Use of Ceftolozane/Tazobactam in the Treatment of Multidrug-resistant Pseudomonas aeruginosa Bloodstream Infection in a Pediatric Leukemia Patient

Aitken, Samuel L; Kontoyiannis, Dimitrios P.; DePombo, April; Bhatti, Micah M.; Tverdek, Frank P.; Gettys, Suzanne C; Nicolau, David P.; Núñez, César

doi:10.1097/inf.0000000000001228

Cited by 33 publications

(29 citation statements)

References 10 publications

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“…For the small cohort of patients with severe immediate-type hypersensitivity reaction, aztreonam [ 85 ] may be used as a—less well-studied—alternative (CIIu). In this setting, the addition of a vancomycin or teicoplanin to aztreonam may be considered due to the lack of activity of aztreonam against gram-positive bacteria (CIII) [ 86 ].For newer broad-spectrum antibacterial agents, such as ertapenem [ 87 ], which has insufficient activity against Pseudomonas spp., doripenem [ 88 ], ceftazidime-avibactam [ 89 ], ceftolozane-tazobactam [ 64 , 90 ], or cefozopran [ 91 ], there is very limited data on their safety and efficacy for empirical treatment in adult febrile neutropenic cancer patients available so far. Tigecycline in combination with an antipseudomonal beta-lactam has shown benefit in terms of a lesser need for treatment modification in institutions with excess rates of multidrug-resistant pathogens [ 92 ] and for 2nd- or 3rd-line treatments [ 93 ].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Heinz

Buchheidt

Christopeit³

et al. 2017

Ann Hematol

144

135

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Fever may be the only clinical symptom at the onset of infection in neutropenic cancer patients undergoing myelosuppressive chemotherapy. A prompt and evidence-based diagnostic and therapeutic approach is mandatory. A systematic search of current literature was conducted, including only full papers and excluding allogeneic hematopoietic stem cell transplant recipients. Recommendations for diagnosis and therapy were developed by an expert panel and approved after plenary discussion by the AGIHO. Randomized clinical trials were mainly available for therapeutic decisions, and new diagnostic procedures have been introduced into clinical practice in the past decade. Stratification into a high-risk versus low-risk patient population is recommended. In high-risk patients, initial empirical antimicrobial therapy should be active against pathogens most commonly involved in microbiologically documented and most threatening infections, including Pseudomonas aeruginosa, but excluding coagulase-negative staphylococci. In patients whose expected duration of neutropenia is more than 7 days and who do not respond to first-line antibacterial treatment, specifically in the absence of mold-active antifungal prophylaxis, further therapy should be directed also against fungi, in particular Aspergillus species. With regard to antimicrobial stewardship, treatment duration after defervescence in persistently neutropenic patients must be critically reconsidered and the choice of anti-infective agents adjusted to local epidemiology. This guideline updates recommendations for diagnosis and empirical therapy of fever of unknown origin in adult neutropenic cancer patients in light of the challenges of antimicrobial stewardship.Electronic supplementary materialThe online version of this article (doi:10.1007/s00277-017-3098-3) contains supplementary material, which is available to authorized users.

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Section: Antimicrobial Therapymentioning

confidence: 99%

Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Heinz

Buchheidt

Christopeit³

et al. 2017

Ann Hematol

144

135

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“…There are no data about ceftolozane‐tazobactam in endocarditis in adults, and there are no published studies of ceftolozane‐tazobactam in paediatric patients. The only clinical experiences are with a 9‐year‐old child with leukaemia who presented a persistent bloodstream infection caused by multidrug‐resistant P. aeruginosa, which was treated successfully with ceftolozane‐tazobactam . A dose of 50 mg/kg of the ceftolozane component was administered intravenously every 8 h over 3 h in extended infusion.…”

Section: Discussionmentioning

confidence: 99%

Successful ceftolozane‐tazobactam rescue therapy in a child with endocarditis caused by multidrug‐resistant Pseudomonas aeruginosa

Martín‐Cazaña

Grau

Epalza

et al. 2019

J Paediatrics Child Health

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The patient was a 5-year-old boy with a complex congenital heart disease (double-outlet right ventricle with Fallot's physiology and single coronary artery anomaly) surgically repaired with ventricular septal defect closure and pulmonary homograft conduit between the pulmonary artery and right ventricle. The patient also had a severe tracheobronchomalacia, corrected with tracheal and bronchial stents, tracheostomy and home ventilatory support. He was colonised with sensitive Pseudomonas aeruginosa that was persistently isolated in respiratory secretions and in skin swabs. Two months before admission, progressive conduit stenosis and right ventricle failure were observed, and 1 month later, a percutaneous stent implantation in the conduit was performed.The child presented to the emergency care unit with hypoxemia, hypoglycaemia and lactic acidosis. He was admitted to the paediatric intensive care unit (PICU) for haemodynamic and ventilatory support. Echocardiography at admission showed right heart failure signs and moderately stenosed right ventriclepulmonary artery conduit. A total of 24 hours after admission, he developed fever and hypotension, and blood tests showed Creactive protein of 15.49 mg/dL, 81.95 ng/mL procalcitonin, 30.6 × 1000/μL white blood cells and 27.10 × 1000/μL neutrophils. Piperacillin-tazobactam plus linezolid were started, but P. aeruginosa was isolated in blood cultures, and treatment was changed to ceftazidime plus tobramycin in accordance with antimicrobial susceptibility test. A new echocardiography was performed 72 h after admission and showed images compatible with vegetation in the pulmonary artery conduit. On the eighth day of admission, the patient developed progressive conduit stenosis, right ventricle failure, persistence of P. aeruginosa in blood cultures and absence of clinical improvement despite antibiotic therapy. The conduit was replaced, and P. aeruginosa was isolated from conduit culture.After surgery, the patient demonstrated clinical improvement and remained afebrile, with negative blood cultures during the following 3 weeks, treated with ceftazidime plus tobramycin. However, 24 days after surgery (day 32 of admission), the patient relapsed with fever and general malaise. New echocardiography showed tricuspid valve vegetation (15 × 6 mm) ( Fig. 1) with moderate tricuspid regurgitation. Then, P. aeruginosa resistant to ceftazidime, cefepime, aztreonam and fluorquinolones, and minimum inhibitory concentration (MIC) for meropenem of 4 μg/mL, was isolated in blood cultures. Treatment was changed to high-dose meropenem (120 mg/kg/day) in extended infusion (3 h), three times a day, plus tobramycin, and further cardiac surgery was planned. Despite the new antibiotic treatment, the child remained febrile, and P. aeruginosa persisted in blood cultures. On day 43, the patient presented with bacteraemic aspect, fever and tachycardia, so a possible pulmonary embolism of vegetation was suspected. Susceptibility to ceftolozane-tazobactam was tested and showed an MIC of 2 μg/mL. On day...

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“…Interestingly, in the last episode, the P. aeruginosa isolate displayed resistance (and clinical failure) to ceftazidime/avibactam and a Minimal Inhibitory Concentration to ceftolozane/tazobactam of 8 µg/mL. The patient was therefore successfully treated with a slightly lower dose of ceftolozane/tazobactam (40 mg/kg of ceftolozane component) with a frequency of 3-hour infusion four times a day in combination with tobramycin and ciprofloxacin, to which the isolate displayed in vitro susceptibility [44]. Finally, So at al.…”

Section: Ceftolozane/tazobactammentioning

confidence: 99%

Ceftazidime/Avibactam and Ceftolozane/Tazobactam for Multidrug-Resistant Gram Negatives in Patients with Hematological Malignancies: Current Experiences

Criscuolo

Trecarichi

2020

Antibiotics

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Patients suffering from hematological malignancies are at high risk for severe infections, including in particular bloodstream infections, which represent one of the most frequent life-threatening complications for these patients, with reported mortality rates reaching 40%. Furthermore, a worrisome increase in antimicrobial resistance of Gram-negative bacteria (e.g., cephalosporin- and/or carbapenem-resistant Enterobacteriaceae and multidrug-resistant (MDR) Pseudomonas aeruginosa) involved in severe infectious complications among patients with hematological malignancies has been reported during the last years. The two novel combination of cephalosporins and β-lactamase inhibitors, ceftolozane/tazobactam and ceftazidime/avibactam, were recently approved for treatment of complicated intra-abdominal and urinary tract infections and nosocomial pneumonia and display activity against several MDR Gram-negative strains. Although not specifically approved for neutropenic and/or cancer patients, these drugs are used in this setting due to increasing rates of infections caused by MDR Gram-negative bacteria. The aim of this review is to describe the actual evidence from scientific literature about the “real-life” use of these two novel drugs in patients with hematological malignancies and infections caused by MDR Gram-negative bacteria.

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Use of Ceftolozane/Tazobactam in the Treatment of Multidrug-resistant Pseudomonas aeruginosa Bloodstream Infection in a Pediatric Leukemia Patient

Cited by 33 publications

References 10 publications

Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Successful ceftolozane‐tazobactam rescue therapy in a child with endocarditis caused by multidrug‐resistant Pseudomonas aeruginosa

Ceftazidime/Avibactam and Ceftolozane/Tazobactam for Multidrug-Resistant Gram Negatives in Patients with Hematological Malignancies: Current Experiences

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