Treatment Outcomes for Carbapenem-Resistant and Cephalosporin-Susceptible Pseudomonas aeruginosa Pneumonia.

BACKGROUND: Carbapenem-resistant (Car-R) Pseudomonas aeruginosa is an urgent threat. These isolates may remain susceptible to traditional noncarbapenem antipseudomonal ß-lactams, but it is unclear if carbapenem resistance impacts the effectiveness of these agents. OBJECTIVE: The purpose of this study was to compare clinical outcomes in Car-R and cephalosporin-susceptible (Ceph-S) P. aeruginosa pneumonia treated with cefepime versus other susceptible agents. METHODS: This retrospective cohort study evaluated patients diagnosed with hospital-acquired or ventilator-associated pneumonia who had a respiratory isolate of Car-R Ceph-S P. aeruginosa. Patients were excluded if they had polymicrobial respiratory cultures, other concomitant infections, empyema, death within 3 days of index culture, or received less than 3 days of susceptible therapy. Patients treated with cefepime were compared to other susceptible therapies. The primary endpoint was 30-day in-hospital mortality. RESULTS: Eighty-seven patients were included: cefepime, n = 61; other susceptible therapies, n = 26. There were no differences in 30-day in-hospital mortality between cefepime and other susceptible therapies (19.6% vs. 19.2%, p value = 0.719). In addition, there were no differences between clinical cure rates (cefepime 65.6% vs. other therapies 72 %, p value = 0.47). In multivariate logistic regression, treatment with cefepime (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.11-2.52) was not independently associated with 30-day in-hospital mortality. CONCLUSION AND RELEVANCE: For the treatment of Car-R Ceph-S P. aeruginosa pneumonia, cefepime showed similar rates of 30-day in-hospital mortality and clinical outcomes when compared to other susceptible therapies. Cefepime may be utilized to conserve novel ß-lactam and ß-lactamase inhibitors.

Ceftolozane/Tazobactam vs Polymyxin or Aminoglycoside-based Regimens for the Treatment of Drug-resistant Pseudomonas aeruginosa.

BACKGROUND: Ceftolozane/tazobactam is a novel cephalosporin/beta-lactamase inhibitor combination that often retains activity against resistant Pseudomonas aeruginosa. The comparative safety and efficacy vs polymyxins or aminoglycosides in this setting remains unknown. METHODS: A retrospective, multicenter, observational cohort study was performed. Patients who received ceftolozane/tazobactam were compared with those treated with either polymyxin or aminoglycoside-based regimens for infections due to drug-resistant P. aeruginosa. Multivariate logistic regression was performed controlling for factors associated with treatment to assess the independent impact of ceftolozane/tazobactam on clinical cure, acute kidney injury (AKI), and in-hospital mortality. RESULTS: A total of 200 patients were included (100 in each treatment arm). The cohort represented an ill population with 69% in the intensive care unit, 63% mechanically ventilated, and 42% in severe sepsis or septic shock at infection onset. The most common infection type was ventilator-associated pneumonia (52%); 7% of patients were bacteremic. Combination therapy was more commonly used in polymyxin/aminoglycoside patients than those who received ceftolozane/tazobactam (72% vs 15%, P < .001). After adjusting for differences between groups, receipt of ceftolozane/tazobactam was independently associated with clinical cure (adjusted odds ratio [aOR], 2.63; 95% confidence interval [CI], 1.31-5.30) and protective against AKI (aOR, 0.08; 95% CI, 0.03-0.22). There was no difference in in-hospital mortality. The number needed to treat for a clinical cure with ceftolozane/tazobactam was 5, and the number needed to harm with AKI with a polymyxin/aminoglycoside was 4. CONCLUSIONS: These data support the preferential use of ceftolozane/tazobactam over polymyxins or aminoglycosides for drug-resistant P. aeruginosa infections.

After-school snack intake among Canadian children and adolescents.

OBJECTIVES: The article describes the after-school (AS) snacking pattern of young Canadians and its relationship with the amount of energy consumed daily and at dinner. METHODS: We analyzed cross-sectional dietary data, measured by 24h recall, from 9,131 children and adolescents aged 4 to 18 years from the Canadian Community Health Survey, cycle 2.2 (2004). We evaluated AS snack intake; i.e., foods consumed Monday to Friday between 3:00 and 6:00 pm, excluding lunch and dinner. We also assessed the consumption frequency of AS snack items, the energy provided by AS snacks and total daily energy intake (TDEI) by age group and sex. RESULTS: Approximately 63% of respondents consumed AS snacks. AS snacks provided on average 1212[95%CI,1157-1268] kJ (290[95%CI,276-303] kcal), representing 13[95%CI,12-13]% of TDEI. Youth who consumed AS snacks contributing 1-418 kJ (1-99 kcal) reported lower TDEI than those who consumed no snack. Among AS snack consumers, TDEI was higher in groups consuming the highest amount of energy from AS snacks. Fruits were among the most frequently consumed food categories. However, the largest energy contributors were mostly foods that may be energy-dense and nutrient-poor, such as cookies, sugar-sweetened beverages and sweets. CONCLUSION: Considering that the majority of children and adolescents consumed AS snacks, that these snacks provided about 13% of their TDEI, and that the majority of the most frequently consumed snacks were generally energy-dense, nutrient-poor foods, the AS time period presents an opportunity to promote healthy eating in order to improve diet quality and potentially influence TDEI among Canadian children and adolescents.