Comparative evaluation of early treatment with ceftolozane/tazobactam versus ceftazidime/avibactam for non-COVID-19 patients with pneumonia due to multidrug-resistant Pseudomonas aeruginosa

IF 3.9 2区医学 Q1 INFECTIOUS DISEASES

Journal of Antimicrobial Chemotherapy Pub Date : 2024-09-11 DOI:10.1093/jac/dkae313

Thomas P Lodise, Engels N Obi, Alexandre H Watanabe, Emre Yucel, Jae Min, Brian H Nathanson

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Abstract

Background Ceftolozane/tazobactam and ceftazidime/avibactam are commonly used in patients with MDR-Pseudomonas aeruginosa (PSA) pneumonia (PNA). This study compared outcomes between non-COVID-19 hospitalized patients with MDR-PSA PNA who received ceftolozane/tazobactam or ceftazidime/avibactam. Methods The study included non-COVID-19 adult hospitalized patients with MDR-PSA PNA in the PINC AI Healthcare Database (2016–22) who received ceftolozane/tazobactam or ceftazidime/avibactam within 3 days of index culture for ≥2 days. Outcomes were mortality, recurrent MDR-PSA PNA, discharge destination, post-index culture day length of stay (LOS) and costs (in US dollars, USD), and hospital readmission. Results The final sample included 197 patients (117 ceftolozane/tazobactam, 80 ceftazidime/avibactam). No significant differences were observed in mortality and post-index culture LOS and costs between groups. In the multivariable analyses, patients who received ceftolozane/tazobactam versus ceftazidime/avibactam had lower recurrent MDR-PSA PNA (7.9% versus 18.0%, P = 0.03) and 60 day PNA-related readmissions (11.1% versus 28.5%, P = 0.03) and were more likely to be discharged home (25.8% versus 9.8%, P = 0.03). Compared with ceftazidime/avibactam patients, ceftolozane/tazobactam patients had lower adjusted median total antibiotic costs (5052 USD versus 8099 USD, P = 0.003) and lower adjusted median comparator (ceftolozane/tazobactam or ceftazidime/avibactam) antibiotic costs (3938 USD versus 6441 USD, P = 0.005). In the desirability of outcome ranking (DOOR) analysis, a ceftolozane/tazobactam-treated patient was more likely to have a more favourable outcome than a ceftazidime/avibactam-treated patient [DOOR probability: 59.6% (95% CI: 52.5%–66.8%)]. Conclusions Early treatment with ceftolozane/tazobactam may offer some clinical and cost benefits over ceftazidime/avibactam in patients with MDR-PSA PNA. Further large-scale studies are necessary to comprehensively understand the outcomes associated with these treatments for MDR-PSA PNA.

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对非COVID-19耐多药铜绿假单胞菌肺炎患者使用头孢妥赞/他唑巴坦与头孢唑肟/阿维巴坦进行早期治疗的比较评估

背景头孢妥仑/他唑巴坦和头孢唑肟/阿维巴坦常用于 MDR-铜绿假单胞菌（PSA）肺炎（PNA）患者。本研究比较了非 COVID-19 住院 MDR-PSA PNA 患者接受头孢妥赞/他唑巴坦或头孢唑肟/阿维巴坦治疗后的疗效。方法研究纳入 PINC AI 医疗数据库（2016-22 年）中接受头孢唑烷/他唑巴坦或头孢嗪肟/阿维巴坦治疗的 MDR-PSA PNA 非 COVID-19 成年住院患者，这些患者在指数培养后 3 天内接受头孢唑烷/他唑巴坦或头孢嗪肟/阿维巴坦治疗，时间≥2 天。研究结果包括死亡率、复发性 MDR-PSA PNA、出院去向、指标培养后住院日（LOS）和费用（以美元计）以及再入院率。结果最终样本包括 197 名患者（117 名头孢羟氨苄/他唑巴坦，80 名头孢唑肟/阿维巴坦）。两组患者的死亡率、指标培养后的住院时间和费用无明显差异。在多变量分析中，接受头孢唑烷/他唑巴坦治疗的患者与头孢唑肟/阿维巴坦相比，MDR-PSA PNA复发率（7.9%对18.0%，P = 0.03）和60天PNA相关再住院率（11.1%对28.5%，P = 0.03）更低，出院回家的可能性更大（25.8%对9.8%，P = 0.03）。与头孢唑肟/阿维巴坦患者相比，头孢羟氨苄/他唑巴坦患者的调整后抗生素总费用中位数较低（5052美元对8099美元，P = 0.003），调整后比较者（头孢羟氨苄/他唑巴坦或头孢唑肟/阿维巴坦）抗生素费用中位数较低（3938美元对6441美元，P = 0.005）。在结果可取性排名（DOOR）分析中，头孢妥赞/他唑巴坦治疗的患者比头孢他啶/阿维巴坦治疗的患者更有可能获得更有利的结果[DOOR概率：59.6%（95% CI：52.5%-66.8%）]。结论在 MDR-PSA PNA 患者中，与头孢他啶/阿维菌素相比，头孢唑烷/他唑巴坦的早期治疗可能具有一定的临床和成本效益。有必要进一步开展大规模研究，以全面了解这些治疗方法对 MDR-PSA PNA 的相关疗效。

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来源期刊

Journal of Antimicrobial Chemotherapy 医学-传染病学

CiteScore

9.20

自引率

5.80%

发文量

423

审稿时长

2-4 weeks

期刊介绍： The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.

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