Estudio de utilización en práctica clínica real de ceftolozano/tazobactam frente a aminoglucósidos y/o colistina en el tratamiento de Pseudomonas aeruginosa

espanolIntroduccion. Se necesitan datos comparativos en “vida real” sobre efectividad y seguridad de ceftolozano/tazobactam (C/T) frente otros regimenes (aminoglucosidos/colistina/combinacion) en el tratamiento de Pseudomonas aeruginosa (PA) multirresistente (MDR) y extremadamente resistente (XDR) para establecer posicionamientos. Material y metodos. Estudio observacional, retrospectivo de pacientes con confirmacion microbiologica de PA MDR y XDR desde julio de 2016 a diciembre de 2018 en un hospital terciario. Variables: edad, sexo, comorbilidades, factores de riesgo de multirresistencia, variables relacionadas con infeccion, foco de infeccion, microorganismo y tipo de muestra, tratamiento antibiotico, curacion clinica, curacion microbiologica, recurrencia, mortalidad en ingreso y 30 dias post-alta. Pacientes clasificados segun tratamiento antibiotico recibido, C/T o aminoglucosidos/colistina/combinacion. Resultados. 405 pacientes con infeccion por PA MDR y XDR (73,1% hombres, edad media 63 ± 15 anos). 87,1% PA XDR y 12,9% MDR. Todos los pacientes recibieron C/T como tratamiento dirigido y en el grupo aminoglucosidos/colistina/ combinacion fueron el 73,5%. El grupo C/T presenta factores de peor pronostico: shock septico (30,0%) y sondaje (90,0%) (p Conclusiones. Los datos obtenidos plantean que no ha habido diferencias de efectividad (curacion clinica ni microbiologica) a favor de C/T, si bien, en el periodo estudiado se utilizo en la mayoria de los casos en pacientes multitratados y con peor pronostico. Se necesitarian estudios aleatorizados y prospectivos para establecer un posicionamiento adecuado. EnglishIntroduction. Comparative “real life” data on the effectiveness and safety of ceftolozane/tazobactam (C/T) versus other regimens (aminoglycosides/colistin/combination), in the treatment of multi-resistant (MDR) and extremely resistant (XDR) Pseudomonas aeruginosa (PA), are needed to establish positions. Material and methods. Observational, retrospective study of patients with microbiological confirmation of MDR and XDR PA from July 2016 up to December 2018 in a tertiary hospital. Variables: age, sex, comorbidities, risk factors for multidrug resistance, variables related to infection, source of infection, microorganism and type of sample, antibiotic treatment, clinical cure, microbiological cure, recurrence, mortality on admission and 30 days post-discharge. Patients were classified according to received antibiotic treatment, C/T or aminoglycosides/colistin/combination Results. A total of 405 patients with PA MDR and XDR infection (73.1% men, mean age 63 ± 15 years) were studied. An 87.1% of PA XDR and a 12.9% MDR were observed. All patients received C/T as targeted therapy and in the aminoglycosides/colistin/combination group were 73.5%. Patients in the C/T group present worse prognostic factors: septic shock (30.0%) and catheterization (90.0%) (p There were not statistically significant differences in mortality at admission (p=0.352) or at 30 days after discharge (p=0.231). A 17.2% of the patients with aminoglycosides/colistin/combination had acute kidney injury according to RIFLE criteria and 4.3% with C/T. Conclusions. The data obtained suggest that there have been no differences in effectiveness (clinical or microbiological cure) in favour of C/T, although, in the period studied, it was used in most cases in multitreated patients with a worse prognosis. Randomized and prospective studies would be needed to establish an adequate positioning.