Ceftazidime-avibactam versus ceftolozane-tazobactam in the treatment of drug-resistant Pseudomonas aeruginosa: a meta-analysis.

OBJECTIVES

Few studies comparing the clinical outcomes of the two novel agents ceftolozane-tazobactam (CT) and ceftazidime-avibactam (CA) in treating infections due to drug-resistant P. aeruginosa have been published. However, these studies demonstrated inconsistent findings and were limited by the small sample sizes. The aim of this meta-analysis is to evaluate the clinical outcomes of CA versus CT in treating infections caused by drug-resistant P. aeruginosa.

METHODS

We conducted a comprehensive literature search up to March 2025 in Medline, Embase, Scopus, China National Knowledge Infrastructure, and Cochrane Library. Included studies should have examined the effectiveness of CA versus CT for the treatment of infections caused by resistant P. aeruginosa. Our primary outcome was 30-day mortality. We used the random-effects model, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals. The study was registered in PROSPERO (CRD420251027545).

RESULTS

A total of 10 studies and 1409 patients were included, 644 in CA group and 765 in CT group. When the data from 8 studies were pooled in a meta-analysis, 30-day mortality did not significantly differ in those who received CA compared to CT (OR = 0.93, 95% CI = 0.71-1.23, I-squared = 0.00%). No statistically significant differences were observed in the other outcomes.

CONCLUSION

Our meta-analysis indicated that CA and CT demonstrated comparable clinical outcomes for the treatment of infection caused by resistant P. aeruginosa. However, limitations of the included studies should be acknowledged. More data are needed to validate these findings.