2055. Ceftolozane/Tazobactam: Outpatient Treatment of Gram-Negative Infections at Physician Office Infusion Centers (POICs) 
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDWeek 2016_Nathan et al_2055_Ceftolozane Tazobactam.pdf (372.7 kB)
  • Background: Ceftolozane/tazobactam (C/T) is a novel cephalosporin and beta-lactamase inhibitor combination with enhanced activity against multidrug-resistant (MDR) Pseudomonas aeruginosaand extended-spectrum β-lactamase (ESBL)-producing strains. With increasing bacterial resistance coupled with recurrent drug shortages and toxicities with other agents, C/T may be an option in outpatient management of these infections. We report the first outpatient clinical experience of C/T in POICs.

    Methods: A retrospective review was conducted of all patients (pts) receiving C/T in 12 POICs from March 2015 to May 2016. Demographics, therapy characteristics, pathogens, adverse events (AEs), and clinical outcomes were evaluated. Clinical success at end of therapy was defined as cured (complete resolution of infection) or improved (partial resolution of infection and/or continued oral antibiotics).

    Results: A total of 28 pts were identified with a mean age of 57 years and 43% female. Infections included 8 respiratory infections (RI), 7 complicated intra-abdominal infections (cIAI), 7 complicated urinary tract infections (cUTI) and 6 complicated skin and soft tissue infections (cSSTI). Multidrug resistant (MDR) pathogens (n=19, 68%) were predominant including MDR Pseudomonas aeruginosa (n=12), ESBL positive (ESBL+) Escherichia coli (n=5), ESBL+ Klebsiella oxytoca (n=1), and MDR Achromobacter xylosoxidans(n=1). Half (n=14) of pts had mixed infections. Median length of therapy was 17 days (range 7-58). Rationale for C/T included lack of alternative due to MDR organism (n=15) and treatment failure on prior antibiotics (n=13). Therapy was initiated in the POIC in 43%. The majority of patients (n=21, 75%) self-administered C/T at home using elastomeric devices. AEs occurred in 11 pts, most commonly diarrhea (n=3), nausea/vomiting (n=2), and fatigue (n=2). Clinical success was achieved in 89% (24 of 27 evaluable pts), with 100% success in the 11 pts who had treatment initiated in POIC.

    Conclusion: C/T outpatient use for a variety of MDR pathogens causing challenging infections was highly effective. AEs were tolerable, suggesting a valuable outpatient treatment option for MDR gram-negative pathogens. Additional studies are warranted.

    Ramesh V. Nathan, MD, FIDSA1, Fernando S. Alvarado, MD, FACP, MPH & TM2, Richard C. Prokesch, MD, FACP, FIDSA3, Quyen Luu, MD4, Thomas K. Sleweon, MD5, Claudia P. Schroeder, PharmD, PhD6 and Lucinda J. Van Anglen, PharmD6, (1)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (2)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL, (3)Infectious Diseases Associates, Riverdale, GA, (4)Quyen Luu, MD, Macon, GA, (5)ID Specialists of Indiana, Highland, IN, (6)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    R. V. Nathan, Merck: Speaker's Bureau , Speaker honorarium
    Actavis: Speaker's Bureau , Speaker honorarium

    F. S. Alvarado, None

    R. C. Prokesch, None

    Q. Luu, None

    T. K. Sleweon, None

    C. P. Schroeder, None

    L. J. Van Anglen, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.