Outcomes of Ceftolozane/Tazobactam Recommended Doses in Treating Multidrug-Resistant Bacteria in Critically Ill Patients Using Renal Replacement Therapy
Bibliographic record
Abstract
Background: Ceftolozane/tazobactam (CEF/TAZ) is a new broad spectrumn cephalosporin effective against Multi-drug Resistant (MDR) bacteria. The clinical outcomes of the recommended dose of CEF/TAZ in patients utilizing renal replacement therapies are lacking. The purpose of this study was to evaluate the clinical and microbilogical efficacy of CEF/TAZ in treating MDR in pateints utlizing continous venovenous hemofiltraion (CVVH) and intermittent hemodialsyis (IHD). Methods: A retrospective cohort study was conducted at our quaternary care hospital between May 2015 and December 2019. We reviewed all hospitalized adults who had MDR Pseudomonas aeruginosa or MDR enterobacteriaceae treated with CEF/TAZ while utilizing CVVH or IHD Results: We identified 11 patients who met the inclusion criteria with a mean age of 63.0 ± 17.8 years and a mean weight of 63.8±15.7 kg. All patients were critically ill, needed mechanical ventilation, and used vasopressors. All 11 patients had pneumonia, one of them developed secondary bacteremia and two had decubitus ulcer. Nine patients had MDR pseudomonas aeruginosa while two had MDR E. coli and Klebsiella Pneumonia. Six patients were on IHD, while the remaining 5 patients were on CVVH. The most commonly used dose for CVVH was 450 or 750 mg intravenous (IV) every 8 hours (only one received 1500 mg at the same frequency). For IHD, the common dose was 450 mg IV every 8 hours. Of the 7 pateints who had repeated cultures, three had microbiological cure and four had clinical cure. Two pateints expired within 30 days and 3 more expired within 90 days. Two of the patients who had clinical cure, had recurrence within 4 weeks. Conclusions: The efficacy of the recommended CEF/TAZ dose in patients utilizing RRT is uncertain. Pharmacokinetics and pharmacodynamics studies are urgently needed to determine the adequacy of CEF/AVI dosing in this population
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".