Study finds ceftolozane-tazobactam non-inferior for serious pneumonia
An international group of researchers, in a phase 3 trial, have demonstrated that ceftolozane-tazobactam—an antibiotic approved in 2014 for complicated urinary tract and intra-abdominal infections—is non-inferior to meropenem for serious cases of nosocomial (hospital-acquired) pneumonia, paving the way for a potential new tool for the disease.
Writing in The Lancet Infectious Diseases yesterday, the team detailed the randomized, controlled trial conducted at 263 hospitals in 34 countries. The scientists included 726 patients with severe nosocomial pneumonia: 71% had ventilator-associated pneumonia, and 92% required intensive care. They placed 362 in the ceftolozane–tazobactam group and 364 in the meropenem group. The former received 3 grams of the drug, while the latter received 1 gram; both antibiotics were administered every 8 hours for 8 to 14 days.
At 28 days, 87 patients (24.0%) in the ceftolozane–tazobactam group and 92 (25.3%) in the meropenem group had died. At the test-of-cure visit, 197 patients (54%) in the ceftolozane–tazobactam group and 194 (53%) in the meropenem group were clinically cured. "Ceftolozane–tazobactam was thus non-inferior to meropenem in terms of both 28-day all-cause mortality and clinical cure at test of cure," the authors conclude.
Citing the most common causes of nosocomial pneumonia, they add, "High-dose ceftolozane-tazobactam can be used to treat nosocomial pneumonia caused by P aeruginosa (including multidrug-resistant strains), Enterobacteriaceae (including producers of extended-spectrum β-lactamases), and other Gram-negative pathogens."
In an accompanying commentary, experts from the United States and Brazil point out that using a higher meropenem dose might have afforded a better comparison. But they write, "Ceftolozane-tazobactam is a welcome addition to the antibiotic armamentarium for nosocomial pneumonia. Still, in view of the high dose used in this trial and the limited safety data available, close monitoring and surveillance of clinical practice and phase 4 safety registries will be necessary to better define the risk-benefit profile of this new antimicrobial."
Sep 25 Lancet Infect Dis study
Sep 24 Lancet Infect Dis commentary
XDR typhoid case reported in Taiwan
Health officials in Taiwan have announced their first imported case of extensively drug-resistant (XDR) typhoid, according to a government statement posted and translated by Avian Flu Diary, an infectious disease news blog.
The statement from Taiwan's Department of Disease Control says the case involves a 30-year-old man who began developing symptoms (diarrhea, fever, and rash) on Aug 4, after traveling to Morocco, India, Indonesia, and Pakistan. Subsequent blood tests confirmed typhoid fever, a highly infectious illness caused by Salmonella enterica serotype Typhi. Genetic sequencing identified the strain, which is resistant to five classes of antibiotics, as originating from Pakistan.
Pakistan is currently the center of an outbreak of XDR Salmonella Typhi that originated in Sindh province in 2016. In December 2018, the World Health Organization reported that the outbreak had affected more than 5,200 people in the country, mainly in Karachi and Hyderabad.
Sep 24 Avian Flu Diary post
UK announces funding to boost AMR surveillance in Africa, Asia
The United Kingdom's outgoing chief medical officer yesterday announced £6.2 million ($7.6 million US) in funding to strengthen antimicrobial resistance (AMR) surveillance systems in Africa and Asia.
Professor Dame Sally Davies announced the funding at the United Nations General Assembly (UNGA) in New York, along with £12 million ($14.8 million US) to improve collaborations on health systems research between the UK and low- and middle-income countries. Davies is representing the UK in UNGA high-level discussions on universal health coverage.
UN member states yesterday adopted a declaration recognizing that addressing AMR and investing in innovative health research are critical strategies for achieving universal health coverage. The AMR funding, which will come from the Fleming Fund, will help improve AMR data quality, collection, and sharing in African and Asian nations, with the goal of developing policy and action from that data.
"I am delighted to announce this funding, which will catalyse regional collaboration to help strengthen AMR surveillance systems across Africa and Asia and support the next generation of health policy and systems research," Davies said in a news release from the UK government's Department of Health and Social Care (DHSC).
Sep 25 DHSC news release