Indian journal of medical microbiology · 2026
Rising threats of ceftolozane-tazobactam resistance in P. aeruginosa and A. baumannii: Species-, phenotype-, and geography-specific insights from a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Wang Hongda, Qiang Weidong, Fan Guoqiang
Аннотация
BACKGROUND: Ceftolozane-tazobactam (C/T) is increasingly used to treat multidrug-resistant Gram-negative infections, but rising resistance threatens its effectiveness. Understanding global patterns is essential for guiding therapy and stewardship.
METHODS: We conducted a systematic review and meta-analysis of studies reporting C/T resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. Pooled resistance proportions were estimated using random-effects models, with subgroup analyses by species, resistance phenotype, infection source, geography, and study period. Heterogeneity, temporal trends, and potential biases were assessed.
RESULTS: Among 75,403 tested isolates, 14,379 were resistant, yielding an overall pooled C/T resistance estimate of 26.2%. P. aeruginosa showed moderate resistance (12.6%), rising sharply in MDR (21.8%) and XDR (44.4%) subsets. A. baumannii demonstrated near-universal resistance (88.2%), particularly among carbapenem-resistant strains (≈99%). Resistance increased over time, from 19.9% in 2013-2021 to 38.7% in 2022-2024. Geographic differences were notable: high prevalence in Germany (46.6%), Mexico (42.6%), and Egypt (41.3%), and lower rates in Taiwan (15.1%) and Canada (1.7%). Respiratory isolates exhibited the highest resistance (49.4%), whereas bloodstream and pediatric infections were lower, though data were limited. Subgroup analyses for XDR, PDR, and carbapenemase producers were constrained by small study numbers.
CONCLUSIONS: C/T retains activity against many P. aeruginosa isolates but is increasingly compromised in MDR/XDR and carbapenemase-producing strains. A. baumannii shows consistently high resistance, limiting C/T utility. Rapidly rising resistance, infection-site variability, and geographic heterogeneity highlight the urgent need for targeted stewardship, local susceptibility-guided empiric therapy, and ongoing research into alternative or combination therapies.
METHODS: We conducted a systematic review and meta-analysis of studies reporting C/T resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. Pooled resistance proportions were estimated using random-effects models, with subgroup analyses by species, resistance phenotype, infection source, geography, and study period. Heterogeneity, temporal trends, and potential biases were assessed.
RESULTS: Among 75,403 tested isolates, 14,379 were resistant, yielding an overall pooled C/T resistance estimate of 26.2%. P. aeruginosa showed moderate resistance (12.6%), rising sharply in MDR (21.8%) and XDR (44.4%) subsets. A. baumannii demonstrated near-universal resistance (88.2%), particularly among carbapenem-resistant strains (≈99%). Resistance increased over time, from 19.9% in 2013-2021 to 38.7% in 2022-2024. Geographic differences were notable: high prevalence in Germany (46.6%), Mexico (42.6%), and Egypt (41.3%), and lower rates in Taiwan (15.1%) and Canada (1.7%). Respiratory isolates exhibited the highest resistance (49.4%), whereas bloodstream and pediatric infections were lower, though data were limited. Subgroup analyses for XDR, PDR, and carbapenemase producers were constrained by small study numbers.
CONCLUSIONS: C/T retains activity against many P. aeruginosa isolates but is increasingly compromised in MDR/XDR and carbapenemase-producing strains. A. baumannii shows consistently high resistance, limiting C/T utility. Rapidly rising resistance, infection-site variability, and geographic heterogeneity highlight the urgent need for targeted stewardship, local susceptibility-guided empiric therapy, and ongoing research into alternative or combination therapies.