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Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.
PLoS One 2016; 11(4):e0153696Plos

Abstract

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), P<0.01). After adjusting for confounders, use of empiric piperacillin-tazobactam was not associated with increased 30-day mortality (OR 1.00, 95% CI; 0.45-2.17). Empiric piperacillin-tazobactam was not associated with increased 30-day mortality and may result in fewer multi-drug resistant and fungal infections when compared with a carbapenem.

Authors+Show Affiliations

Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore, Singapore. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia.Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore.Department of Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.Department of Medicine, National University of Singapore, Singapore, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27104951

Citation

Ng, Tat Ming, et al. "Empiric Piperacillin-Tazobactam Versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae." PloS One, vol. 11, no. 4, 2016, pp. e0153696.
Ng TM, Khong WX, Harris PN, et al. Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. PLoS ONE. 2016;11(4):e0153696.
Ng, T. M., Khong, W. X., Harris, P. N., De, P. P., Chow, A., Tambyah, P. A., & Lye, D. C. (2016). Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. PloS One, 11(4), pp. e0153696. doi:10.1371/journal.pone.0153696.
Ng TM, et al. Empiric Piperacillin-Tazobactam Versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. PLoS ONE. 2016;11(4):e0153696. PubMed PMID: 27104951.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. AU - Ng,Tat Ming, AU - Khong,Wendy X, AU - Harris,Patrick N A, AU - De,Partha P, AU - Chow,Angela, AU - Tambyah,Paul A, AU - Lye,David C, Y1 - 2016/04/22/ PY - 2015/10/23/received PY - 2016/04/03/accepted PY - 2016/4/23/entrez PY - 2016/4/23/pubmed PY - 2017/3/7/medline SP - e0153696 EP - e0153696 JF - PloS one JO - PLoS ONE VL - 11 IS - 4 N2 - Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), P<0.01). After adjusting for confounders, use of empiric piperacillin-tazobactam was not associated with increased 30-day mortality (OR 1.00, 95% CI; 0.45-2.17). Empiric piperacillin-tazobactam was not associated with increased 30-day mortality and may result in fewer multi-drug resistant and fungal infections when compared with a carbapenem. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27104951/Empiric_Piperacillin_Tazobactam_versus_Carbapenems_in_the_Treatment_of_Bacteraemia_Due_to_Extended_Spectrum_Beta_Lactamase_Producing_Enterobacteriaceae_ L2 - http://dx.plos.org/10.1371/journal.pone.0153696 DB - PRIME DP - Unbound Medicine ER -