Re-evaluation of cefepime or piperacillin-tazobactam to decrease use of carbapenems in extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (REDUCE-BSI)
To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs). Retrospective cohort study. Tertiary-care, academic medical center. The study included...
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Published in: | Antimicrobial stewardship & healthcare epidemiology : ASHE Vol. 2; no. 1; p. e39 |
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Abstract | To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs).
Retrospective cohort study.
Tertiary-care, academic medical center.
The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection.
We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development.
Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%;
= .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had
and 38 had
spp). We detected no differences in secondary outcomes between the groups.
Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms. |
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AbstractList | To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs).ObjectiveTo re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs).Retrospective cohort study.DesignRetrospective cohort study.Tertiary-care, academic medical center.SettingTertiary-care, academic medical center.The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection.PatientsThe study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection.We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development.MethodsWe compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development.Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups.ResultsData from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups.Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms.ConclusionCompared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms. To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs). Retrospective cohort study. Tertiary-care, academic medical center. The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection. We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development. Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had and 38 had spp). We detected no differences in secondary outcomes between the groups. Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms. Abstract Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase–producing Enterobacterales bloodstream infections (ESBL-E BSIs). Design: Retrospective cohort study. Setting: Tertiary-care, academic medical center. Patients: The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection. Methods: We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development. Results: Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups. Conclusion: Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms. Abstract Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase–producing Enterobacterales bloodstream infections (ESBL-E BSIs). Design: Retrospective cohort study. Setting: Tertiary-care, academic medical center. Patients: The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection. Methods: We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development. Results: Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups. Conclusion: Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms. |
ArticleNumber | e39 |
Author | Venugopalan, Veena Santevecchi, Barbara A Voils, Stacy A Ramphal, Reuben Vu, Catherine H Cherabuddi, Kartikeya DeSear, Kathryn |
AuthorAffiliation | 2 Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy , Gainesville , Florida 3 Department of Medicine, College of Medicine, University of Florida , Gainesville , Florida 4 Department of Pharmacy, University of Florida Health Shands Hospital , Gainesville , Florida 1 Department of Pharmacy , University Medical Center New Orleans, New Orleans , Louisiana |
AuthorAffiliation_xml | – name: 3 Department of Medicine, College of Medicine, University of Florida , Gainesville , Florida – name: 2 Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy , Gainesville , Florida – name: 4 Department of Pharmacy, University of Florida Health Shands Hospital , Gainesville , Florida – name: 1 Department of Pharmacy , University Medical Center New Orleans, New Orleans , Louisiana |
Author_xml | – sequence: 1 givenname: Catherine H surname: Vu fullname: Vu, Catherine H organization: Department of Pharmacy, University Medical Center New Orleans, New Orleans, Louisiana – sequence: 2 givenname: Veena orcidid: 0000-0002-9424-5783 surname: Venugopalan fullname: Venugopalan, Veena organization: Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida – sequence: 3 givenname: Barbara A orcidid: 0000-0001-5239-8303 surname: Santevecchi fullname: Santevecchi, Barbara A organization: Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida – sequence: 4 givenname: Stacy A orcidid: 0000-0002-6741-5249 surname: Voils fullname: Voils, Stacy A organization: Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida – sequence: 5 givenname: Reuben orcidid: 0000-0002-9087-1816 surname: Ramphal fullname: Ramphal, Reuben organization: Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida – sequence: 6 givenname: Kartikeya surname: Cherabuddi fullname: Cherabuddi, Kartikeya organization: Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida – sequence: 7 givenname: Kathryn orcidid: 0000-0002-9042-9075 surname: DeSear fullname: DeSear, Kathryn organization: Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, Florida |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36310806$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1016_j_ejps_2022_106334 crossref_primary_10_1093_jacamr_dlad021 crossref_primary_10_3390_pharmacy11020074 crossref_primary_10_25259_JLP_2023_4_29__1769 crossref_primary_10_1186_s13613_023_01134_9 crossref_primary_10_1016_S1473_3099_24_00149_X crossref_primary_10_2217_fmb_2022_0097 |
Cites_doi | 10.1128/AAC.00365-16 10.1093/jac/dkl349 10.1016/j.ijantimicag.2018.07.021 10.1093/cid/ciaa1479 10.1093/jac/dky168 10.1001/jama.2018.12163 10.1016/j.ijantimicag.2005.06.004 10.1128/AAC.00164-17 10.1093/cid/cir790 10.1093/ofid/ofy347 10.1128/AAC.01477-15 10.1016/j.cmi.2019.03.030 10.1093/cid/cit017 10.1128/AAC.05419-11 10.1093/cid/cis916 10.1128/AAC.00355-19 10.1177/0897190017743134 10.1093/ofid/ofw132 10.1093/infdis/jiw282 10.3390/antibiotics9020061 10.1128/AAC.01813-18 10.1128/AAC.48.6.1941-1947.2004 10.1093/cid/cix034 10.1128/JCM.02128-16 10.1007/s10096-017-3133-2 10.1128/JCM.02424-15 10.1111/j.1469-0691.2005.01265.x |
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Snippet | To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing... Abstract Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum... Abstract Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum... |
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Title | Re-evaluation of cefepime or piperacillin-tazobactam to decrease use of carbapenems in extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (REDUCE-BSI) |
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