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Published in: Infection 2/2020

01-04-2020 | Soft Tissue Infection | Case Report

Efficacy and safety of ceftolozane/tazobactam as therapeutic option for complicated skin and soft tissue infections by MDR/XDR Pseudomonas aeruginosa in patients with impaired renal function: a case series from a single-center experience

Authors: A. R. Buonomo, A. E. Maraolo, R. Scotto, M. Foggia, E. Zappulo, P. Congera, S. Parente, I. Gentile

Published in: Infection | Issue 2/2020

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Abstract

Introduction

Pseudomonas aeruginosa (PA) is a known cause of skin and soft tissue infections (SSTIs). Therapeutic options against multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of PA are limited, especially in patients with impaired renal function. Ceftolozane/tazobactam (C/T) is a novel beta-lactam/beta-lactamase inhibitor with powerful anti-PA activity. Thanks to its characteristics, it appears to be the best available anti-pseudomonal drug in many clinical scenarios. A case series of four adult patients followed between January 2018 and May 2019 is reported. All subjects presented complicated SSTIs by MDR- or XDR-PA and were affected by chronic kidney disease.

Results

C/T was used as a monotherapy in three cases and in combination regimen in the remaining case. In two cases, C/T was the first-line option, in the remaining ones was the salvage treatment. All patients were successfully treated without worsening of renal function and without any other adverse events.

Conclusions

C/T may represent a useful option against MDR- and XDR-PA strains responsible of complicated SSTIs in patients affected by impaired renal function.
Literature
1.
go back to reference Ruiz-Garbajosa P, Canton R. Epidemiology of antibiotic resistance in Pseudomonas aeruginosa Implications for empiric and definitive therapy. Rev Esp Quimioter. 2017;30:8–12.PubMed Ruiz-Garbajosa P, Canton R. Epidemiology of antibiotic resistance in Pseudomonas aeruginosa Implications for empiric and definitive therapy. Rev Esp Quimioter. 2017;30:8–12.PubMed
2.
go back to reference Rojas A, Palacios-Baena ZR, Lopez-Cortes LE, Rodriguez-Bano J. Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis. Clin Microbiol Infect. 2019;25:964–70.CrossRef Rojas A, Palacios-Baena ZR, Lopez-Cortes LE, Rodriguez-Bano J. Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis. Clin Microbiol Infect. 2019;25:964–70.CrossRef
3.
go back to reference Palavutitotai N, Jitmuang A, Tongsai S, Kiratisin P, Angkasekwinai N. Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections. PLoS ONE. 2018;13:e0193431.CrossRef Palavutitotai N, Jitmuang A, Tongsai S, Kiratisin P, Angkasekwinai N. Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections. PLoS ONE. 2018;13:e0193431.CrossRef
4.
go back to reference Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18:318–27.CrossRef Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18:318–27.CrossRef
5.
go back to reference Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs Context. 2018;7:212527.CrossRef Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs Context. 2018;7:212527.CrossRef
6.
go back to reference Leong HN, Kurup A, Tan MY, Kwa ALH, Liau KH, Wilcox MH. Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics. Infect Drug Resist. 2018;11:1959–74.CrossRef Leong HN, Kurup A, Tan MY, Kwa ALH, Liau KH, Wilcox MH. Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics. Infect Drug Resist. 2018;11:1959–74.CrossRef
7.
go back to reference Maraolo AE, Cascella M, Corcione S, Cuomo A, Nappa S, Borgia G, et al. Management of multidrug-resistant Pseudomonas aeruginosa in the intensive care unit: state of the art. Exp Rev Anti-infect Ther. 2017;15:861–71.CrossRef Maraolo AE, Cascella M, Corcione S, Cuomo A, Nappa S, Borgia G, et al. Management of multidrug-resistant Pseudomonas aeruginosa in the intensive care unit: state of the art. Exp Rev Anti-infect Ther. 2017;15:861–71.CrossRef
8.
go back to reference Gentile I, Maraolo AE, Borgia G. What is the role of the new beta-lactam/beta-lactamase inhibitors ceftolozane/tazobactam and ceftazidime/avibactam? Exp Rev Anti-infect Ther. 2016;14:875–8.CrossRef Gentile I, Maraolo AE, Borgia G. What is the role of the new beta-lactam/beta-lactamase inhibitors ceftolozane/tazobactam and ceftazidime/avibactam? Exp Rev Anti-infect Ther. 2016;14:875–8.CrossRef
9.
go back to reference Wooley M, Miller B, Krishna G, Hershberger E, Chandorkar G. Impact of renal function on the pharmacokinetics and safety of ceftolozane–tazobactam. Antimicrob Agents Chemother. 2014;58:2249–55.CrossRef Wooley M, Miller B, Krishna G, Hershberger E, Chandorkar G. Impact of renal function on the pharmacokinetics and safety of ceftolozane–tazobactam. Antimicrob Agents Chemother. 2014;58:2249–55.CrossRef
10.
go back to reference Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRef Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRef
11.
go back to reference Dryden MS. Complicated skin and soft tissue infection. J Antimicrob Chemother. 2010;65:iii35–44.CrossRef Dryden MS. Complicated skin and soft tissue infection. J Antimicrob Chemother. 2010;65:iii35–44.CrossRef
12.
go back to reference Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO. clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2012;2013:1–150. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO. clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2012;2013:1–150.
13.
go back to reference Mensa J, Barberan J, Soriano A, Llinares P, Marco F, Canton R, et al. Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: guidelines by the Spanish Society of Chemotherapy. Rev Esp Quimioter. 2018;31:78–100.PubMedPubMedCentral Mensa J, Barberan J, Soriano A, Llinares P, Marco F, Canton R, et al. Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: guidelines by the Spanish Society of Chemotherapy. Rev Esp Quimioter. 2018;31:78–100.PubMedPubMedCentral
14.
go back to reference Gentile I, Buonomo AR, Maraolo AE, Scotto R, De Zottis F, Di Renzo G, et al. Successful treatment of post-surgical osteomyelitis caused by XDR Pseudomonas aeruginosa with ceftolozane/tazobactam monotherapy. J Antimicrob Chemother. 2017;72:2678–9.CrossRef Gentile I, Buonomo AR, Maraolo AE, Scotto R, De Zottis F, Di Renzo G, et al. Successful treatment of post-surgical osteomyelitis caused by XDR Pseudomonas aeruginosa with ceftolozane/tazobactam monotherapy. J Antimicrob Chemother. 2017;72:2678–9.CrossRef
15.
go back to reference Frattari A, Savini V, Polilli E, Cibelli D, Talamazzi S, Bosco D, et al. Ceftolozane–tazobactam and Fosfomycin for rescue treatment of otogenous meningitis caused by XDR Pseudomonas aeruginosa: case report and review of the literature. IDCases. 2018;14:e00451.CrossRef Frattari A, Savini V, Polilli E, Cibelli D, Talamazzi S, Bosco D, et al. Ceftolozane–tazobactam and Fosfomycin for rescue treatment of otogenous meningitis caused by XDR Pseudomonas aeruginosa: case report and review of the literature. IDCases. 2018;14:e00451.CrossRef
16.
go back to reference Martin-Cazana M, Grau S, Epalza C, Branas P, Flores M, Olmedilla M, et al. Successful ceftolozane–tazobactam rescue therapy in a child with endocarditis caused by multidrug-resistant Pseudomonas aeruginosa. J Paediatr Child Health. 2019;55:985–7.CrossRef Martin-Cazana M, Grau S, Epalza C, Branas P, Flores M, Olmedilla M, et al. Successful ceftolozane–tazobactam rescue therapy in a child with endocarditis caused by multidrug-resistant Pseudomonas aeruginosa. J Paediatr Child Health. 2019;55:985–7.CrossRef
17.
go back to reference Bassetti M, Castaldo N, Cattelan A, Mussini C, Righi E, Tascini C, et al. Ceftolozane/tazobactam for the treatment of serious Pseudomonas aeruginosa infections: a multicentre nationwide clinical experience. Int J Antimicrob Agents. 2019;53:408–15.CrossRef Bassetti M, Castaldo N, Cattelan A, Mussini C, Righi E, Tascini C, et al. Ceftolozane/tazobactam for the treatment of serious Pseudomonas aeruginosa infections: a multicentre nationwide clinical experience. Int J Antimicrob Agents. 2019;53:408–15.CrossRef
18.
go back to reference Gallagher JC, Satlin MJ, Elabor A, Saraiya N, McCreary EK, Molnar E, et al. Ceftolozane–tazobactam for the treatment of multidrug-resistant Pseudomonas aeruginosa infections: a multicenter study. Open Forum Infect Dis. 2018;5:ofy280.CrossRef Gallagher JC, Satlin MJ, Elabor A, Saraiya N, McCreary EK, Molnar E, et al. Ceftolozane–tazobactam for the treatment of multidrug-resistant Pseudomonas aeruginosa infections: a multicenter study. Open Forum Infect Dis. 2018;5:ofy280.CrossRef
21.
go back to reference Kullar R, Wagenlehner FM, Popejoy MW, Long J, Yu B, Goldstein EJ. Does moderate renal impairment affect clinical outcomes in complicated intra-abdominal and complicated urinary tract infections? Analysis of two randomized controlled trials with ceftolozane/tazobactam. J Antimicrob Chemother. 2017;72:900–5.PubMed Kullar R, Wagenlehner FM, Popejoy MW, Long J, Yu B, Goldstein EJ. Does moderate renal impairment affect clinical outcomes in complicated intra-abdominal and complicated urinary tract infections? Analysis of two randomized controlled trials with ceftolozane/tazobactam. J Antimicrob Chemother. 2017;72:900–5.PubMed
22.
go back to reference Crass RL, Rodvold KA, Mueller BA, Pai MP. Renal dosing of antibiotics: are we jumping the gun? Clin Infect Dis. 2019;68:1596–602.CrossRef Crass RL, Rodvold KA, Mueller BA, Pai MP. Renal dosing of antibiotics: are we jumping the gun? Clin Infect Dis. 2019;68:1596–602.CrossRef
Metadata
Title
Efficacy and safety of ceftolozane/tazobactam as therapeutic option for complicated skin and soft tissue infections by MDR/XDR Pseudomonas aeruginosa in patients with impaired renal function: a case series from a single-center experience
Authors
A. R. Buonomo
A. E. Maraolo
R. Scotto
M. Foggia
E. Zappulo
P. Congera
S. Parente
I. Gentile
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 2/2020
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-020-01390-y

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