El Nekidy Wasim S, Al Ali Mooza, Abidi Emna, El Lababidi Rania, Alrahmany Diaa, Ghazi Islam M, Mooty Mohamad, Hijazi Fadi, Ghosn Muriel, Mallat Jihad
Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 112412, United Arab Emirates.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA.
Antibiotics (Basel). 2024 Jul 26;13(8):699. doi: 10.3390/antibiotics13080699.
The optimal doses of ceftazidime-avibactam (CZA) and ceftolozane-tazobactam (C/T) for treating multidrug-resistant (MDR) Pseudomonas aeruginosa (PSA) in patients utilizing renal replacement therapy (RRT) are not well established. Hence, the objective of this study is to evaluate the clinical outcomes associated with the suggested doses of CZA and C/T in patients with PSA infection utilizing RRT.
This is a retrospective study conducted at our hospital between September 2018 and March 2022. Clinical cure was the primary endpoint, while microbiologic cure, 30-day recurrence, and 30-day mortality were the secondary endpoints.
In total, 45 subjects met the inclusion criteria, with 25 receiving CZA and 20 receiving C/T. The median age was 69 (52-81) and 69 (61.5-83) years, respectively, while the median weight was 70 (55.5-81.5) and 66 (57-79) kg, respectively. Clinical cure was achieved in 12 (48%) subjects in the CZA group and 12 (60%) in the C/T group ( = 0.432). Of the 36 subjects who had repeated cultures, a microbiologic cure was achieved in 14/23 (60%) subjects and 10/13 (76.9%) subjects ( = 0.273). Thirty-day recurrence was reported in 3 (12%) cases in the CZA group and 6 (30%) in the C/T group ( = 0.082). The 30-day mortality was 13 (52%) subjects in the CZA group and 10 (50%) in the C/T group ( = 0.894). The median maintenance dose of CZA was 1.88 (0.94-3.75) g and 2.25 (1.5-2.25) g for C/T. Multivariate logistic regression analysis indicated that both drugs did not differ significantly in clinical cure. Bloodstream infection (BSI) (OR = 25, 95% CI: 1.63-411.7, = 0.021) was the only independent factor associated with clinical cure in this population.
Our findings indicated that C/T and CZA did not significantly differ in achieving clinical cure in patients with MDR PSA infections undergoing RRT. Larger clinical trials are needed to confirm our findings.
对于接受肾脏替代治疗（RRT）的患者，头孢他啶-阿维巴坦（CZA）和头孢洛扎-他唑巴坦（C/T）治疗多重耐药（MDR）铜绿假单胞菌（PSA）的最佳剂量尚未明确。因此，本研究的目的是评估在接受RRT的PSA感染患者中，使用建议剂量的CZA和C/T的临床结局。
这是一项于2018年9月至2022年3月在我院进行的回顾性研究。临床治愈是主要终点，而微生物学治愈、30天复发率和30天死亡率是次要终点。
共有45名受试者符合纳入标准，其中25名接受CZA治疗，20名接受C/T治疗。中位年龄分别为69（52 - 81）岁和69（61.5 - 83）岁，中位体重分别为70（55.5 - 81.5）kg和66（57 - 79）kg。CZA组12名（48%）受试者和C/T组12名（60%）受试者实现了临床治愈（P = 0.432）。在36名进行重复培养的受试者中，14/23名（60%）受试者和10/13名（76.9%）受试者实现了微生物学治愈（P = 0.273）。CZA组有3例（12%）报告了30天复发，C/T组有6例（30%）（P = 0.082）。CZA组30天死亡率为13名（52%）受试者，C/T组为10名（50%）（P = 0.894）。CZA的中位维持剂量为1.88（0.94 - 3.75）g，C/T为2.25（1.5 - 2.25）g。多因素逻辑回归分析表明，两种药物在临床治愈方面无显著差异。血流感染（BSI）（OR = 25，95%CI：1.63 - 411.7，P = 0.021）是该人群中与临床治愈相关的唯一独立因素。
我们的研究结果表明，在接受RRT的MDR PSA感染患者中，C/T和CZA在实现临床治愈方面无显著差异。需要更大规模的临床试验来证实我们的研究结果。
