P07 Study of Prescribing patterns and Effectiveness of Ceftolozane/Tazobactam Real-world Analysis (SPECTRA): results on critical care patients from a multinational, multicentre, observational analysis

Abstract

Abstract Background Ceftolozane/tazobactam (C/T) is indicated for the treatment of complicated intra-abdominal infections (cIAI),1 complicated urinary tract infections (cUTI), including pyelonephritis,2 and hospital-acquired bacterial and ventilator-associated bacterial pneumonia.3 Information on real-world use and outcomes of patients treated with C/T in critical care settings is important to help inform disease management and clinical practice. Objectives This study presents findings on patient/treatment characteristics and outcomes associated with C/T use in patients managed in the critical care setting. Methods Data were collected from the SPECTRA study, a multinational, multicentre, retrospective, inpatient, observational study of patients treated with C/T across hospitals in seven countries (Spain, the UK, Germany, Italy, Austria, Australia and Mexico) from 2016–2020. All adult patients admitted to the ICU during the index hospitalization and treated with C/T for ≥48 h were included. Demographics, clinical characteristics, treatment management patterns and outcomes were assessed. Results The study sample included 298 critical care patients receiving C/T (mean age 57.0 years; 68.8% male), 41.9% of which had an infection-related ICU admission. Sites of infection were respiratory (50.0%), skin/wound/tissue (21.1%), blood (13.7%), urine (10.3%), pleural fluid/cerebrospinal fluid/other fluid (9.3%), line/device (2.9%), abdominal (1.0%), bone/joint (0.5%) and stool (0.5%). The most common pathogens were Pseudomonas aeruginosa (89.7%) and Escherichia coli (6.4%). Most patients (81.5%) had at least one comorbidity, with the most common being immunocompromised state (44.6%), sepsis (41.6%), heart disease (29.2%) and chronic pulmonary disease (27.2%). Renal replacement therapy was initiated in 21.5% of patients during index hospitalization, with 14.4% on continuous renal replacement therapy. The most common C/T regimen was 1.5 g every 8 h (36.9% of patients). About 51.6% of patients received C/T as third line or salvage (24.8% and 23.5% received C/T as first or second line, respectively). Median C/T treatment duration was 11.0 days (Q1, Q3: 7.0, 16.5 days). Clinical success was 53.4%. All-cause in-hospital mortality was 35.6% overall, and 13.8% infection related. Thirty-day all-cause readmission was 3.4% overall, and 1.7% infection related. Conclusions This multinational real-world study included a high number of critical care patients and reported outcomes associated with C/T use. In this very high-risk cohort presenting with severe Gram-negative infections, most C/T patients had beneficial outcomes despite their clinical complexity and late intervention with C/T.