2382. Ceftolozane/tazobactam for the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infections in Immunocompromised Patients: A Multi-Center Study.
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • project copy copy-converted.pdf (482.8 kB)
  • Background: Ceftolozane/tazobactam (TOL-TAZ) is a novel cephalosporin antibiotic combined with a known beta-lactamase inhibitor. It has activity against some extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and multidrug-resistant Pseudomonas aeruginosa (MDRPA). To date, little experience has been published on outcomes with TOL-TAZ for MDRPA infections in immunocompromised patients.

    Methods: This was a retrospective study of adult patients (≥18 years) with an immunocompromising condition (solid-organ transplant; hematologic malignancy; solid tumors; metastatic cancer) at 20 academic medical centers who had microbiologically confirmed MDRPA isolated in culture and received TOL-TAZ for at least 24 hours. 30-day survival, in-hospital mortality, and the rates of microbiologic and clinical cure were assessed.

    Results:

    Characteristic

    Result (N=65)

    Immunocompromising condition:

    Solid-organ transplant

    Solid tumor

    Leukemia

    Lymphoma/Multiple Myeloma

    Metastatic cancer

    n(%)

    35 (53.8)

    20 (30.7)

    4 (6.1)

    3 (4.6)

    3 (4.6)

    Male, n(%)

    38 (58.4)

    Age (median, IQR)

    64 (20-87)

    Charlson Comorbidity Index (median, IQR)

    6 (1-12)

    APACHE II score (median, IQR)

    20 (4-41)

    ICU, n(%)

    37(56.9)

    Hospital day index infection diagnosed (median, IQR)

    17 (0-265)

    Hospital day TOL-TAZ started (median, IQR)

    19 (0-284)

    3grs q8hrs, n%

    1.5grs q8hrs, n%

    23 (35.3)

    23 (35.3)

    Concomitant IV antibiotics, n(%)

    Aminoglycoside, n/N(%)

    Fluoroquinolone, n/N(%)

    Polymyxin, n/N(%)

    Beta-lactam, n/N(%)

    15 (23.0)

    7/15 (46.7)

    4/15 (26.7)

    3/15 (20)

    1/15 (6.6)

    TOL-TAZ susceptible isolates, n/N (%)

    35/37 (94.6)

    Outcomes by primary infection

    Primary infection

    n (%)

    30-day survival n/N(%)

    Microbiologic cure n/N(%)

    Clinical cure n/N(%)

    Pneumonia

    33 (50.7)

    30/33 (90.9)

    24/33 (72.7)

    28/33 (84.8)

    Wound/Bone/Joint

    12 (18.4)

    8/12 (66.6)

    7/12 (58.3)

    7/12 (58.3)

    UTI

    9 (13.8)

    7/9 (77.7)

    7/9 (77.7)

    8/9 (88.8)

    Intra-abdominal

    7 (10.7)

    7/7 (100)

    7/7 (100)

    4/7 (57.1)

    Bloodstream

    4 (6.1)

    4/4 (100)

    4/4 (100)

    4/4 (100)

    Overall outcomes, n(%)

    30-day survival

    56 (86.1)

    In-hospital mortality

    17 (26.1)

    Microbiologic cure

    49 (75.3)

    Clinical cure

    51(78.4)

    Conclusion: In this study of 65 critically-ill immunocompromised patients, the 30-day survival was 86.1%; clinical cure was78.4% and microbiologic cure 75.3%. TOL-TAZ is a viable option for immunocompromised patients with MDRPA infections.

    Abdulrahman Elabor, MD, Infectious Diseases, Temple University Hospital, Philadelphia, PA, Esther Molnar, MD, Infectious Disease, Temple University Hospital, Philadelphia, PA, Madeline King, Pharm D, Pharmacy, University of the Sciences, Philadelphia College of Pharmacy, Philadelphia, PA, Jason Gallagher, PharmD, FCCP, FIDSA, BCPS, Temple University School of Pharmacy, Philadelphia, PA and TOL-TAZ for Resistant Pseudomonas Study Group

    Disclosures:

    A. Elabor, None

    E. Molnar, None

    M. King, None

    J. Gallagher, Achaogen: Consultant , Consulting fee . Merck: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee and Research grant . Allergan: Consultant and Speaker's Bureau , Consulting fee . Astellas: Consultant and Speaker's Bureau , Consulting fee . Cempra: Consultant , Consulting fee . Cidara: Consultant , Consulting fee . CutisPharma: Consultant , Consulting fee . Paratek: Consultant , Consulting fee . Shionogi: Consultant , Consulting fee . Tetraphase: Consultant , Consulting fee . Theravance: Consultant , Consulting fee . The Medicines Company: Consultant , Consulting fee . Melinta: Speaker's Bureau , Consulting fee .

    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.