Estudio de utilización en práctica clínica real de ceftolozano/tazobactam frente a aminoglucósidos y/o colistina en el tratamiento de Pseudomonas aeruginosa
2021
Introduction. Comparative “real life” data on the effectiveness and safety of ceftolozane/tazobactam (C/T) versus
other regimens (aminoglycosides/colistin/combination), in the
treatment of multi-resistant (MDR) and extremely resistant
(XDR) Pseudomonas aeruginosa (PA), are needed to establish
positions.
Material and methods. Observational, retrospective
study of patients with microbiological confirmation of MDR
and XDR PA from July 2016 up to December 2018 in a tertiary hospital. Variables: age, sex, comorbidities, risk factors for
multidrug resistance, variables related to infection, source of
infection, microorganism and type of sample, antibiotic treatment, clinical cure, microbiological cure, recurrence, mortality
on admission and 30 days post-discharge. Patients were classified according to received antibiotic treatment, C/T or aminoglycosides/colistin/combination
Results. A total of 405 patients with PA MDR and XDR
infection (73.1% men, mean age 63 ± 15 years) were studied. An 87.1% of PA XDR and a 12.9% MDR were observed. All
patients received C/T as targeted therapy and in the aminoglycosides/colistin/combination group were 73.5%. Patients in
the C/T group present worse prognostic factors: septic shock
(30.0%) and catheterization (90.0%) (p<0.05). There were not
statistically significant differences in microbiological cure
(p=0.412), recurrence (p=0.880) and clinical cure (p=0.566).
There were not statistically significant differences in mortality
at admission (p=0.352) or at 30 days after discharge (p=0.231).
A 17.2% of the patients with aminoglycosides/colistin/combination had acute kidney injury according to RIFLE criteria and
4.3% with C/T.
Conclusions. The data obtained suggest that there have
been no differences in effectiveness (clinical or microbiological
cure) in favour of C/T, although, in the period studied, it was
used in most cases in multitreated patients with a worse prognosis. Randomized and prospective studies would be needed to
establish an adequate positioning.
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