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

Marin H. Kollef, Jean François Timsit, Ignacio Martin-Loeches, Richard G. Wunderink, Jennifer A. Huntington, Erin H. Jensen, Brian Yu, Christopher J. Bruno*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Ceftolozane/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. Methods: The 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. Results: In 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. Conclusions: This 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.

Original languageEnglish (US)
Article number373
JournalCritical Care
Volume26
Issue number1
DOIs
StatePublished - Dec 2022

Funding

We thank the participants and their families and caregivers for participating in this study, along with all investigators and site personnel. The authors thank Dominik J Wolf, MSc, and Elizabeth G Rhee, MD, of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA (MSD) for his contributions to the study and/or manuscript development. Medical writing and/or editorial assistance was provided by Becky Orndorff, PhD, CMPP, of The Lockwood Group, Stamford, CT, USA. This assistance was funded by MSD. This research was presented in part at ISICEM 2020 in Brussels, Belgium. We thank the participants and their families and caregivers for participating in this study, along with all investigators and site personnel. The authors thank Dominik J Wolf, MSc, and Elizabeth G Rhee, MD, of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA (MSD) for his contributions to the study and/or manuscript development. Medical writing and/or editorial assistance was provided by Becky Orndorff, PhD, CMPP, of The Lockwood Group, Stamford, CT, USA. This assistance was funded by MSD. This research was presented in part at ISICEM 2020 in Brussels, Belgium.

Keywords

  • All-cause mortality
  • Clinical response
  • Failing prior antibacterial therapy
  • HABP
  • Mechanical ventilation
  • Multivariable analysis
  • Nosocomial pneumonia
  • Refractory
  • VABP

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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