Global evaluation of the antibacterial activity of Ceftolozane/Tazobactam against ESBLs-producing Escherichia coli and Klebsiella pneumoniae: a systematic review and meta-analysis

Marzieh Rahim Khorasani; Soodabeh Rostami; Arash Bakhshi; Raheleh Sheikhi

doi:10.1177/20499361231212074

Global evaluation of the antibacterial activity of Ceftolozane/Tazobactam against ESBLs-producing Escherichia coli and Klebsiella pneumoniae: a systematic review and meta-analysis

Ther Adv Infect Dis. 2023 Nov 17:10:20499361231212074. doi: 10.1177/20499361231212074. eCollection 2023 Jan-Dec.

Authors

Marzieh Rahim Khorasani¹, Soodabeh Rostami², Arash Bakhshi³, Raheleh Sheikhi⁴

Affiliations

¹ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
² Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Student Research Committee, Schoolof Medicine, Guilan University of Medical Sciences, Rasht, Iran.
⁴ Department of Microbiology, Virology and Microbial Toxins, School of Medicine, Guilan University Complex, Tehran Road Km 6th, Rasht, 3363, Guilan, Iran.

Abstract

Background: Ceftolozane/Tazobactam is a β-lactam/β-lactamase inhibitor combination with a high range of efficacy and broad-spectrum action against multidrug-resistant bacterial strains.

Objectives: The present study aimed to analyze the in vitro activity of Ceftolozane/Tazobactam against extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli (ESBLs-EC) and Klebsiella pneumonia (ESBLs-KP) in the published literature to provide international data on the antimicrobial stewardship programs.

Design: Systematic review and meta-analysis.

Methods: A systematic literature search was conducted on the Web of Science, Embase, PubMed, Scopus, and Google Scholar electronic databases from the beginning of databases to December 2022 to cover all published articles relevant to our scope.

Results: At last, 31 publications that met our inclusion criteria were selected for data extraction and analysis by Comprehensive Meta-Analysis Software. The pooled prevalence of Ceftolozane/Tazobactam susceptibility for ESBLs-EC and ESBLs-KP was estimated at 91.3% [95% confidence interval (CI): 90.1-92.5%] and 65.6% (95% CI: 60.8-70.2%), respectively. There was significant heterogeneity among the 31 studies for ESBLs-EC (χ² = 91.621; p < 0.001; I² = 67.256%) and ESBLs-KP (χ² = 348.72; p < 0.001; I² = 91.4%). Most clinical isolates of ESBLs-EC had MIC₅₀ and MIC₉₀ at a concentration of 0.5 and 2 µg/mL [minimum inhibitory concentration (MIC) at which 50% and 90% of isolates were inhibited], respectively. In contrast, most clinical isolates of ESBLs-KP had MIC₅₀ and MIC₉₀ at a concentration of 1 and 32 µg/mL, respectively.

Conclusion: Based on the meta-analysis results, Ceftolozane/Tazobactam has a more promising in vitro antibacterial activity against ESBLs-EC isolates from different clinical sources than ESBLs-KP isolates. Therefore, Ceftolozane/Tazobactam can be a useful therapeutic drug as an alternative to carbapenems. Randomized clinical trials are needed to provide clinical evidence to support these observations.

Keywords: Ceftolozane/Tazobactam; ESBL; Escherichia coli; Klebsiella pneumoniae; antibacterial activity.