Methods: Retrospective case series of patients admitted to Cleveland Clinic Health System who received C/T. The primary objectives were to describe the utilization of C/T and determine clinical and microbiological cure rates. Secondary objectives included determining the percent susceptibility of PsA to C/T.
Results: Between April 2015 and February 2016 there were 60 patient encounters evaluated. Most patients were in the intensive care unit (ICU) (61.7%) and many received C/T as combination therapy (48.3%). The mean duration of C/T use was 8 days. The most common source of infection was pneumonia (34 [56.7%]), followed by intra-abdominal infection (11 [18.3%]); 21.7% of encounters had a concomitant bacteremia. The primary pathogen isolated was PsA in 52 (86.7%) encounters; 40.4% of which were MDR and 25% were extensively drug resistant (XDR). The overall susceptibility rate for C/T was 83% against PsA. The rates against non-MDR, MDR and XDR isolates were 94.1%, 94.7% and 45.5%, respectively. Clinical and microbiological cure rates were 64.1% and 38.5%, respectively. Twenty-four patients died during hospitalization.
Conclusion: In this primarily ICU patient population, the clinical cure rate was 64%. In patients with limited alternative antimicrobial options, this rate compares favorably to outcomes of therapy with greater toxicity. C/T susceptibility rates were higher among non-MDR and MDR PsA isolates compared to XDR. The overall susceptibility of PsA to C/T (83%) observed in this evaluation highlights the importance of susceptibility confirmation to guide therapy. Prospective clinical data are needed to evaluate the use of C/T in this severely ill patient population.
V. Athans, None
A. Pallotta, None
S. Bass, None
S. Bauer, None
K. Brizendine, None