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Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort.
Infect Drug Resist 2019; 12:1257-1264ID

Abstract

Objectives:

On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli.

Methods:

From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality.

Results:

A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12-13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67-6.15), hospital-acquired infection (MRR 2,17, CI 1.02-4.62), admission at intensive care unit (MRR 20.45, 5.31-78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98-4.68).

Conclusion:

Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.

Authors+Show Affiliations

Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark. Toxicology Laboratory, Analytical BioSciences, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark. Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.Toxicology Laboratory, Analytical BioSciences, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31190913

Citation

Thønnings, Sara, et al. "Cefuroxime Compared to Piperacillin/tazobactam as Empirical Treatment of Escherichia Coli Bacteremia in a Low Extended-spectrum Beta-lactamase (ESBL) Prevalence Cohort." Infection and Drug Resistance, vol. 12, 2019, pp. 1257-1264.
Thønnings S, Jansåker F, Gradel KO, et al. Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort. Infect Drug Resist. 2019;12:1257-1264.
Thønnings, S., Jansåker, F., Gradel, K. O., Styrishave, B., & Knudsen, J. D. (2019). Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort. Infection and Drug Resistance, 12, pp. 1257-1264. doi:10.2147/IDR.S197735.
Thønnings S, et al. Cefuroxime Compared to Piperacillin/tazobactam as Empirical Treatment of Escherichia Coli Bacteremia in a Low Extended-spectrum Beta-lactamase (ESBL) Prevalence Cohort. Infect Drug Resist. 2019;12:1257-1264. PubMed PMID: 31190913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low Extended-spectrum beta-lactamase (ESBL) prevalence cohort. AU - Thønnings,Sara, AU - Jansåker,Filip, AU - Gradel,Kim Oren, AU - Styrishave,Bjarne, AU - Knudsen,Jenny Dahl, Y1 - 2019/05/13/ PY - 2018/12/11/received PY - 2019/02/21/accepted PY - 2019/6/14/entrez PY - 2019/6/14/pubmed PY - 2019/6/14/medline KW - bacteremia KW - cefuroxime, E. coli KW - mortality KW - piperacillin/tazobactam SP - 1257 EP - 1264 JF - Infection and drug resistance JO - Infect Drug Resist VL - 12 N2 - Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli. Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality. Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12-13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67-6.15), hospital-acquired infection (MRR 2,17, CI 1.02-4.62), admission at intensive care unit (MRR 20.45, 5.31-78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98-4.68). Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam. SN - 1178-6973 UR - https://www.unboundmedicine.com/medline/citation/31190913/Cefuroxime_compared_to_piperacillin/tazobactam_as_empirical_treatment_of_Escherichia_coli_bacteremia_in_a_low_Extended-spectrum_beta-lactamase_(ESBL)_prevalence_cohort L2 - https://dx.doi.org/10.2147/IDR.S197735 DB - PRIME DP - Unbound Medicine ER -