A Multicenter Evaluation of Ceftolozane/Tazobactam Treatment Outcomes in Immunocompromised Patients With Multidrug-Resistant <i>Pseudomonas aeruginosa</i> Infections
Delaney E Hart, Jason C Gallagher, Laura Puzniak, Elizabeth B. Hirsch, C/T Alliance to deliver Real-world Evidence (CARE), Aiman Bandali, Kirthana Beaulac, Tiffany E. Bias, Kenneth Biason, Christopher M. Bland, Kimberly Boeser, Saira Chaudhry, Kimberly C. Claeys, Ashley L Cubillos, Brandon Dionne, Deepali Dixit, Claudine El‐Beyrouty, Abdulrahman Elabor, Elizabeth Gancher, Yi Guo, Nicole Harrington, Emily L. Heil, Jon Hiles, Bruce M Jones, Madeline King, Xiaoning Lu, Monica V. Mahoney, Dorothy McCoy, Erin K McCreary, Esther Molnar, Ashley Piche, Janet Raddatz, Lynette Richards, Nidhi Saraiya, Michael J. Satlin, Jin‐Suck Suh, Abinash Virk, Nikunj Vyas, Daohai Yu
Abstract
Abstract Background Real-world data assessing outcomes of immunocompromised patients treated with ceftolozane/tazobactam (C/T) are limited. This study evaluated treatment and clinical outcomes of immunocompromised patients receiving C/T for multidrug-resistant (MDR) Pseudomonas aeruginosa. Methods This was a 14-center retrospective cohort study of adult immunocompromised inpatients treated for ≥24 hours with C/T for MDR P. aeruginosa infections. Patients were defined as immunocompromised if they had a history of previous solid organ transplant (SOT), disease that increased susceptibility to infection, or received immunosuppressive therapies. The primary outcomes were all-cause 30-day mortality and clinical cure. Results Sixty-nine patients were included; 84% received immunosuppressive agents, 68% had a history of SOT, and 29% had diseases increasing susceptibility to infection. The mean patient age was 57 ± 14 years, and the median (interquartile range) patient Acute Physiology and Chronic Health Evaluation II and Charlson Comorbidity Index scores were 18 (13) and 5 (4), respectively, with 46% receiving intensive care unit care at C/T initiation. The most frequent infection sources were respiratory (56%) and wound (11%). All-cause 30-day mortality was 19% (n = 13), with clinical cure achieved in 47 (68%) patients. Clinical cure was numerically higher (75% vs 30%) in pneumonia patients who received 3-g pneumonia regimens vs 1.5-g regimens. Conclusions Of 69 immunocompromised patients treated with C/T for MDR P. aeruginosa, clinical cure was achieved in 68% and mortality was 19%, consistent with other reports on a cross-section of patient populations. C/T represents a promising agent for treatment of P. aeruginosa resistant to traditional antipseudomonal agents in this high-risk population.