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多中心评估头孢洛扎/他唑巴坦治疗免疫功能低下的多重耐药感染患者的疗效

A Multicenter Evaluation of Ceftolozane/Tazobactam Treatment Outcomes in Immunocompromised Patients With Multidrug-Resistant Infections.

作者信息

Hart Delaney E, Gallagher Jason C, Puzniak Laura A, Hirsch Elizabeth B

机构信息

University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA.

Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA.

出版信息

Open Forum Infect Dis. 2021 Mar 6;8(3):ofab089. doi: 10.1093/ofid/ofab089. eCollection 2021 Mar.

Abstract

BACKGROUND

Real-world data assessing outcomes of immunocompromised patients treated with ceftolozane/tazobactam (C/T) are limited. This study evaluated treatment and clinical outcomes of immunocompromised patients receiving C/T for multidrug-resistant (MDR) .

METHODS

This was a 14-center retrospective cohort study of adult immunocompromised inpatients treated for ≥24 hours with C/T for MDR infections. Patients were defined as immunocompromised if they had a history of previous solid organ transplant (SOT), disease that increased susceptibility to infection, or received immunosuppressive therapies. The primary outcomes were all-cause 30-day mortality and clinical cure.

RESULTS

Sixty-nine patients were included; 84% received immunosuppressive agents, 68% had a history of SOT, and 29% had diseases increasing susceptibility to infection. The mean patient age was 57 ± 14 years, and the median (interquartile range) patient Acute Physiology and Chronic Health Evaluation II and Charlson Comorbidity Index scores were 18 (13) and 5 (4), respectively, with 46% receiving intensive care unit care at C/T initiation. The most frequent infection sources were respiratory (56%) and wound (11%). All-cause 30-day mortality was 19% (n = 13), with clinical cure achieved in 47 (68%) patients. Clinical cure was numerically higher (75% vs 30%) in pneumonia patients who received 3-g pneumonia regimens vs 1.5-g regimens.

CONCLUSIONS

Of 69 immunocompromised patients treated with C/T for MDR , clinical cure was achieved in 68% and mortality was 19%, consistent with other reports on a cross-section of patient populations. C/T represents a promising agent for treatment of resistant to traditional antipseudomonal agents in this high-risk population.

摘要

背景

评估接受头孢洛扎/他唑巴坦(C/T)治疗的免疫功能低下患者结局的真实世界数据有限。本研究评估了接受C/T治疗多重耐药(MDR)的免疫功能低下患者的治疗及临床结局。

方法

这是一项在14个中心开展的回顾性队列研究,纳入接受C/T治疗≥24小时的成年免疫功能低下住院患者,用于治疗MDR感染。如果患者有实体器官移植(SOT)史、增加感染易感性的疾病或接受免疫抑制治疗,则被定义为免疫功能低下。主要结局为全因30天死亡率和临床治愈。

结果

共纳入69例患者;84%接受免疫抑制剂治疗,68%有SOT史,29%有增加感染易感性的疾病。患者平均年龄为57±14岁,患者急性生理与慢性健康状况评分系统II(APACHE II)和查尔森合并症指数的中位数(四分位间距)分别为18(13)和5(4),46%的患者在开始使用C/T时接受重症监护病房护理。最常见的感染源为呼吸道(56%)和伤口(11%)。全因30天死亡率为19%(n = 13),47例(68%)患者实现临床治愈。接受3g肺炎治疗方案的肺炎患者临床治愈率在数值上高于接受1.5g治疗方案的患者(75%对30%)。

结论

在69例接受C/T治疗MDR的免疫功能低下患者中,68%实现临床治愈,死亡率为19%,与其他关于不同患者群体的报告一致。在这一高危人群中,C/T是治疗对传统抗假单胞菌药物耐药菌的一种有前景的药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5ac/7990512/610504fdc78f/ofab089_fig1.jpg

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