Comparison of Ceftolozane-Tazobactam and Ceftazidime-Avibactam in the Treatment of Multidrug-Resistant/Difficult-to-Treat Resistant Pseudomonas aeruginosa Infections: A Systematic Review and Meta-analysis
Abstract
Background: Ceftolozane-tazobactam and ceftazidime-avibactam are considered first-line treatment for multidrug-resistant (MDR) and/or difficult-to-treat resistant (DTR) Pseudomonas aeruginosa infections. Conflicting results in terms of clinical outcome and resistance development emerged from real-world comparative studies. We performed a systematic review with meta-analysis to compare ceftolozane-tazobactam and ceftazidime-avibactam in the treatment of MDR/DTR P. aeruginosa infections.
Methods: Two authors independently searched PubMed-MEDLINE and Scopus databases from inception to 18 November 2025 to retrieve studies comparing ceftolozane-tazobactam versus ceftazidime-avibactam in the management of MDR/DTR P. aeruginosa infections. Clinical cure was set as the primary outcome, whereas 90-day resistance development, microbiological failure, and the 30-day mortality rate were set as the secondary outcomes. Meta-analysis was performed by pooling the odds ratios (ORs) retrieved from studies providing adjustment for confounders by means of a random-effects model with the inverse variance method. The risk of bias in the included studies was independently assessed using the RoB 2.0 and the ROBINS-I tools.
Results: Among a total of 1193 articles screened, 6 observational studies were retrieved and included (n = 1161; 644 receiving ceftolozane-tazobactam vs 517 receiving ceftazidime-avibactam). Ceftolozane-tazobactam showed a higher clinical cure rate than ceftazidime-avibactam (n =…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,161 participants or records.
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