PDF(Pubmed)
Abstract：
BACKGROUND: Gram-negative nosocomial pneumonia (NP), including hospital-acquired bacterial pneumonia (HABP), ventilated HABP (vHABP), and ventilator-associated bacterial pneumonia (VABP), is a significant cause of morbidity and mortality. Common pathogens, including Enterobacterales and Pseudomonas aeruginosa, are prevalent in healthcare settings and have few effective treatment options due to high rates of antibacterial resistance. Resistant pathogens are associated with significantly worse outcomes, relative to patients with susceptible infections. Ceftolozane/tazobactam (C/T) has established efficacy in clinical trials of patients with NP. This review aims to collate data on C/T use for HABP/vHABP/VABP infections in real-world clinical practice.
METHODS: This systematic literature review searched online biomedical databases for real-world studies of C/T used to treat Gram-negative respiratory tract infections (RTIs) between January 2009 and June 2020.
RESULTS: Thirty-three studies comprising 658 patients were identified. Pneumonia was the most common infection treated with C/T (85%), with a smaller number of unspecified RTIs (9%) and tracheobronchitis (5%) reported. The majority of patients had respiratory infections caused by P. aeruginosa (92.8%), of which 88.1% were multidrug-resistant. Examination of these studies demonstrated an increase in the percentage of patients receiving the recommended dose of C/T for respiratory infections (3 g q8h or renal impairment-adjusted) over time (36.8% of patients in 2017 to 71.5% in 2020). Clinical success rates ranged from 51.4 to 100%, with 10 studies (55.6% of studies reporting clinical success) reporting clinical success rates of > 70%; microbiological success rates ranged from 57.0 to 100.0%, with three studies (60.0% of studies reporting microbiological success) reporting microbiological success rates of > 70%. Thirty-day mortality ranged from 0.0 to 33.0%, with nine studies (90% of studies reporting mortality) reporting 30-day mortality of < 30%.
CONCLUSIONS: The studies identified in this review demonstrate that C/T shows similar outcomes as those seen in clinical trials, despite the higher frequency of multidrug-resistant pathogens, and comorbidities that may have been excluded from the trials.
METHODS: This systematic literature review searched online biomedical databases for real-world studies of C/T used to treat Gram-negative respiratory tract infections (RTIs) between January 2009 and June 2020.
RESULTS: Thirty-three studies comprising 658 patients were identified. Pneumonia was the most common infection treated with C/T (85%), with a smaller number of unspecified RTIs (9%) and tracheobronchitis (5%) reported. The majority of patients had respiratory infections caused by P. aeruginosa (92.8%), of which 88.1% were multidrug-resistant. Examination of these studies demonstrated an increase in the percentage of patients receiving the recommended dose of C/T for respiratory infections (3 g q8h or renal impairment-adjusted) over time (36.8% of patients in 2017 to 71.5% in 2020). Clinical success rates ranged from 51.4 to 100%, with 10 studies (55.6% of studies reporting clinical success) reporting clinical success rates of > 70%; microbiological success rates ranged from 57.0 to 100.0%, with three studies (60.0% of studies reporting microbiological success) reporting microbiological success rates of > 70%. Thirty-day mortality ranged from 0.0 to 33.0%, with nine studies (90% of studies reporting mortality) reporting 30-day mortality of < 30%.
CONCLUSIONS: The studies identified in this review demonstrate that C/T shows similar outcomes as those seen in clinical trials, despite the higher frequency of multidrug-resistant pathogens, and comorbidities that may have been excluded from the trials.
摘要：
背景：革兰氏阴性医院获得性肺炎（NP），包括医院获得性细菌性肺炎（HABP），通风HABP（vHABP），呼吸机相关细菌性肺炎（VABP），是发病率和死亡率的重要原因。常见病原体,包括肠杆菌和铜绿假单胞菌,在医疗机构中普遍存在，并且由于抗菌耐药率高，几乎没有有效的治疗选择。耐药病原体与明显更差的结果相关，相对于易感感染的患者。头孢洛赞/他唑巴坦（C/T）已在NP患者的临床试验中确立了疗效。这篇综述旨在整理在现实世界临床实践中用于HABP/vHABP/VABP感染的C/T使用数据。
方法：本系统文献综述在2009年1月至2020年6月期间检索了用于治疗革兰氏阴性呼吸道感染（RTIs）的C/T的真实世界研究的在线生物医学数据库。
结果：确定了包括658名患者的33项研究。肺炎是C/T治疗最常见的感染（85％），报告了较少数量的未指明的RTI（9％）和气管支气管炎（5％）。大多数患者有由铜绿假单胞菌引起的呼吸道感染（92.8%），其中88.1%为多重耐药。对这些研究的检查表明，随着时间的推移，接受推荐剂量C/T治疗呼吸道感染（3gq8h或肾功能损害调整）的患者百分比有所增加（2017年占36.8％，2020年占71.5％）。临床成功率从51.4%到100%不等,有10项研究(55.6%的研究报告临床成功)报告临床成功率>70%;微生物成功率从57.0%到100.0%,有3项研究(60.0%的研究报告微生物成功)报告微生物成功率>70%。30天死亡率为0.0-33.0%，9项研究（90%的研究报告死亡率）报告30天死亡率<30%。
结论：本综述中确定的研究表明，C/T显示出与临床试验相似的结果，尽管多重耐药病原体的出现频率较高，以及可能被排除在试验之外的合并症。
方法：本系统文献综述在2009年1月至2020年6月期间检索了用于治疗革兰氏阴性呼吸道感染（RTIs）的C/T的真实世界研究的在线生物医学数据库。
结果：确定了包括658名患者的33项研究。肺炎是C/T治疗最常见的感染（85％），报告了较少数量的未指明的RTI（9％）和气管支气管炎（5％）。大多数患者有由铜绿假单胞菌引起的呼吸道感染（92.8%），其中88.1%为多重耐药。对这些研究的检查表明，随着时间的推移，接受推荐剂量C/T治疗呼吸道感染（3gq8h或肾功能损害调整）的患者百分比有所增加（2017年占36.8％，2020年占71.5％）。临床成功率从51.4%到100%不等,有10项研究(55.6%的研究报告临床成功)报告临床成功率>70%;微生物成功率从57.0%到100.0%,有3项研究(60.0%的研究报告微生物成功)报告微生物成功率>70%。30天死亡率为0.0-33.0%，9项研究（90%的研究报告死亡率）报告30天死亡率<30%。
结论：本综述中确定的研究表明，C/T显示出与临床试验相似的结果，尽管多重耐药病原体的出现频率较高，以及可能被排除在试验之外的合并症。
