Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
APMIS. 2023 Aug;131(8):419-425. doi: 10.1111/apm.13331. Epub 2023 Jun 9.
Ceftolozane-tazobactam is a new β-lactam/β-lactamase inhibitor combination approved by the U.S. Food and Drug Administration in 2019 for the treatment of hospital-acquired and ventilator-associated pneumonia. The combination is a particularly potent inhibitor of penicillin-binding proteins with higher affinity than other β-lactam agents. Persons with cystic fibrosis (pwCF) often harbour resistant Gram-negative bacteria in the airways and need antibiotics to prevent declining lung function. To test whether the introduction of ceftolozane-tazobactam in the period 2015-2020 led to a bacterial population level increase in cephalosporin resistance in a Danish CF population. In vitro, activity of ceftolozane-tazobactam was evaluated by susceptibility testing of clinical Pseudomonas aeruginosa isolated from pwCF from January 1, 2015, to June 1, 2020. Six thousand three hundred thirty two isolates collected from 210 adult pwCF were included. Thirty pwCF were treated with ceftolozane-tazobactam at least once. Ceftolozane-tazobactam exposure did not increase cephalosporin resistance on an individual or population level. However, resistance to ceftolozane-tazobactam was recorded despite no prior exposure in four pwCF. Compared to ceftazidime, ceftolozane-tazobactam had a better in vitro activity on P. aeruginosa. The percentage of non-mucoid P. aeruginosa isolates susceptible to ceftolozane-tazobactam were higher or equal to 5 other β-lactams. Ceftolozane-tazobactam expands the armamentaria against P. aeruginosa with acceptable levels for a selection of drug resistance.
头孢洛扎他唑巴坦是一种新的β-内酰胺/β-内酰胺酶抑制剂组合,于 2019 年获得美国食品和药物管理局批准,用于治疗医院获得性和呼吸机相关性肺炎。该组合是青霉素结合蛋白的一种特别有效的抑制剂,其亲和力高于其他β-内酰胺药物。囊性纤维化(CF)患者的气道中经常存在耐药革兰氏阴性菌,需要使用抗生素来防止肺功能下降。为了测试 2015 年至 2020 年期间引入头孢洛扎他唑巴坦是否导致丹麦 CF 人群中头孢菌素耐药性的细菌群体水平增加。在体外,通过对 2015 年 1 月 1 日至 2020 年 6 月 1 日从 CF 患者中分离的临床铜绿假单胞菌进行药敏试验评估头孢洛扎他唑巴坦的活性。共收集了 210 名成年 CF 患者的 6332 株分离株。30 名 CF 患者至少接受过一次头孢洛扎他唑巴坦治疗。个体或人群水平的头孢菌素耐药性并未因头孢洛扎他唑巴坦暴露而增加。然而,尽管没有先前暴露,仍有 4 名 CF 患者记录到对头孢洛扎他唑巴坦的耐药性。与头孢他啶相比,头孢洛扎他唑巴坦对铜绿假单胞菌的体外活性更好。对头孢洛扎他唑巴坦敏感的非粘液铜绿假单胞菌分离株的百分比高于或等于其他 5 种β-内酰胺。头孢洛扎他唑巴坦扩大了针对铜绿假单胞菌的武器库,耐药性选择的耐药水平可接受。
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