P. aeruginosa Infections with Ceftolozane/Tazobactam (C/T) versus a Polymyxin or Aminoglycoside (Poly/AG) based regimen: A Multicenter Comparative Effectiveness Study"> Abstract: "Real World" Treatment of Multi-drug Resistant (MDR) or Extensively-drug Resistant (XDR) <em>P. aeruginosa</em> Infections with Ceftolozane/Tazobactam (C/T) versus a Polymyxin or Aminoglycoside (Poly/AG) based regimen: A Multicenter Comparative Effectiveness Study (IDWeek 2018) P. aeruginosa Infections with Ceftolozane/Tazobactam (C/T) versus a Polymyxin or Aminoglycoside (Poly/AG) based regimen: A Multicenter Comparative Effectiveness Study">
2406. "Real World" Treatment of Multi-drug Resistant (MDR) or Extensively-drug Resistant (XDR) P. aeruginosa Infections with Ceftolozane/Tazobactam (C/T) versus a Polymyxin or Aminoglycoside (Poly/AG) based regimen: A Multicenter Comparative Effectiveness Study
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • CT poster ID week 092618 final.pdf (202.4 kB)
  • Background:

    The emergence of MDR/XDR P. aeruginosa has led to a reliance on suboptimal agents (Poly/AG) for the management of infections due to this pathogen. C/T is a novel agent with excellent in vitro activity against resistant P.aeruginosa that is indicated for cUTI and cIAI and being reviewed for VABP; however real world comparative data for invasive infections are lacking. The purpose of this study was to assess comparative rates of clinical cure, mortality, and acute kidney injury (AKI) among patients treated with C/T versus a Poly/AG based regimen for P. aeruginosa infections

    Methods:

    This was a retrospective, multi-site cohort of adult inpatients from 1/1/12-2/28-18 with infections due to MDR or XDR P. aeruginosa. Patients treated for >/= 48 hours with C/T or a Poly/AG-based regimen were eligible for inclusion. Patients with a creatinine clearance < 20 mL/min, or those requiring renal replacement therapy at baseline were excluded. Bivariate comparisons for baseline clinical characteristics and outcomes were assessed.

    Results:

    A total of 117 (57 C/T, 60 Poly/AG) patients were included. Baseline characteristics, infection source, severity of illness, and time to appropriate therapy were similar between the treatment groups. Mean age was 58.6 ± 15.1 years, and 70% were male. Common comorbidities included diabetes (35%) and CHF (28%), and the median (IQR) Charlson Comorbidity Index was 3 (1-4). 42% of the population presented with severe sepsis or septic shock, and 68% were in the ICU at the onset of the infection. The most common infections were ventilator associated (54%) or hospital acquired (17%) pneumonia. Combination therapy was more frequently used in the Poly/AG group (72% vs. 12%; p < 0.001) Treatment with C/T was associated with a higher rate of clinical cure (79% vs. 62%; p = 0.046) and a lower incidence of AKI (7% vs. 33%; p < 0.001) compared to Poly/AG based therapy. In hospital mortality rates were similar (28% vs. 37%; p =0.33). No patients receiving C/T had hypersensitivity reactions, neurological adverse events, or C. difficile infections.

    Conclusion:

    This multi-center retrospective analysis provides real world data supporting improved outcomes with C/T compared to Poly/AG based regimens for invasive infections due to MDR/XDR P. aeruginosa.

    Jason M. Pogue, PharmD, BCPS-AQ ID, Detroit Medical Center, Detroit, MI, Keith S. Kaye, MD, MPH, Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI, Michael Veve, PharmD, University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN, Anthony Gerlach, PharmD, Ohio State University Wexner Medical Center, Columbus, OH, Twisha S. Patel, PharmD, BCPS, Michigan Medicine, Ann Arbor, MI, Susan L Davis, PharmD, Pharmacy Practice, Wayne State University, Detroit, MI, Eugene Chaung, MD, University Hospitals Cleveland Medical Center, Cleveland, OH, Amy Ray, MD, MPH, Department of Medicine, Division of Infectious Diseases, University Hospital of Cleveland, Cleveland, OH, Laura Puzniak, PhD, MPH, Merck & Co., Inc., Kenilworth, NJ, Robert A. Bonomo, MD, Medicine, Case Western Reserve University, Cleveland, OH and Federico Perez, MD, MS, Louis Stokes Cleveland VA Medical Center, Cleveland, OH

    Disclosures:

    J. M. Pogue, Merck: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium . Allergan: Speaker's Bureau , Speaker honorarium .

    K. S. Kaye, Merck: Consultant and Grant Investigator , Consulting fee and Research grant .

    M. Veve, None

    A. Gerlach, None

    T. S. Patel, None

    S. L. Davis, None

    E. Chaung, None

    A. Ray, Merck: Speaker's Bureau , Speaker honorarium .

    L. Puzniak, Merck: Employee , Salary .

    R. A. Bonomo, None

    F. Perez, Merck: Grant Investigator , Grant recipient .

    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.