Lodise Thomas P, Min Jae, Nathanson Brian H, Yücel Emre
Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
Merck & Co., Inc., Rahway, New Jersey, USA.
Antimicrob Agents Chemother. 2025 Nov 5;69(11):e0056925. doi: 10.1128/aac.00569-25. Epub 2025 Sep 18.
Ceftolozane/tazobactam and polymyxin-based regimens are frequently used to treat pneumonia caused by multi-drug-resistant (MDR-PSA). However, comparative data on global clinical outcomes between these therapies are limited. A multi-centered observational study was performed using the PINC AI Healthcare Database (2016-2022). The study population included hospitalized patients ≥ 18 years who were diagnosed with pneumonia and had MDR-PSA (defined as non-susceptible to ≥1 agent in ≥3 antimicrobial categories) on a respiratory or blood culture, receipt of ceftolozane/tazobactam or a polymyxin-based regimen within 3 days of index MDR-PSA culture, receipt of ≥2 days of ceftolozane/tazobactam or a polymyxin-based regimen, and without a COVID-19 diagnosis. A Desirability of Outcome Ranking (DOOR) analysis was performed. Components of the DOOR included in-hospital mortality, discharge destination (home vs other), recurrent MDR-PSA pneumonia, receipt of any renal replacement therapy (RRT) post-index culture in RRT-naive patients, and 30-day pneumonia-related readmissions. In total, 186 patients met the study criteria (104 ceftolozane/tazobactam and 82 polymyxin). In the IPW-adjusted DOOR analysis, a ceftolozane/tazobactam-treated patient had a higher probability of a more favorable outcome (DOOR probability: 61.3%; 95% CI: 56.8%, 65.7%). In the DOOR partial credit analyses, a ceftolozane/tazobactam-treated patient had a higher probability of being discharged home alive with no undesirable outcomes than a polymyxin-treated patient (20.2% vs 9.8%, = 0.04). This real-world evidence study of non-COVID-19 patients with MDR-PSA pneumonia suggests that patients treated with ceftolozane/tazobactam have a higher probability of a more favorable outcome compared with patients treated with a polymyxin-based regimen. Further large-scale studies with detailed dosing are needed to validate the findings.
头孢洛扎/他唑巴坦和基于多粘菌素的治疗方案常用于治疗由多重耐药（MDR-PSA）引起的肺炎。然而，关于这些疗法全球临床结局的比较数据有限。使用PINC AI医疗数据库（2016 - 2022年）进行了一项多中心观察性研究。研究人群包括年龄≥18岁的住院患者，这些患者被诊断为肺炎且在呼吸道或血液培养中存在MDR-PSA（定义为对≥3类抗菌药物中的≥1种药物不敏感），在MDR-PSA培养指标后的3天内接受了头孢洛扎/他唑巴坦或基于多粘菌素的治疗方案，接受了≥2天的头孢洛扎/他唑巴坦或基于多粘菌素的治疗方案，且未被诊断为COVID-19。进行了结局期望排名（DOOR）分析。DOOR的组成部分包括住院死亡率、出院目的地（回家与其他）、复发性MDR-PSA肺炎、在未接受过肾脏替代治疗（RRT）的患者中指标培养后接受任何肾脏替代治疗（RRT）的情况，以及30天内与肺炎相关的再入院情况。共有186名患者符合研究标准（104名接受头孢洛扎/他唑巴坦治疗，82名接受多粘菌素治疗）。在倾向评分加权调整的DOOR分析中，接受头孢洛扎/他唑巴坦治疗的患者获得更有利结局的概率更高（DOOR概率：61.3%；95%置信区间：56.8%，65.7%）。在DOOR部分信用分析中，与接受多粘菌素治疗的患者相比，接受头孢洛扎/他唑巴坦治疗的患者活着出院回家且无不良结局的概率更高（20.2%对9.8%，P = 0.04）。这项针对非COVID-19的MDR-PSA肺炎患者的真实世界证据研究表明，与接受基于多粘菌素治疗方案的患者相比，接受头孢洛扎/他唑巴坦治疗的患者获得更有利结局的概率更高。需要进一步开展大规模、详细给药方案的研究来验证这些发现。
