Review Article

Effectiveness of Cephalosporins /Siderophore Cephalosporins Versus Meropenem as Therapy in Patients with Hospital Acquired Pneumonia

Abstract

Background: Hospital Acquired Pneumonia (HAP) or nosocomial pneumonia is an infection caused mainly by gram-negative bacteria. Carbapenems and cephalosporins/cephalosporin siderophores are effective for infections caused by gram-negative bacteria. Objective: To compare the effectiveness of antibiotics from the Carbapenem group (meropenem) compared to the cephalosporin/cephalosporin siderophore group in HAP infections caused by gram-negative bacteria. Methods:  Sources of article searches used Cochrane and PubMed, which were then selected by the PICO method with a population of adult HAP patients, with comparator cephalosporins/cephalosporin siderophores that have clinical improvement outcomes with parameters of microbiological response and death, the flow chart PRISMA described it. Results: A total of 7 articles comprehensively discussed the effectiveness of cephalosporins/siderophore cephalosporins and meropenem against Klebsiella pneumonia, Pseudomonas aeruginosa, and Escherichia coli. The clinical recovery of patients after administering these two antibiotics showed high therapeutic effectiveness and could reduce mortality. Ceftazidime-avibactam, ceftolozane-tazobactam, and cefiderocol are new antibiotics that are effective for HAP. Meropenem at high doses can offset the efficacy of the three antibiotic combinations and minimize antibiotic resistance. Conclusion:  meropenem and cephalosporins/siderophore cephalosporins have similar effectiveness as therapy for gram-negative infections in HAP.

Hospital-Acquired Pneumonia (Nosocomial Pneumonia) and Ventilator-Associated Pneumonia: Overview, Pathophysiology, Etiology. Published online June 18, 2023. Accessed December 27, 2023. https://emedicine.medscape.com/article/234753-overview?form=fpf&scode=msp&st=fpf&socialSite=google&icd=login_success_gg_match_fpf&isSocialFTC=true

Liu JW, Chen YH, Lee WS, et al. Randomized Noninferiority Trial of Cefoperazone-Sulbactam versus Cefepime in the Treatment of Hospital-Acquired and Healthcare-Associated Pneumonia. Antimicrob Agents Chemother. 2019;63(8):e00023-19. doi:10.1128/AAC.00023-19

Azmi S, Aljunid SM, Maimaiti N, et al. Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines. International Journal of Infectious Diseases. 2016;49:87-93. doi:10.1016/j.ijid.2016.05.021

Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases. 2016;63(5):e61-e111. doi:10.1093/cid/ciw353

Nicolau DP. Carbapenems: a potent class of antibiotics. Expert Opin Pharmacother. 2008;9(1):23-37. doi:10.1517/14656566.9.1.23

Bui T, Preuss CV. Cephalosporins. In: StatPearls. StatPearls Publishing; 2023. Accessed December 27, 2023. http://www.ncbi.nlm.nih.gov/books/NBK551517/

Syed YY. Cefiderocol: A Review in Serious Gram-Negative Bacterial Infections. Drugs. 2021;81(13):1559-1571. doi:10.1007/s40265-021-01580-4

Matsunaga Y, Sonoyama T, Casanova L, et al. 1292. Safety Profile of the Novel Siderophore Cephalosporin Cefiderocol in Randomized Phase 2 and Phase 3 Clinical Studies of Serious Gram-Negative Infections. Open Forum Infectious Diseases. 2020;7(Supplement_1):S661-S662. doi:10.1093/ofid/ofaa439.1475

Bilal M, El Tabei L, Büsker S, Krauss C, Fuhr U, Taubert M. Clinical Pharmacokinetics and Pharmacodynamics of Cefiderocol. Clin Pharmacokinet. 2021;60(12):1495-1508. doi:10.1007/s40262-021-01063-5

Wunderink RG, Matsunaga Y, Ariyasu M, et al. Cefiderocol versus high-dose, extended-infusion meropenem for the treatment of Gram-negative nosocomial pneumonia (APEKS-NP): a randomised, double-blind, phase 3, non-inferiority trial. The Lancet Infectious Diseases. 2021;21(2):213-225. doi:10.1016/S1473-3099(20)30731-3

Matsunaga Y, Echols R, Ariyasu M, Portsmouth S, Menon A, Nagata T. Efficacy of Cefiderocol in Severely Ill Nosocomial Pneumonia Patients in APEKS-NP Study. In: B28. HOST AND MICROBIAL CLINICAL STUDIES IN LUNG INFECTIONS AND LUNG DISEASES. American Thoracic Society International Conference Abstracts. American Thoracic Society; 2020:A2951-A2951. doi:10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A2951

Viale P, Sandrock CE, Ramirez P, Rossolini GM, Lodise TP. Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence. Ann Intensive Care. 2023;13(1):52. doi:10.1186/s13613-023-01146-5

Rup AR, Dash AK, Patnaik S. Ceftazidime-Avibactam for Hospital Acquired Pneumonia Due to Extended Drug-Resistant Klebsiella pneumoniae. Indian J Pediatr. 2021;88(3):290-291. doi:10.1007/s12098-020-03546-y

Torres A, Zhong N, Pachl J, et al. Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial. The Lancet Infectious Diseases. 2018;18(3):285-295. doi:10.1016/S1473-3099(17)30747-8

Torres A, Rank D, Melnick D, et al. Randomized Trial of Ceftazidime-Avibactam vs Meropenem for Treatment of Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia (REPROVE): Analyses per US FDA–Specified End Points. Open Forum Infectious Diseases. 2019;6(4). doi:10.1093/ofid/ofz149

Chen Y, Huang HB, Peng JM, Weng L, Du B. Efficacy and Safety of Ceftazidime-Avibactam for the Treatment of Carbapenem-Resistant Enterobacterales Bloodstream Infection: a Systematic Review and Meta-Analysis. Microbiology Spectrum. 2022;10(2). doi:10.1128/spectrum.02603-21

Zhuang HH, Chen Y, Hu Q, et al. Efficacy and mortality of ceftazidime/avibactam-based regimens in carbapenem-resistant Gram-negative bacteria infections: A retrospective multicenter observational study. Journal of Infection and Public Health. 2023;16(6):938-947. doi:10.1016/j.jiph.2023.04.014

Shirley M. Ceftazidime-Avibactam: A Review in the Treatment of Serious Gram-Negative Bacterial Infections. Drugs. 2018;78(6):675-692. doi:10.1007/s40265-018-0902-x

Montero M, Ochoa SD, López-Causapé C, et al. Efficacy of Ceftolozane-Tazobactam in Combination with Colistin against Extensively Drug-Resistant Pseudomonas aeruginosa, Including High-Risk Clones, in an In Vitro Pharmacodynamic Model. Antimicrobial Agents and Chemotherapy. 2020;64(4). doi:10.1128/AAC.02542-19

Martin-Loeches I, Timsit JF, Kollef MH, et al. Clinical and microbiological outcomes, by causative pathogen, in the ASPECT-NP randomized, controlled, Phase 3 trial comparing ceftolozane/tazobactam and meropenem for treatment of hospital-acquired/ventilator-associated bacterial pneumonia. Journal of Antimicrobial Chemotherapy. 2022;77(4):1166-1177. doi:10.1093/jac/dkab494

Zhang Z, Patel YT, Fiedler‐Kelly J, Feng H, Bruno CJ, Gao W. Population Pharmacokinetic Analysis for Plasma and Epithelial Lining Fluid Ceftolozane/Tazobactam Concentrations in Patients With Ventilated Nosocomial Pneumonia. The Journal of Clinical Pharma. 2021;61(2):254-268. doi:10.1002/jcph.1733

Kollef MH, Nováček M, Kivistik Ü, et al. Ceftolozane–tazobactam versus meropenem for treatment of nosocomial pneumonia (ASPECT-NP): a randomised, controlled, double-blind, phase 3, non-inferiority trial. The Lancet Infectious Diseases. 2019;19(12):1299-1311. doi:10.1016/S1473-3099(19)30403-7

Huntington JA, Yu B, Li L, et al. Outcomes in Participants with Renal Impairment from a Phase 3 Clinical Trial for Ceftolozane/Tazobactam Treatment of Nosocomial Pneumonia (ASPECT-NP). Antimicrob Agents Chemother. 2020;64(12):e00731-20. doi:10.1128/AAC.00731-20

Zhanel GG, Chung P, Adam H, et al. Ceftolozane/tazobactam: a novel cephalosporin/β-lactamase inhibitor combination with activity against multidrug-resistant gram-negative bacilli. Drugs. 2014;74(1):31-51. doi:10.1007/s40265-013-0168-2

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IssueVol 10 No 3 (2024) QRcode
SectionReview Article(s)
Keywords
Hospital Acquired Pneumonia Meropenem Cephalosporins Nosocomial Pneumonia.

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How to Cite
1.
Ruflianasari P, Andayani T, Endarti D. Effectiveness of Cephalosporins /Siderophore Cephalosporins Versus Meropenem as Therapy in Patients with Hospital Acquired Pneumonia. JPPM. 2025;10(3):1-7.