Escolà-Vergé Laura, Pigrau Carlos, Almirante Benito
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.
Infect Drug Resist. 2019 Jul 1;12:1853-1867. doi: 10.2147/IDR.S180905. eCollection 2019.
The current prevalence of infections caused by multidrug-resistant (MDR) organisms is a global threat, and thus, the development of new antimicrobial agents with activity against these pathogens is a healthcare priority. Ceftolozane-tazobactam (C/T) is a new combination of a cephalosporin with a β-lactamase inhibitor that shows excellent in vitro activity against a broad spectrum of Enterobacteriaceae and , including extended spectrum β-lactamase-producing (ESBL) strains and MDR or extensively drug-resistant (XDR) . In phase III randomized clinical trials, C/T demonstrated similar efficacy to meropenem for the treatment of complicated intra-abdominal infections (cIAIs) and superior efficacy to levofloxacin for the treatment of complicated urinary tract infections (cUTIs), including pyelonephritis. The drug is generally safe and well tolerated and its PK/PD profile is very favorable. Observational studies with C/T have revealed good efficacy for the treatment of different types of infection caused by MDR or XDR , including some that originated from the digestive or urinary tracts. The place of C/T in therapy is not well defined, but its use could be recommended in a carbapenem-sparing approach for the treatment of infections caused by ESBL-producing strains or for the treatment of infections caused by if there are no other more favorable therapeutic options. Further clinical experience is needed to position this new antimicrobial drug for the empirical treatment of cIAIs or cUTIs.
多重耐药(MDR)菌引起的感染在当前的流行情况是一个全球性威胁,因此,开发对这些病原体具有活性的新型抗菌药物是医疗保健的优先事项。头孢他啶-阿维巴坦(C/T)是一种头孢菌素与β-内酰胺酶抑制剂的新组合,对广泛的肠杆菌科细菌显示出优异的体外活性,包括产超广谱β-内酰胺酶(ESBL)菌株以及MDR或广泛耐药(XDR)菌。在III期随机临床试验中,C/T在治疗复杂性腹腔内感染(cIAIs)方面显示出与美罗培南相似的疗效,在治疗复杂性尿路感染(cUTIs)包括肾盂肾炎方面显示出优于左氧氟沙星的疗效。该药物总体安全且耐受性良好,其药代动力学/药效学特征非常有利。对C/T的观察性研究表明,其在治疗由MDR或XDR菌引起的不同类型感染方面疗效良好,包括一些源自消化道或泌尿道的感染。C/T在治疗中的地位尚未明确界定,但在采用碳青霉烯类药物节省策略治疗由产ESBL菌株引起的感染或在没有其他更有利治疗选择时治疗由(特定菌)引起的感染时,可推荐使用C/T。需要更多临床经验来确定这种新型抗菌药物在cIAIs或cUTIs经验性治疗中的地位。