, Khalid; Mansour, Reem; Al Qahtani, Maha M.; Abbara, Dana; Aldhayyan, Nada; Dyab, Nariman; Afaneh, Liyan; Islami, Muna; Al Duhailib, Zainab
• Is Part Of: Journal of infection and public health. Volume 15:Issue 10(2022)
• Page Start: 1081
• Page End: 1088
• Publication Date: 2022-10
• Subjects: MDR P. aeruginosa -- Ceftolozane-tazobactam -- Colistin -- Bacteremia -- Bloodstream ‎infection; Communicable diseases -- Periodicals; Public health -- Periodicals; Epidemiology -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Medical microbiology -- Periodicals; 614.4
• DOI: 10.1016/j.jiph.2022.08.020
• Languages: English
• ISSNs: 1876-0341

Abstract

Abstract: Background: Ceftolozane-tazobactam is an emerging ‎treatment for severe infections caused by multidrug-resistant (MDR) Pseudomonas ‎aeruginosa . However, limited ‎data support its use in bacteremia treatment. This study aimed to assess the effectiveness of the treatment of MDR P. aeruginosa bacteremia using ceftolozane-‎tazobactam-based or colistin-based regimens. ‎ Patients and methods: This retrospective, cohort, multicentre study included adult patients with ‎ MDR P. aeruginosa bacteremia treated with either ceftolozane-tazobactam or ‎colistin, between September 2018 and August 2021, at four hospitals in Saudi ‎Arabia. The primary endpoint was the 30-day risk-adjusted mortality. Secondary endpoints included the 14-day risk of mortality, bacterial eradication, and clinical ‎success. Cox proportional hazards ‎regression and relative risk estimation were used for analysis, as appropriate. ‎ Results: In total, 46 patients were included; 17 patients received ceftolozane-‎tazobactam-based regimen, and 29 received a colistin-based regimen. There was no association with the use of ‎ceftolozane-tazobactam compared to colistin and the 30-day risk-adjusted mortality ‎‎(hazard ratio [HR] ‎0.58, 95% confidence interval [CI] 0.16–2.13, P = 0.42). Also, the ‎‎14-day risk of mortality and bacterial eradication were not different between the ‎ceftolozane-tazobactam and colistin regimens, HR 2.1, 95% CI 0.42–10.48; P = 0.36; and ‎relative risk (RR) 0.65; 95% CI 0.28–1.52; P = 0.30; respectively. On the other hand, ‎ceftolozane-tazobactam use was associated with higher clinical success than colistin ‎‎(RR 1.84, 95% CI 1.11–3.06: P = 0.021).‎ Conclusion: The risk of mortality of MDR P.aeruginosa bacteremia was ‎similar when treated with ceftolozane-tazobactam-based or colistin-based antimicrobial regimens. A higher clinical success was observed with the ceftolozane-‎tazobactam-based regimen compared to the colistin-based regimen. ‎