Pharmacodynamics of Ceftolozane plus Tazobactam Studied in anIn VitroPharmacokinetic Model of Infection
ABSTRACTCeftolozane plus tazobactam is an antipseudomonal cephalosporin combined with tazobactam, an established beta-lactamase inhibitor, and hasin vitropotency against a range of clinically important β-lactamase-producing bacteria, including most extended-spectrum-β-lactamase (ESBL)-positiveEnterobacteriaceae. The pharmacodynamics of β-lactam–β-lactamase inhibitor combinations presents a number of theoretical and practical challenges, including modeling different half-lives of the compounds. In this study, we studied the pharmacodynamics of ceftolozane plus tazobactam againstEscherichia coliandPseudomonas aeruginosausing anin vitropharmacokinetic model of infection. Five strains ofE. coli, including three clinical strains plus two CTX-M-15 (one high and one moderate) producers, and five strains ofP. aeruginosa, including two with OprD overexpression and AmpC β-lactamases, were employed. Ceftolozane MICs (E. coli, 0.12 to 0.25 mg/liter, andP. aeruginosa, 0.38 to 8 mg/liter) were determined in the presence of 4 mg/liter tazobactam. Dose ranging of ceftolozane (percentage of time in which the free-drug concentration exceeds the MIC [fT>MIC], 0 to 100%) plus tazobactam (human pharmacokinetics) was simulated every 8 hours, with half-lives (t1/2) of 2.5 and 1 h, respectively. Ceftolozane and tazobactam concentrations were confirmed by high-performance liquid chromatography (HPLC). The ceftolozane-plus-tazobactamfT>MIC values at 24 h for a static effect and a 1-log and 2-log drop in initial inoculum forE. coliwere 27.8% ± 5.6%, 33.0% ± 5.6%, and 39.6% ± 8.5%, respectively. CTX-M-15 production did not affect the 24-hfT>MIC forE. colistrains. The ceftolozane-plus-tazobactamfT>MIC values for a 24-h static effect and a 1-log and 2-log drop forP. aeruginosawere 24.9% ± 3.0%, 26.6% ± 3.9%, and 31.2% ± 3.6%. Despite a wide range of absolute MICs, the killing remained predictable as long as the MICs were normalized to the correspondingfT>MIC. Emergence of resistance on 4× MIC plates and 8× MIC plates occurred maximally at anfT>MIC of 10 to 30% and increased as time of exposure increased. ThefT>MIC for a static effect for ceftolozane plus tazobactam is less than that observed with other cephalosporins againstE. coliandP. aeruginosaand is more similar to thefT>MIC reported for carbapenems.