Outcomes in participants with failure of initial antibacterial therapy for hospital-acquired/ventilator-associated bacterial pneumonia prior to enrollment in the randomized, controlled phase 3 ASPECT-NP trial of ceftolozane/tazobactam versus meropenem

Critical Care

Research

Ignacio Martin-Loeches¹  Marin H. Kollef²  Jean-François Timsit³  Brian Yu⁴  Jennifer A. Huntington⁴  Erin H. Jensen⁴  Christopher J. Bruno⁴  Richard G. Wunderink⁵ 

[1] Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’ Hospital, Dublin, Ireland;Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain;Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA;Intensive Care Medicine Department, Université Paris Diderot and Hôpital Bichat, Paris, France;Merck & Co., Inc., Rahway, NJ, USA;Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;

关键词: Nosocomial pneumonia;    HABP;    VABP;    Mechanical ventilation;    All-cause mortality;    Clinical response;    Multivariable analysis;    Refractory;    Failing prior antibacterial therapy;   

DOI  :  10.1186/s13054-022-04192-w

 received in 2022-07-08, accepted in 2022-10-10,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundCeftolozane/tazobactam, a combination antibacterial agent comprising an anti-pseudomonal cephalosporin and β-lactamase inhibitor, is approved for the treatment of hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) in adults. Participants in the ASPECT-NP trial received ceftolozane/tazobactam (3 g [2 g ceftolozane/1 g tazobactam] every 8 h) or meropenem (1 g every 8 h). Participants failing prior antibacterial therapy for the current HABP/VABP episode at study entry had lower 28-day all-cause mortality (ACM) rates with ceftolozane/tazobactam versus meropenem treatment. Here, we report a post hoc analysis examining this result.MethodsThe phase 3, randomized, controlled, double-blind, multicenter, noninferiority trial compared ceftolozane/tazobactam versus meropenem for treatment of adults with ventilated HABP/VABP; eligibility included those failing prior antibacterial therapy for the current HABP/VABP episode at study entry. The primary and key secondary endpoints were 28-day ACM and clinical response at test of cure (TOC), respectively. Participants who were failing prior therapy were a prospectively defined subgroup; however, subgroup analyses were not designed for noninferiority testing. The 95% CIs for treatment differences were calculated as unstratified Newcombe CIs. Post hoc analyses were performed using multivariable logistic regression analysis to determine the impact of baseline characteristics and treatment on clinical outcomes in the subgroup who were failing prior antibacterial therapy.ResultsIn the ASPECT-NP trial, 12.8% of participants (93/726; ceftolozane/tazobactam, n = 53; meropenem, n = 40) were failing prior antibacterial therapy at study entry. In this subgroup, 28-day ACM was higher in participants who received meropenem versus ceftolozane/tazobactam (18/40 [45.0%] vs 12/53 [22.6%]; percentage difference [95% CI]: 22.4% [3.1 to 40.1]). Rates of clinical response at TOC were 26/53 [49.1%] for ceftolozane/tazobactam versus 15/40 [37.5%] for meropenem (percentage difference [95% CI]: 11.6% [− 8.6 to 30.2]). Multivariable regression analysis determined concomitant vasopressor use and treatment with meropenem were significant factors associated with risk of 28-day ACM. Adjusting for vasopressor use, the risk of dying after treatment with ceftolozane/tazobactam was approximately one-fourth the risk of dying after treatment with meropenem.ConclusionsThis post hoc analysis further supports the previously demonstrated lower ACM rate for ceftolozane/tazobactam versus meropenem among participants who were failing prior therapy, despite the lack of significant differences in clinical cure rates.ClinicalTrials.gov registrationNCT02070757. Registered February 25, 2014, clinicaltrials.gov/ct2/show/NCT02070757.

【 授权许可】

CC BY   
© The Author(s) 2022

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