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Piperacillin-tazobactam appeared inferior to carbapenems for ESBL bacteremia
Treatment with piperacillin-tazobactam appears inferior to carbapenems for treatment of extended-spectrum beta-lactamase bacteria in the blood, according to data published in Clinical Infectious Diseases.
“If a patient with bacteremia is at high-risk of harboring an [extended-spectrum beta-lactamase (ESBL)], early carbapenem therapy is recommended,” Pranita Tamma, MD, MHS, assistant professor of pediatrics and director of the pediatric antimicrobial stewardship program at Johns Hopkins Hospital, told Infectious Disease News. “However, because the indiscriminate use of carbapenems can further carbapenem resistance, patient risk factors such as a history of highly drug-resistant Gram-negative infections, recent broad-spectrum antibiotic use and the patient’s epidemiological history should be considered when making this decision.”
Pranita Tamma
According to Tamma, the prevalence of ESBLs is increasing and although carbapenems are the treatment of choice, the role of piperacillin-tazobactam (PTZ) has been unclear.
Tamma and colleagues identified 213 patients with ESBL bacteremia who were hospitalized at The Johns Hopkins Hospital from January 2007 to April 2014. Among those, 103 patients received empiric piperacillin-tazobactam (PTZ) and switched to carbapenem treatment after susceptibility results. The median time to changing therapy was 84 hours. The other 110 patients received carbapenems for the full course of therapy.
Seventeen percent of patients in the PTZ group and 8% in the carbapenem group died within 14 days of the first positive blood culture. After matching patients with similar risk factors and additional adjustment for age, Pitt bacteremia score and ICU care, PTZ treatment was associated with a 1.92 increased risk for death by day 14 (95% CI, 1.07-3.45).
“Our data suggest that PTZ is inferior to carbapenems for the treatment of invasive ESBL infections,” Tamma said. “However, there were no patients in our cohort who received prolonged infusion PTZ therapy and there were a limited number of patients who received high-dose or 4.5 g of PTZ per dose. Further work evaluating the role of these administration strategies of PTZ for invasive ESBL infections is necessary.”
The researchers also said that the retrospective nature of the study did not allow for control of all measured and unmeasured confounders, which may affect the relationship between PTZ and 14-day mortality in these patients. – by Emily Shafer
Pranita Tamma, MD, MHS, can be reached at ptamma1@jhmi.edu.
Disclosure: Tamma has received research funding from Merck and Pfizer, unrelated to the current work.