Use of continuous-infusion ceftolozane/tazobactam for resistant Gram-negative bacterial infections: a retrospective analysis and brief review of the literature

Sheffield, Mary; Nelson, Dana D.; O’Neal, Melissa; Gould, Alyssa P; Bouchard, Jeannette; Nicolau, David P.; Justo, Julie Ann; Hucks, Jennifer; Bookstaver, P. Brandon

doi:10.1016/j.ijantimicag.2020.106158

Cited by 24 publications

(16 citation statements)

References 19 publications

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“…In addition, the emergence of resistance within microbial species, including previously susceptible strains, has increased interest in antibiotic dosing and in adapting dosing and administration methods. Thus, several studies [ 20 , 48 , 50 , 67 , 77 , 78 ] have emphasized the importance of administration methods in the outcome of infected patients.…”

Section: Discussionmentioning

confidence: 99%

When and How to Use MIC in Clinical Practice?

et al. 2022

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Bacterial resistance to antibiotics continues to be a global public health problem. The choice of the most effective antibiotic and the use of an adapted dose in the initial phase of the infection are essential to limit the emergence of resistance. This will depend on (i) the isolated bacteria and its resistance profile, (ii) the pharmacodynamic (PD) profile of the antibiotic used and its level of toxicity, (iii) the site of infection, and (iv) the pharmacokinetic (PK) profile of the patient. In order to take account of both parameters to optimize the administered treatment, a minimal inhibitory concentration (MIC) determination associated with therapeutic drug monitoring (TDM) and their combined interpretation are required. The objective of this narrative review is thus to suggest microbiological, pharmacological, and/or clinical situations for which this approach could be useful. Regarding the microbiological aspect, such as the detection of antibiotic resistance and its level, the preservation of broad-spectrum β-lactams is particularly discussed. PK-PD profiles are relevant for difficult-to-reach infections and specific populations such as intensive care patients, cystic fibrosis patients, obese, or elderly patients. Finally, MIC and TDM are tools available to clinicians, who should not hesitate to use them to manage their patients.

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Section: Discussionmentioning

confidence: 99%

When and How to Use MIC in Clinical Practice?

et al. 2022

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“…The continuous infusion of CTZ and CZA with a loading dose has been successfully used for deep-seated infections, achieving high clinical and microbiological cure rates. Therapeutic drug monitoring (TDM) confirmed that CI achieved PK/PD targets throughout the dosing interval [ 103 , 104 ]. Meropenem/vaborbactam and CFD showed physicochemical stability in syringes in normal saline for 8h and 24h, respectively, opening the possibility of prolonged or continuous infusion [ 105 ].…”

Section: How To Administer These New Antibiotics (Pk/pd Criteria)mentioning

confidence: 99%

What to Do with the New Antibiotics?

Chaïbi

Jauréguy²,

Rego

et al. 2023

Antibiotics

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Multidrug-resistant Gram-negative bacteria-related infections have become a real public health problem and have exposed the risk of a therapeutic impasse. In recent years, many new antibiotics have been introduced to enrich the therapeutic armamentarium. Among these new molecules, some are mainly of interest for the treatment of the multidrug-resistant infections associated with Pseudomonas aeruginosa (ceftolozane/tazobactam and imipenem/relebactam); others are for carbapenem-resistant infections associated with Enterobacterales (ceftazidime/avibactam, meropenem/vaborbactam); and finally, there are others that are effective on the majority of multidrug-resistant Gram-negative bacilli (cefiderocol). Most international guidelines recommend these new antibiotics in the treatment of microbiologically documented infections. However, given the significant morbidity and mortality of these infections, particularly in the case of inadequate therapy, it is important to consider the place of these antibiotics in probabilistic treatment. Knowledge of the risk factors for multidrug-resistant Gram-negative bacilli (local ecology, prior colonization, failure of prior antibiotic therapy, and source of infection) seems necessary in order to optimize antibiotic prescriptions. In this review, we will assess these different antibiotics according to the epidemiological data.

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“…In three randomized controlled trials (RCT) overall 66 patients were bacteremic [34][35][36]. Recent small retrospective series (Table 2) suggest use of a higher dose (3gr Â 3/d), administered as extended (3 h) or continuous infusion (Ruiz et al, 2020, Sheffield et al, 2020. A meta-analysis of retrospective studies compared TOL-TAZ monotherapy vs. combination for any infection (most by Pseudomonas aeruginosa).…”

Section: Ceftolozane-tazobactammentioning

confidence: 99%

New evidence for managing Gram-negative bloodstream infections

Nutman

Tellapragada

Giske

et al. 2021

Current Opinion in Infectious Diseases

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Purpose of reviewGram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findingsNew rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened ( 7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined. SummaryRDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.

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Use of continuous-infusion ceftolozane/tazobactam for resistant Gram-negative bacterial infections: a retrospective analysis and brief review of the literature

Cited by 24 publications

References 19 publications

When and How to Use MIC in Clinical Practice?

When and How to Use MIC in Clinical Practice?

What to Do with the New Antibiotics?

New evidence for managing Gram-negative bloodstream infections

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