Outpatient Parenteral Antimicrobial Therapy With Ceftolozane/Tazobactam via Continuous Infusion for Multidrug-Resistant Pseudomonas aeruginosa Osteomyelitis

Otero, Judith Álvarez; Ferreiro, José Luis; Rivo, Ana Sanjurjo; Aguado, Javier de la Fuente

doi:10.1093/ofid/ofaa409

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Real-world evidence concerning the use of ceftolozane-tazobactam in prolonged infusion are summarized in Table 2. Overall, one prospective study, one Monte Carlo simulation study, three retrospective studies, and four case reports [36 ▪▪ ,37,38 ▪▪ ,39–44] compared prolonged with intermittent infusion of ceftolozane-tazobactam or reported real-world experiences of ceftolozane-tazobactam prolonged infusion in the management of MDR P. aeruginosa infections (including pneumonia, bloodstream infections, complicated urinary or intrabdominal infections, bone or joint infections, meningitis, or skin and soft tissue infections). Pilmis et al [36 ▪▪ ] prospectively assessed 72 patients treated with ceftolozane-tazobactam for MDR P. aeruginosa infections (26.3% MIC ≥4 mg/L; 66.7% pneumonia), of whom 79% was admitted to intensive care unit (ICU), and more than half were immunocompromised.…”

Section: Introductionmentioning

confidence: 99%

Continuous versus intermittent infusion of antibiotics in Gram-negative multidrug-resistant infections

Gatti

Pea

2021

Current Opinion in Infectious Diseases

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Purpose of reviewThe aim of this review was to perform a critical reappraisal of the real-world evidence supporting administration by prolonged infusion of novel beta-lactams for the management of multidrug-resistant Gramnegative infections. Recent findingsReal-world evidence support the use of novel beta-lactams by prolonged infusion over intermittent infusion in terms of achieving aggressive pharmacokinetic/pharmacodynamic (PK/PD) target for either maximizing efficacy and clinical outcome or suppressing the emergence of resistance development. Continuous infusion of ceftolozane-tazobactam showed a marked superiority toward both intermittent and extended infusion (EI) in achieving a PK/PD target of 100%fT > 4 X MIC in infections caused by less-susceptible Pseudomonas aeruginosa isolates. No resistance development was found in critically ill or immunocompromised patients treated with EI ceftolozane-tazobactam compared to intermittent infusion. Prolonged infusion of ceftazidimeavibactam was negatively associated with mortality in patients affected by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae infections. Different challenging scenarios (patients showing augmented renal clearance of affected by deep-seated infections) could benefit from prolonged infusion to optimize the efficacy of novel agents.

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Section: Introductionmentioning

confidence: 99%

Continuous versus intermittent infusion of antibiotics in Gram-negative multidrug-resistant infections

Gatti

Pea

2021

Current Opinion in Infectious Diseases

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“…This is particularly useful in the nonacute health care setting, but to date, limited data exist on the utilization and outcome of C/T in this setting. The case reports described in the literature have shown successful outcomes with C/T in the outpatient setting primarily against MDR P. aeruginosa infections administered as continuous infusions [ 6 , 11 , 14 , 16 , 18 , 25 ]. Jones and colleagues reported symptomatic and microbiologic resolution in 6/7 and 3/3 patients, respectively, following continuous infusion of C/T for P. aeruginosa infections in the outpatient setting [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the treatments, including colistin and polymyxin B, precluded transition to outpatient therapy due to potential adverse events, especially nephrotoxicity [ 22–24 ]. In addition, real-world experience of C/T utilization and associated outcomes in the outpatient setting is limited to case studies [ 6 , 11 , 14 , 16 , 18 , 25 ]. Previous studies have reported successful outcomes following continuous infusion of C/T for P. aeruginosa infections in both inpatient and outpatient settings [ 11 , 14 ].…”

mentioning

confidence: 99%

“…Previous studies have reported successful outcomes following continuous infusion of C/T for P. aeruginosa infections in both inpatient and outpatient settings [ 11 , 14 ]. Other case reports have demonstrated successful outcomes with C/T in the community including 1 patient with MDR P. aeruginosa UTI [ 6 ], 1 patient with carbapenem-resistant (CR) P. aeruginosa lung abscess [ 25 ], and 2 cases with resistant P. aeruginosa osteomyelitis [ 16 , 18 ].…”

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confidence: 99%

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A Real-world Multicenter Outpatient Experience of Ceftolozane/Tazobactam

Anglen

Schroeder

Couch

2023

Open Forum Infectious Diseases

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Background Ceftolozane/tazobactam (C/T) is indicated for the treatment of complicated intra-abdominal infection (IAI), complicated urinary tract infection (UTI), and hospital-acquired/ventilator-associated bacterial pneumonia caused by susceptible bacteria. Since real-world data are limited, we report utilization and associated outcomes of C/T use in the outpatient setting. Methods This is a multicenter, retrospective study of patients who received C/T between May 2015 and December 2020. Demographics, infection types, C/T utilization characteristics, microbiology, and healthcare resource utilization were collected. Clinical success was defined as complete or partial symptom resolution at completion of C/T. Persistent infection and discontinuation of C/T were deemed non-success. Logistic regression analysis was used to identify predictors associated with clinical outcomes. Results A total of 126 patients (median age: 59 years, 59% male, median Charlson index: 5) from 33 office infusion centers were identified. Infection types included 27% bone and joint (BJI), 23% UTI, 18% respiratory tract (RTI), 16% IAI, 13% complicated skin and soft tissue (cSSTI), and 3% bacteremia. The median daily dose of C/T was 4.5 g primarily administered via elastomeric pumps as intermittent infusion. The most common Gram-negative pathogen was P. aeruginosa (63%), of which 66% were multidrug-resistant and 45% carbapenem-resistant. Enterobacterales were identified in 26% of isolates, of which 44% were extended-spectrum beta-lactamase producers. Overall clinical success rate of C/T was 84.7%. Non-successful outcomes were due to persistent infections (9.7%) and drug discontinuations (5.6%). Conclusions C/T was successfully used in the outpatient setting to treat a variety of serious infections with a high prevalence of resistant pathogens.

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“…Most patients have a history of having been recently hospitalized or being immunocompromised by diabetes mellitus ( 3 , 5 ). Otero et al described an 88-year-old woman with a history of obesity and type 2 diabetes mellitus who had acute osteomyelitis of the phalanx and metatarsal of the toe caused by P. aeruginosa soon after amputation of the fourth toe ( 2 ). As Otero et al noted, cases of osteomyelitis induced by P. aeruginosa in otherwise healthy adults are rare.…”

Section: Discussionmentioning

confidence: 99%

Community-acquired <i>Pseudomonas aeruginosa</i> Osteomyelitis Caused by an Injury from a Dishwasher

et al. 2022

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A 70-year-old healthy woman came to our hospital with right index finger pain and swelling after an injury incurred due to a commercial dishwasher. X-ray of the hand showed osteolysis around the distal interphalangeal joint. A further examination revealed Pseudomonas aeruginosa in the unexposed pus, so the patient was treated with a total of 10 weeks of cefepime, followed by levofloxacin and debridement twice. While this may have been a case of bacterial replacement, we should still consider P. aeruginosa infection in healthy adults when faced with an episode of waterborne injury.

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Outpatient Parenteral Antimicrobial Therapy With Ceftolozane/Tazobactam via Continuous Infusion for Multidrug-Resistant Pseudomonas aeruginosa Osteomyelitis

Cited by 6 publications

References 8 publications

Continuous versus intermittent infusion of antibiotics in Gram-negative multidrug-resistant infections

Continuous versus intermittent infusion of antibiotics in Gram-negative multidrug-resistant infections

A Real-world Multicenter Outpatient Experience of Ceftolozane/Tazobactam

Community-acquired <i>Pseudomonas aeruginosa</i> Osteomyelitis Caused by an Injury from a Dishwasher

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