BETTER OUTCOME OF HIGH-DOSE CEFTAZIDIME IN HEMATO – ONCOLOGICAL PATIENTS WITH INFECTIONS CAUSED BY EXTENSIVELY DRUG-RESISTANT PSEUDOMONAS AERUGINOSA

Abstract

Background: P. aeruginosa sepsis in immunocompromised patients is serious complication of cancer treatment, especially in case of XDR pathogen. The purpose of the study is to evaluate the efficacy of high-dose ceftazidime in treatment of XDR P. aeruginosa infection and to compare it with the conventionally treated cohort in hemato-oncological patients. Methods: We identified 27 patients with XDR P. aeruginosa infection during the 2008-2018 period, 16 patients served as a conventionally treated cohort with antipseudomonal beta-lactam antibiotic in standard dose (cohort A), and 11 patients were treated with high-dose ceftazidime (cohort B).  Most of the patients were neutropenic and under active treatment for their cancer in both cohorts. Results: Mortality and related mortality were statistically significantly better for cohort B compared to cohort A,  it was  18.2% and 9.1% for cohort B and 68.8% and 68.8% for cohort A, respectively. More patients in cohort A needed mechanical ventilation and renal replacement therapy, 75% and 50% for cohort A and 27.3% and 9.9% for cohort B, respectively.  It corresponded well with the worst SOFA in cohort A in comparison to cohort B, 16 versus 7 respectively. Reversible neurotoxicity was seen only in two patients in cohort B. Conclusion: Ceftazidime in high doses is a very potent ATB for the treatment of XDR P. aeruginosa infections in neutropenic cancer with acceptable toxicity.