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Article

Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis

1
Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
2
Medical Statistics Unit, Department of Public, Clinical and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
3
Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy
4
Department of Anaesthesiology, Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
*
Author to whom correspondence should be addressed.
Received: 11 December 2020 / Revised: 2 January 2021 / Accepted: 13 January 2021 / Published: 15 January 2021
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
Ceftolozane-tazobactam (C/T) is a combination of an advanced-generation cephalosporin (ceftolozane) with a β-lactamase inhibitor (tazobactam). It is approved for the treatment of complicated urinary-tract/intra-abdominal infections and hospital-acquired/ventilator-associated pneumonia. This systematic review and meta-analysis (registered prospectively on PROSPERO, no. CRD42019134099, on 20 January 2020) aimed to evaluate the effectiveness of C/T combination therapy compared to C/T monotherapy for the treatment of severe infections and to describe the prevalence of microorganisms in the included studies. We retrieved literature from PubMed, EMBASE, and CENTRAL, until 26 November 2020. Eligible studies were both randomised trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was all-cause mortality; secondary outcomes were (i) clinical improvement and (ii) microbiological cure. Eight nonrandomised studies were included in the qualitative synthesis: Seven retrospective cohort studies and one case-control study. The meta-analysis of the four studies evaluating all-cause mortality (in total 148 patients: 87 patients treated with C/T alone and 61 patients treated with C/T combination therapy) showed a significant reduction of mortality in patients receiving C/T combination therapy, OR: 0.31, 95% CI: 0.10–0.97, p = 0.045. Conversely, the meta-analysis of the studies evaluating clinical improvement and microbiological cure showed no differences in C/T combination therapy compared to C/T monotherapy. The most consistent data come from the analysis of the clinical improvement, n = 391 patients, OR: 0.97, 95% CI: 0.54–1.74, p = 0.909. In 238 of the 391 patients included (60.8%), C/T was used for the treatment of infections caused by Pseudomonas aeruginosa. View Full-Text
Keywords: pseudomonas aeruginosa; ESBLs; multidrug resistance; β-lactamase inhibitors; anti-infective agents; bacteremia; ceftolozane; sepsis; infection; systematic review; meta-analysis pseudomonas aeruginosa; ESBLs; multidrug resistance; β-lactamase inhibitors; anti-infective agents; bacteremia; ceftolozane; sepsis; infection; systematic review; meta-analysis
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MDPI and ACS Style

Fiore, M.; Corrente, A.; Pace, M.C.; Alfieri, A.; Simeon, V.; Ippolito, M.; Giarratano, A.; Cortegiani, A. Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis. Antibiotics 2021, 10, 79. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010079

AMA Style

Fiore M, Corrente A, Pace MC, Alfieri A, Simeon V, Ippolito M, Giarratano A, Cortegiani A. Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis. Antibiotics. 2021; 10(1):79. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010079

Chicago/Turabian Style

Fiore, Marco, Antonio Corrente, Maria C. Pace, Aniello Alfieri, Vittorio Simeon, Mariachiara Ippolito, Antonino Giarratano, and Andrea Cortegiani. 2021. "Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis" Antibiotics 10, no. 1: 79. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010079

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