Table 3.
Univariate Analysis of Risk Factors for Clinical Failure of C/T Therapy Among Patients With Enterobacterales Infection
| Variable | Clinical Success (n = 128), No. (%)a | Clinical Failure (n = 25), No. (%)a | P Value |
|---|---|---|---|
| Age, median (IQR), y | 69 (48–78) | 68 (47–77) | .92 |
| Male sex | 69 (53.9) | 13 (52) | 1.0 |
| Community-acquired infection | 9 (7) | 1 (4) | .78 |
| Hospital-acquired infection | 119 (92.9) | 24 (96) | .89 |
| Ward | |||
| Medical | 85 (66.4) | 13 (52) | .17 |
| Surgical | 23 (17.9) | 2 (8) | .37 |
| ICU | 20 (15.6) | 10 (40) | .01 |
| Charlson comorbidity index, mean ± SD | 3.6 ± 3 | 5.4 ± 2.6 | <.001 |
| Underlying diseases | |||
| Cardiac disease | 46 (35.9) | 10 (40) | .82 |
| Neurological disease | 46 (35.9) | 7 (28) | .49 |
| Chronic renal disease | 36 (28.1) | 15 (60) | <.001 |
| Diabetes mellitus | 35 (27.3) | 7 (28) | 1.0 |
| Gastrointestinal disease | 35 (27.3) | 6 (24) | .8 |
| Solid-organ tumor | 28 (21.8) | 9 (36) | .19 |
| Solid-organ transplant | 14 (10.9) | 5 (20) | .2 |
| Hematological malignancy | 15 (11.7) | 5 (20) | .28 |
| COPD | 29 (22.6) | 6 (24) | 1.0 |
| Liver disease | 18 (14) | 4 (16) | .92 |
| Other predisposing conditionsb | |||
| Corticosteroids | 45 (35.1) | 7 (28) | .64 |
| Other immunosuppressive therapy | 23 (17.9) | 6 (24) | .57 |
| Chemotherapy | 14 (10.9) | 3 (12) | 1.0 |
| Neutropeniac | 14 (10.9) | 1 (4) | .46 |
| Invasive procedures | |||
| Central venous catheter | 58 (45.3) | 18 (72) | .01 |
| Urinary catheter | 91 (71.1) | 20 (80) | .46 |
| Previous surgeryb | 48 (37.5) | 10 (40) | .82 |
| Mechanical ventilation/NIV | 18 (14) | 10 (40) | .004 |
| Percutaneous endoscopic gastrostomy | 2 (1.5) | 0 | 1.0 |
| Intermittent hemodialysis | 17 (13.2) | 8 (32) | .03 |
| CRRT | 8 (6.2) | 10 (40) | <.001 |
| Previous ESBL-E colonizationb | 40 (31.2) | 10 (40) | .48 |
| Severity of clinical presentation | |||
| No sepsis | 52 (40.6) | 0 | <.001 |
| Sepsis | 54 (42.2) | 5 (20) | .04 |
| Septic shock | 22 (17.2) | 20 (80) | <.001 |
| ICU admission due to ESBL-E infection | 62 (48.4) | 12 (48) | 1.0 |
| Type of infection | |||
| Nosocomial pneumoniae | 33 (25.7) | 13 (25) | 1.0 |
| ABSSSI | 25 (19.5) | 0 | .01 |
| cUTI | 31 (24.2) | 3 (12) | .29 |
| cIAI | 19 (14.8) | 6 (24) | .24 |
| Bone infection | 4 (3.1) | 1 (4) | 1.0 |
| Primary bacteremia | 14 (10.9) | 2 (8) | 1.0 |
| Other infectionsd | 2 (1.5) | 0 | 1.0 |
| Concomitant ESBL-E bacteremia | 35 (27.3) | 12 (48) | .05 |
| Life-threatening infection | 81 (63.2) | 10 (40) | .04 |
| Polymicrobial infection | 24 (18.7) | 7 (28) | .28 |
| Antibiotics before C/T treatment | |||
| Received antibiotics before C/T for current infection | 35 (27.3) | 17 (68) | <.001 |
| No. of antibiotics received, median (range) | 1 (1–3) | 2 (1–4) | .08 |
| Days of antibiotic therapy, median (range) | 6 (3–13) | 7 (4–15) | .07 |
| C/T treatment | |||
| Empiric treatment | 46 (35.9) | 0 | <.001 |
| Combination therapy | 23 (17.9) | 3 (12) | .57 |
| Time from infection onset to C/T administration, median (IQR), d | 4 (1–6) | 7 (5–14) | <.001 |
| Days of treatment, median (range) | 11 (6–22) | 17 (7–29) | <.001 |
| Extended infusion | 32 (25) | 2 (8) | .06 |
| Continuous infusion | 9 (7) | 2 (8) | 1.0 |
| Intermittent infusion | 87 (67.9) | 21 (84) | .14 |
| Standard dosage (or adjusted according to creatinine clearance)f | 95 (74.2) | 20 (80) | .62 |
| Off-label dosage | 33 (25.7) | 5 (20) | .68 |
| Adequate source control of infection | 43/57 (75.4) | 4/57 (7.1) | <.001 |
Abbreviations: ABSSSI, acute bacterial skin and skin-structure infection; C/T, ceftolozane/tazobactam; cIAI, complicated intra-abdominal infection; COPD, chronic obstructive pulmonary disease; CRRT, continuous renal replacement therapy; cUTI, complicated urinary tract infection; ESBL-E, extended-spectrum β-lactamase Enterobacterales; ICU, intensive care unit; IQR, interquartile range; NIV, noninvasive ventilation.
aData are No. (%) unless otherwise stated.
bWithin previous 30 days.
cAbsolute neutrophil count <500/mm3.
dOther infections include central venous catheter–related bacteremia (n = 1) and community-acquired pneumonia (n = 1).
eNosocomial pneumonia was divided into 26 patients with hospital-acquired pneumonia and 7 with ventilator-associated pneumonia among patients with clinical success; 6 patients with hospital-acquired pneumonia and 7 with ventilator-associated pneumonia among patients with clinical failure.
fAugmented renal clearance was reported in 4 patients with clinical success and 2 patients with clinical failure.