Background. Few data are reported in the literature about the outcome of patients with severe extended-spectrum beta-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.

Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing Enterobacterales Infections: A Multicenter Nationwide Clinical Experience (CEFTABUSE II Study)

Rovelli, Cristina;Grossi, Paolo;Maddalena Peghin;Paolo Grossi;Cristina Rovelli;
2020

Abstract

Background. Few data are reported in the literature about the outcome of patients with severe extended-spectrum beta-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.
CRRT; ESBL; Enterobacterales; ceftolozane/tazobactam; septic shock
Bassetti, Matteo; Vena, Antonio; Giacobbe, Daniele Roberto; Falcone, Marco; Tiseo, Giusy; Giannella, Maddalena; Pascale, Renato; Meschiari, Marianna; Digaetano, Margherita; Oliva, Alessandra; Rovelli, Cristina; Carannante, Novella; Losito, Angela Raffaella; Carbonara, Sergio; Mariani, Michele Fabiano; Mastroianni, Antonio; Angarano, Gioacchino; Tumbarello, Mario; Tascini, Carlo; Grossi, Paolo; Mastroianni, Claudio Maria; Mussini, Cristina; Viale, Pierluigi; Menichetti, Francesco; Viscoli, Claudio; Russo, ; Alessandro, • CEFTABUSE Study Group: Matteo Bassetti; Antonio, Vena; Daniele Roberto Giacobbe, ; Claudio, Viscoli; Alessandro, Russo; Marco, Falcone; Giusy, Tiseo; Francesco, Menichetti; Stefano, Verdenelli; Silvia, Fabiani; Nadia, Castaldo; Davide, Pecori; Alessia, Carnellutti; Filippo, Givone; Elena, Graziano; Maria, Merelli; Barbara, Cadeo; Peghin, Maddalena; Maddalena, Giannella; Renato, Pascale; Pierlugi, Viale; Annamaria, Cattelan; Ludovica, Cipriani; Davide, Coletto; Cristina, Mussini; Margherita, Digaetano; Carlo, Tascini; Novella, Carannante; Claudio Maria Mastroianni, ; Russo, Gianluca; Alessandra, Oliva; Maria Rosa Ciardi, ; Camilla, Ajassa; Tiziana, Tieghi; Mario, Tumbarello; Angela Raffaella Losito, ; Francesca, Raffaelli; Grossi, PAOLO ANTONIO; Rovelli, Cristina; Stefania, Artioli; Giorgia, Caruana; Roberto, Luzzati; Giulia, Bontempo; Nicola, Petrosillo; Alessandro, Capone; Giuliano, Rizzardini; Massimo, Coen; Matteo, Passerini; Antonio, Mastroianni; Giuliana, Guadagnino; Filippo, Urso; Guglielmo, Borgia; Ivan, Gentile; Alberto Enrico Maraolo, ; Massimo, Crapis; Sergio, Venturini; Giustino, Parruti; Francesca, Trave; Gioacchino, Angarano; Sergio, Carbonara; Michele Fabiano Mariani, ; Massimo, Girardis; Antonio, Cascio; Claudia, Gioe; Marco, Anselmo; Emanuele, Malfatto
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2140752
Citazioni
  • ???jsp.display-item.citation.pmc??? 16
  • Scopus 28
  • ???jsp.display-item.citation.isi??? 30
social impact