Ceftobiprole and pneumonia in adults admitted to the emergency department is it time to assess a new therapeutic algorithm?

Abstract

Objective

Ceftobiprole is an advance generation cephalosporin which has broad-spectrum bacterial activity (both against Gram-positive and negative pathogens) and was approved for the treatment of community-acquired pneumonia (CAP) and non-ventilated hospital-acquired pneumonia (HAP) in most European countries. We aimed to evaluate the efficacy and safety of ceftobiprole in the treatment of pneumonia in a cohort of severely ill patients admitted to the emergency department (ED).

Methods

1-year observational retrospective mono-centric study. Were defined two primary endpoints: first, to evaluate the clinical cure at the test-of-cure (TOC); the second, to evaluate the early improvement, defined as a reduction of symptoms and inflammatory parameters 72 hours after the start of treatment. The secondary endpoint is to evaluate the reduction of antibiotic “burden” using ceftobiprole despite standard of care in severe hospital-acquired pneumonia.

Results

During the study period, a total of 48 patients with severe pneumonia received ceftobiprole: twenty-two patients (45.8%) as empiric therapy, 9 (18.5%) as a de-escalation option from previous combination therapies, 13 patients (27.1%) as an escalation therapy from ceftriaxone or amoxicillin/clavulanate and four patients (8.3%) as a targeted therapy based on microbiological results. Ceftobiprole mean duration therapy was 10.2 days. Forty-six patients with severe pneumonia had an early clinical improvement 72 hours after the start of treatment (95.8%). In general, ceftobiprole was well tolerated; only one patient suspended the drug because of poor tolerability. The clinical cure at TOC was 85.4% and 30-days crude mortality was 10.4%.

Conclusions

This study confirms that ceftobiprole is effective in severely ill patients with pneumonia at risk of poor outcomes.

Keywords:

• Community-acquired pneumonia
• hospital-acquired pneumonia
• Ceftobiprole
• MRSA
• Pseudomonas
• emergency department

Additional information

Notes on contributors

Massimo Crapis

Dr. Massimo Crapis, Medicine degree in Udine in 2004. Specialist in infectious disease in Udine in 2008. Working in Santa Maria degli Angeli hospital in Pordenone since 2016.

Sergio Venturini

Dr. Sergio Venturini, Medicine degree in Udine in 2010. Specialist in infectious disease in Verona in 2016. Working in Santa Maria degli Angeli hospital in Pordenone since 2017.

Paola Della Siega

Dr. Paola della Siega, Medicine degree in Udine in 2010. Specialist in infectious disease in Udine in 2016. Working in Santa Maria della Misericordia in Udine since 2019.

Maurizio Tonizzo

Dr. Maurizio Tonizzo, Medicine degree in Trieste in 1983. Specialist in internal medicine in Trieste in 1996. Working in Santa Maria degli Angeli hospital in Pordenone since 1998.

Elena Garlatti

Dr. Elena Garlatti Costa, Medicine degree in Udine in 2005. Specialist in internal medicine in Udine in 2010. Working in Santa Maria degli Angeli hospital in Pordenone since 2012.

Rita De Rosa

Dr. Rita de Rosa, Medicine degree in Trieste in 1988. Specialist in patology in Padova in 1994. Working in Santa Maria degli Angeli hospital in Pordenone since 2007.

Barbara Basso

Dr. Barbara Basso, Farmacist degree in Padova in 1999. Working in Santa Maria degli Angeli hospital in Pordenone since 2008.

Elisa Pontoni

Dr. Elisa Pontoni, Medicine degree in Padova in 1996. Specialist in internal medicine in Padova in 2000. Working in Santa Maria degli Angeli hospital in Pordenone since 2009.