Ceftolozane/Tazobactam for Resistant Drugs Pseudomonas aeruginosa Respiratory Infections: A Systematic Literature Review of the Real-World Evidence

Abstract

Background: Ceftolozane/tazobactam (C/T) is a β-lactam/β-lactamase inhibitor combination that mainly targets Gram-negative bacteria. The current international guidelines recommend including C/T treatment in the empirical therapy for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Pseudomonas aeruginosa (PA) is one of the most challenging Gram-negative bacteria. We conducted a systematic review of all cases reported in the literature to summarize the existing evidence.

Methods: The main electronic databases were screened to identify case reports of patients with drug-resistant PA respiratory infections treated with C/T.

Results: A total of 22 publications were included for a total of 84 infective episodes. The clinical success rate was 72.6% across a wide range of comorbidities. The 45.8% of patients treated with C/T presented colonization by PA. C/T was well tolerated. Only six patients presented adverse events, but none had to stop treatment. The most common therapeutic regimens were 1.5 g every 8 h and 3 g every 8 h.

Conclusion: C/T may be a valid therapeutic option to treat multidrug-resistant (MDR), extensively drug-resistant (XDR), pandrug-resistant (PDR), and carbapenem-resistant (CR) PA infections. However, further data are necessary to define the optimal treatment dosage and duration.

Keywords: Pseudomonas aeruginosa; carbapenem-resistant (CR); ceftolozane/tazobactam; extensively drug-resistant (XDR); hospital-acquired pneumonia (HAP); multidrug-resistant (MDR); pandrug-resistant (PDR); ventilator-associated pneumonia (VAP).

Figure 1

Flow diagram study selection process.

Figure 2

Type of infection (a) and resistance profile (n, %)(b).

Figure 3

Co-infections (n, %).

Figure 4

Co-infection microorganisms.

Figure 5

Clinical outcome.

Figure 6

Microbiological outcome.