{"id":27749,"date":"2025-04-05T04:34:00","date_gmt":"2025-04-04T20:34:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27749"},"modified":"2025-04-05T06:07:00","modified_gmt":"2025-04-04T22:07:00","slug":"lancet-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a4%b4%e5%ad%a2%e4%bb%96%e5%95%b6-%e9%98%bf%e7%bb%b4%e5%b7%b4%e5%9d%a6%e4%b8%8e%e5%a4%b4%e5%ad%a2%e6%b4%9b%e6%89%8e-%e4%bb%96","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27749","title":{"rendered":"[Lancet Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u5934\u5b62\u4ed6\u5576-\u963f\u7ef4\u5df4\u5766\u4e0e\u5934\u5b62\u6d1b\u624e-\u4ed6\u5511\u5df4\u5766\u6cbb\u7597\u7f8e\u56fd\u591a\u91cd\u8010\u836f\u94dc\u7eff\u5047\u5355\u80de\u83cc\u7684\u7597\u6548"},"content":{"rendered":"\n

Effectiveness of ceftazidime\u2013avibactam versus ceftolozane\u2013tazobactam for multidrug-resistant\u00a0Pseudomonas aeruginosa<\/em>infections in the USA (CACTUS): a multicentre, retrospective, observational study<\/h1>\n\n\n\n

Ryan K\u00a0Shields,\u00a0Lilian M\u00a0Abbo,\u00a0Renee\u00a0Ackley, et al<\/h3>\n\n\n\n

Lancet Infect Dis Available online 16 December 2024<\/h3>\n\n\n\n

https:\/\/doi.org\/10.1016\/S1473-3099(24)00648-0<\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Ceftolozane\u2013tazobactam and ceftazidime\u2013avibactam are preferred treatment options for multidrug-resistant Pseudomonas aeruginosa<\/em> infections; however, real-world comparative effectiveness studies are scarce. Pharmacokinetic and pharmacodynamic differences between the agents might affect clinical response rates. We aimed to compare the effectiveness of ceftolozane\u2013tazobactam and ceftazidime\u2013avibactam for treatment of invasive multidrug-resistant P aeruginosa<\/em> infections.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

This multicentre, retrospective, observational study was conducted at 28 hospitals in the USA between Jan 1, 2016, and Dec 31, 2023. Eligible patients were adults (age \u226518 years old) with microbiologically confirmed multidrug-resistant P aeruginosa<\/em> pneumonia or bacteraemia treated with ceftolozane\u2013tazobactam or ceftazidime\u2013avibactam for more than 48 h. Patients were matched (1:1) by study site, severity of illness, time to treatment initiation (\u226472 h or >72 h), and infection type. The primary outcome was clinical success at day 30, which was defined as survival, resolution of signs and symptoms of infection with the intended treatment course, and the absence of recurrent infection due to P aeruginosa<\/em>. Secondary outcomes included all-cause mortality and development of resistance to study drug.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

420 eligible patients were included (210 in each treatment group), of whom 350 (83%) had pneumonia and 70 (17%) had bacteraemia. Baseline demographics, comorbidities, and severity of illness indicators were similar between groups. On treatment initiation, 336 (80%) patients were in the intensive care unit, 296 (70%) were receiving mechanical ventilation, and 168 (40%) required vasopressor support. Clinical success was observed in 128 (61%) of 210 patients treated with ceftolozane\u2013tazobactam and 109 (52%) of 210 patients treated with ceftazidime\u2013avibactam. By conditional logistic regression analysis, the adjusted odds ratio (aOR) of success after treatment with ceftolozane\u2013tazobactam compared with ceftazidime\u2013avibactam was 2\u00b707 (95% CI 1\u00b716\u20133\u00b770). For patients with pneumonia, clinical success was observed in 110 (63%) of 175 patients in the ceftolozane\u2013tazobactam group and 89 (51%) of 175 patients in the ceftazidime\u2013avibactam group (aOR 2\u00b734 [95% CI 1\u00b722\u20134\u00b747]). Among patients with bacteraemia, rates of clinical success were 51% (18 of 35 patients) for patients treated with ceftolozane\u2013tazobactam and 57% (20 of 35 patients) for those treated with ceftazidime\u2013avibactam (0\u00b776 [0\u00b723\u20132\u00b757]). There were no significant differences between groups in 30-day or 90-day mortality. Among patients whose baseline isolates were tested for susceptibility, resistance developed in 22% (38 of 173) of patients treated with ceftolozane\u2013tazobactam and 23% (40 of 177) of patients treated with ceftazidime\u2013avibactam.<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

Treatment with ceftolozane\u2013tazobactam resulted in higher rates of clinical success compared with ceftazidime\u2013avibactam for invasive infections due to multidrug-resistant P aeruginosa<\/em>. Differences were driven by improved response rates for patients with pneumonia who were treated with ceftolozane\u2013tazobactam. There were no significant differences between study groups with respect to all-cause mortality; treatment-emergent resistance was common with both agents.<\/p>\n","protected":false},"excerpt":{"rendered":"

Effectiveness of ceftazidime\u2013avibactam versus ceftoloza […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27749"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27749"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27749\/revisions"}],"predecessor-version":[{"id":27750,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27749\/revisions\/27750"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27749"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27749"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27749"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}