Crapis Massimo, Venturini Sergio, Della Siega Paola, Tonizzo Maurizio, Garlatti Elena, Rosa Rita De, Basso Barbara, Pontoni Elisa
Infectious Diseases Division, Santa Maria degli Angeli Hospital, Pordenone, Italy.
Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy.
J Chemother. 2021 May;33(3):174-179. doi: 10.1080/1120009X.2020.1821486. Epub 2020 Sep 30.
Ceftobiprole is an advance generation cephalosporin which has broad-spectrum bacterial activity (both against Gram-positive and negative pathogens) and was approved for the treatment of community-acquired pneumonia (CAP) and non-ventilated hospital-acquired pneumonia (HAP) in most European countries. We aimed to evaluate the efficacy and safety of ceftobiprole in the treatment of pneumonia in a cohort of severely ill patients admitted to the emergency department (ED).
1-year observational retrospective mono-centric study. Were defined two primary endpoints: first, to evaluate the clinical cure at the test-of-cure (TOC); the second, to evaluate the early improvement, defined as a reduction of symptoms and inflammatory parameters 72 hours after the start of treatment. The secondary endpoint is to evaluate the reduction of antibiotic "burden" using ceftobiprole despite standard of care in severe hospital-acquired pneumonia.
During the study period, a total of 48 patients with severe pneumonia received ceftobiprole: twenty-two patients (45.8%) as empiric therapy, 9 (18.5%) as a de-escalation option from previous combination therapies, 13 patients (27.1%) as an escalation therapy from ceftriaxone or amoxicillin/clavulanate and four patients (8.3%) as a targeted therapy based on microbiological results. Ceftobiprole mean duration therapy was 10.2 days. Forty-six patients with severe pneumonia had an early clinical improvement 72 hours after the start of treatment (95.8%). In general, ceftobiprole was well tolerated; only one patient suspended the drug because of poor tolerability. The clinical cure at TOC was 85.4% and 30-days crude mortality was 10.4%.
This study confirms that ceftobiprole is effective in severely ill patients with pneumonia at risk of poor outcomes.
头孢比普是新一代头孢菌素，具有广谱细菌活性（对革兰氏阳性和阴性病原体均有效），在大多数欧洲国家已被批准用于治疗社区获得性肺炎（CAP）和非通气医院获得性肺炎（HAP）。我们旨在评估头孢比普治疗急诊科（ED）收治的重症患者肺炎的疗效和安全性。
为期1年的观察性回顾性单中心研究。定义了两个主要终点：第一，评估治愈试验（TOC）时的临床治愈情况；第二，评估早期改善情况，定义为治疗开始72小时后症状和炎症参数的降低。次要终点是评估在重症医院获得性肺炎的标准治疗基础上使用头孢比普减少抗生素“负担”的情况。
在研究期间，共有48例重症肺炎患者接受了头孢比普治疗：22例患者（45.8%）接受经验性治疗，9例（18.5%）作为先前联合治疗的降阶梯选择，13例患者（27.1%）作为从头孢曲松或阿莫西林/克拉维酸升级的治疗，4例患者（8.3%）根据微生物学结果进行靶向治疗。头孢比普的平均治疗持续时间为10.2天。46例重症肺炎患者在治疗开始72小时后有早期临床改善（95.8%）。总体而言，头孢比普耐受性良好；只有1例患者因耐受性差而停药。TOC时的临床治愈率为85.4%，30天粗死亡率为10.4%。
本研究证实头孢比普对有不良预后风险的重症肺炎患者有效。
