Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing Enterobacterales Infections: A Multicenter Nationwide Clinical Experience (CEFTABUSE II Study)
Author:
Bassetti Matteo1, Vena Antonio1, Giacobbe Daniele Roberto1, Falcone Marco2, Tiseo Giusy2, Giannella Maddalena3, Pascale Renato3, Meschiari Marianna4, Digaetano Margherita4, Oliva Alessandra56ORCID, Rovelli Cristina7, Carannante Novella8, Losito Angela Raffaella9, Carbonara Sergio10, Mariani Michele Fabiano10, Mastroianni Antonio11, Angarano Gioacchino10, Tumbarello Mario12, Tascini Carlo8, Grossi Paolo7, Mastroianni Claudio Maria5, Mussini Cristina4, Viale Pierluigi3, Menichetti Francesco2, Viscoli Claudio1, Russo Alessandro2, , Bassetti Matteo, Vena Antonio, Giacobbe Daniele Roberto, Viscoli Claudio, Russo Alessandro, Falcone Marco, Tiseo Giusy, Menichetti Francesco, Verdenelli Stefano, Fabiani Silvia, Castaldo Nadia, Pecori Davide, Carnellutti Alessia, Givone Filippo, Graziano Elena, Merelli Maria, Cadeo Barbara, Peghin Maddalena, Giannella Maddalena, Pascale Renato, Viale Pierlugi, Cattelan Annamaria, Cipriani Ludovica, Coletto Davide, Mussini Cristina, Digaetano Margherita, Tascini Carlo, Carannante Novella, Mastroianni Claudio Maria, Gianluca Russo, Oliva Alessandra, Ciardi Maria Rosa, Ajassa Camilla, Tieghi Tiziana, Tumbarello Mario, Losito Angela Raffaella, Raffaelli Francesca, Grossi Paolo, Rovelli Cristina, Artioli Stefania, Caruana Giorgia, Luzzati Roberto, Bontempo Giulia, Petrosillo Nicola, Capone Alessandro, Rizzardini Giuliano, Coen Massimo, Passerini Matteo, Mastroianni Antonio, Guadagnino Giuliana, Urso Filippo, Borgia Guglielmo, Gentile Ivan, Maraolo Alberto Enrico, Crapis Massimo, Venturini Sergio, Parruti Giustino, Trave Francesca, Angarano Gioacchino, Carbonara Sergio, Mariani Michele Fabiano, Girardis Massimo, Cascio Antonio, Gioe Claudia, Anselmo Marco, Malfatto Emanuele
Affiliation:
1. Department of Health Sciences, University of Genoa, Genoa, Italy 2. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 3. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy 4. Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy 5. Department of Public Health and Infectious Diseases, ‘Sapienza’ University of Rome, Rome, Italy 6. IRCCS Neuromed, Pozzilli, Isernia, Italy 7. Department of Infectious and Tropical Diseases, University of Insubria, Ospedale di Circolo-Fondazioni Macchi, Varese, Italy 8. First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy 9. UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy 10. Clinic of Infectious Diseases, University of Bari, Bari, Italy 11. Infectious Diseases Unit, ‘Annunziata’ Hospital, Cosenza, Italy 12. UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
Abstract
Abstract
Background
Few data are reported in the literature about the outcome of patients with severe extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy.
Methods
A multicenter retrospective study was performed in Italy (June 2016–June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy.
Results
C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index >4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9–3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8–7.9; P < .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9–5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01–0.34; P < .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14–0.55; P < .001) were associated with clinical success.
Conclusions
Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
51 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|