BackgroundMultidrug-resistant Pseudomonas aeruginosa infections remain common in hospitals worldwide. We investigated the outcomes associated with the use of ceftolozane-tazobactam for the treatment of these infections.MethodsData were collected retrospectively from 20 hospitals across the United States about adults who received ceftolozane-tazobactam for the treatment of multidrug-resistant P aeruginosa infections of any source for at least 24 hours. The primary outcome was a composite of 30-day and inpatient mortality, and secondary outcomes were clinical success and microbiological cure. Multivariable regression analysis was conducted to determine factors associated with outcomes.ResultsTwo-hundred five patients were included in the study. Severe illness and high degrees of comorbidity were common, with median Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 19 (interquartile range [IQR], 11–24) and median Charlson Comorbidity Indexes of 4 (IQR, 3–6). Delayed initiation of ceftolozane-tazobactam was common with therapy started a median of 9 days after culture collection. Fifty-nine percent of patients had pneumonia. On susceptibility testing, 125 of 139 (89.9%) isolates were susceptible to ceftolozane-tazobactam. Mortality occurred in 39 patients (19%); clinical success and microbiological cure were 151 (73.7%) and 145 (70.7%), respectively. On multivariable regression analysis, starting ceftolozane-tazobactam within 4 days of culture collection was associated with survival (adjusted odds ratio [OR], 5.55; 95% confidence interval [CI], 2.14–14.40), clinical success (adjusted OR, 2.93; 95% CI, 1.40–6.10), and microbiological cure (adjusted OR, 2.59; 95% CI, 1.24–5.38).ConclusionsCeftolozane-tazobactam appeared to be effective in the treatment of multidrug-resistant P aeruginosa infections, particularly when initiated early after the onset of infection.

Across three studies, members of underrepresented groups felt that they were the center of others' attention when topics related to their group were discussed, and this experience was accompanied by negative emotions. Black participants reported that they would feel most ''in the spotlight'' when they were the only Black individual in a class in which the professor drew attention to their group with a provocative comment (Study 1). Black and Latino/Latina (Study 2) and female (Study 3) participants likewise reported that two confederates looked at them more when they heard (and believed the confederates had also heard) a recording that pertained to their group than when they heard a recording on a neutral topic-despite the fact that the confederates' gaze did not differ across conditions. We discuss these results in light of research on solo status and targeted social referencing.

BackgroundCeftolozane-tazobactam (TOL-TAZ) is a novel cephalosporin combination that is beneficial for the treatment of multidrug-resistant (MDR) Pseudomonas infections. However, little data are available on the utility of TOL-TAZ for patients with bloodstream infections (BSIs) caused by this organism.MethodsA retrospective, multicenter chart review was conducted at 11 hospitals to evaluate the utility of TOL-TAZ for MDR Pseudomonas BSIs from June 2016 to February 2018. Patients were included if they were over 18 years old with positive blood cultures for Pseudomonas aeruginosa and received TOL-TAZ for at least 24 hours. Patients were evaluated for in-hospital and 30-day mortality, as well as microbiologic and clinical cure.ResultsCharacteristic Results (N = 25)Male gender, n (%)15 (60)Age, median (range)60 (52–66)Charlson comorbidity index, median (IQR)5 (4–7)APACHE II score, median (IQR)19 (16.25–25.5)ICU, n (%)15 (60)Organ transplant, n (%)8 (32)Concomitant antibiotics used, n (%)14 (56)Aminoglycoside, n/N (%)8/14 (57)Fluoroquinolone, n/N (%)5/14 (35)Polymyxin, n/N (%)2/14 (14)β-Lactam, n/N (%)1/14 (7)Duration of TOL-TAZ, days (median, IQR)13 (8-14)Susceptibility to TOL-TAZ, n/N tested (%)19/20 (95)High dose (3g every 8 hours), n (%)6 (24)Renal dose adjustment, n (%)8 (32)Adverse events, n (%)1 (4)Primary infection30 day mortality, n/N (%)In-hospital mortality, n/N (%)Microbiologic success, n/N (%)Clinical Success, n/N (%)Primary bacteremia1/7 (14.3)0/7 (0)7/7 (100)6/7 (85.7)Pneumonia5/8 (62.5)5/8 (62.53/8 (37.5)3/8 (37.5)UTI1/6 (16.7)1/6 (16.7)6/6 (100)6/6 (100)Intra-abdominal0/4 (0)0/4 (0)4/4 (100)4/4 (100)30 day mortality, n (%)7 (28)In hospital mortality, n (%)6 (24)Microbiologic cure, n (%)20 (80)Clinical success, n (%)19 (76)ConclusionIn this multi-center evaluation of 25 patients from 11 health centers, mortality was seen at 30 days and at the end of stay in 28% and 24% of patients, respectively. Clinical and microbiologic success occurred in over 70% of patients. One patient developed C. difficile infection. The 7 patients with primary bacteremia had microbiologic success and survived their hospital stay. Two of 3 patients with pneumonia who survived received high dose TOL-TAZ. TOL-TAZ is an option for patients with MDR Pseudomonas bloodstream infections.Disclosures J. Gallagher, Achaogen: Consultant, Consulting fee. Merck: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee and Research grant. Allergan: Consultant and Speaker’s Bureau, Consulting fee. Astellas: Consultant and Speaker’s Bureau, Consulting fee. Cempra: Consultant, Consulting fee. Cidara: Consultant, Consulting fee. CutisPharma: Consultant, Consulting fee. Paratek: Consultant, Consulting fee. Shionogi: Consultant, Consulting fee. Tetraphase: Consultant, Consulting fee. Theravance: Consultant, Consulting fee. The Medicines Company: Consultant, Consulting fee. Melinta: Speaker’s Bureau, Consulting fee.

Eravacycline (ERV) was used in 35 patients for various infections. The most common pathogen was Klebsiella pneumoniae, and 30-day survival was 74%. Absence of 30-day recurrence and resolution of signs and symptoms of infection were 91% and 57%, respectively. ERV was well-tolerated, with adverse events leading to drug discontinuation in one patient.