2423. Effectiveness and Safety of Ceftolozane/Tazobactam (TOL/TAZ) Use for Carbapenem-Resistant Pseudomonas Infections in Children
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Zerbaxa poster IDweek 2018.pdf (199.4 kB)
  • Background:

    Evidence for ceftolozane/tazobactam use in children is limited. We describe herein the outcomes of children treated with TOL/TAZ for various types of infections caused by carbapenem-resistant Pseudomonas aeruginosa (CR-PA).

    Methods:

    Retrospective analysis of children who received TOL/TAZ while hospitalized from 2014 to 2017. Clinical and microbiological outcomes and safety data were analyzed.

    Results:

    8 children received TOL/TAZ for CR-PA infections (Table): 3 cystic fibrosis (CF) exacerbations, 2 ventilator-associated pneumonia (VAP), 1 tracheitis, 1 chronic osteomyelitis (OM), 1 complicated intra-abdominal infection with urinary tract infection (cIAI/cUTI). All initial isolates were susceptible to TOL/TAZ per E-test. Creatinine clearance (CrCl) >90 mL/min in all patients. Median total length of stay (LOS) was 73 days (d) (range 11-221) and median inpatient duration of TOL/TAZ was 13.5 d (range 5-61). One patient died from causes unrelated to infection; all other patients achieved clinical cure and TOL/TAZ was well tolerated. One patient experienced a slight increase in liver function tests that required dose reduction. 3 children received multiple courses (range: 2-8) for CF exacerbations. TOL/TAZ resistant PA was detected in 1 patient after 2 months of therapy for OM. TOL/TAZ intermediately susceptible PA was detected in 1 patient after 7 courses of therapy for CF exacerbation, though subsequent cultures grew TOL/TAZ susceptible PA.

    Conclusion:

    TOL/TAZ was effective in treating various CR-PA infections. Therapy was well tolerated with no significant adverse events. Reduced TOL/TAZ susceptibility after prolonged or repeated courses was observed and presents potential opportunities for dose optimization and antimicrobial stewardship.

    Pt #

    Age, yr

    Indication

    CrCl, mL/min

    Dose, TOL mg/kg (g) per dose every 8 hours

    Duration, d

    LOS, d

    # of courses

    30 d readmit (Y/N)

    1

    14

    cIAI/cUTI

    139

    13.8 (1.5)

    19

    142

    1

    N

    2

    16

    OM

    155

    16.2 (1.5)

    61

    221

    1

    N

    3

    19

    CF

    95

    34.8 (3)

    9

    14

    2

    Y

    4

    17

    VAP

    223

    32.3 (3)

    17

    65

    1

    N

    5

    14

    CF

    142

    30 (1.5)

    15

    36

    7

    N

    6

    11

    CF

    148

    21.3 (1.5)

    5

    11

    3

    Y

    7

    0.25

    VAP

    198

    20 (0.08)

    12

    98

    1

    N

    8

    3

    Tracheitis

    145

    18.8 (0.25)

    10

    81

    1

    N

    Leah Molloy, Pharm D1, Ibrahim Abdulhamid, MD2,3, Ruma Srivastava, MD2,3 and Jocelyn Ang, MD3,4, (1)Pharmacy, Children's Hospital of Michigan, Detroit, MI, (2)Pulmonary Medicine Division, Children's Hospital of Michigan, Detroit, MI, (3)Pediatrics, Wayne State University School of Medicine, Detroit, MI, (4)Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, MI

    Disclosures:

    L. Molloy, None

    I. Abdulhamid, None

    R. Srivastava, None

    J. Ang, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.