Background:
We present our experience in patients with hematologic malignancy and Pseudomonas aeruginosa infection treated with ceftolozane-tazobactam.
Materials/methods:We performed a single-center case-control study including all patients with hematologic malignancy and P. aeruginosa infection treated with ceftolozane-tazobactam (study group) and compared them with similar patients not treated with ceftolozane-tazobactam (control group) to assess safety and efficacy.
Results:Nineteen cases and 38 controls were analyzed. Cases were younger (45.6 y vs 57.6 y, p=0.012) and less frequently had bacteremia (52.6% vs 86.8%, p=0.008). They also had a worse MASCC score (10.2 vs 16.1, p=0.0001), more hospital-acquired infections (78.9% vs 47.4%, p=0.013), and more XDR P. aeruginosa (47.4% vs 21.1%, p=0.015).
Cases received a median of 14 days (7-18) of ceftolozane-tazobactam (monotherapy in 11 cases [57.9.6%]). Ceftolozane-tazobactam was mostly used as targeted therapy (16; 84.2%) because of resistance (9; 47.4%), failure (4; 21.1%), and toxicity (3; 15.8%). Ten cases had bacteremia (52.6%). The sources were pneumonia (26.3%), catheter-related bacteremia (21.1%), primary bacteremia (21.1%), perianal/genital (15.7%), urinary (10.5%), and skin/soft tissue infection (5.3%). No toxicity was attributed to ceftolozane/tazobactam. More than 60% had neutropenia, and 15.8% fulfilled the criteria for sepsis.
There were no significant differences in clinical cure at day 14 (89.5% vs 71.1%, p=0.183) or recurrence (15.8% vs 10.5%, p=0.675). Thirty-day mortality was lower among cases (5.3% vs 28.9%, p=0.045).
Conclusions:Ceftolozane-tazobactam was well tolerated and at least as effective as other alternatives for P. aeruginosa infection in patients with hematologic malignancy, including neutropenic patients with sepsis caused by XDR strains.
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