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Justine Haquin - One of the best experts on this subject based on the ideXlab platform.
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ceftazidime Carbapenems or piperacillin tazobactam as single definitive therapy for pseudomonas aeruginosa bloodstream infection a multisite retrospective study
Clinical Infectious Diseases, 2020Co-Authors: Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, Ruben Cardona, Alba Rivera, Céline Pulcini, Manal Abdel Fattah, Justine HaquinAbstract:BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Although β-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS: A multinational retrospective study (9 countries, 25 centers) including 767 hospitalized patients with P. aeruginosa bacteremia treated with β-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate, including propensity-adjusted, analyses were conducted introducing monotherapy type as an independent variable. RESULTS: Thirty-day mortality was 37/213 (17.4%), 42/210 (20%), and 55/344 (16%) in the ceftazidime, Carbapenem, and piperacillin-tazobactam groups, respectively. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate, or propensity-adjusted analyses (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.52-2.46, for ceftazidime; OR, 1.3; 95% CI, 0.67-2.51, for piperacillin-tazobactam, with Carbapenems as reference in propensity adjusted multivariate analysis; 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with Carbapenems (36/206 [17.5%]) versus ceftazidime (25/201 [12.4%]) and piperacillin-tazobactam (28/332 [8.4%] (P = .007). CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with Carbapenems, along with the general preference for Carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
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Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study
Clinical Infectious Diseases, 2019Co-Authors: Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, Ruben Cardona, Alba Rivera, Céline Pulcini, Manal Abdel Fattah, Justine HaquinAbstract:BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Though beta-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS: A multinational retrospective study (9 countries, 25 centers), including hospitalized patients with P . aeruginosa bacteremia treated with beta-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses, including propensity adjusted analysis, were conducted introducing monotherapy type as an independent variable. RESULTS: We included 767 patients. Thirty-day mortality was 37/213 (17.4%) in the ceftazidime group; 42/210 (20%) in the Carbapenem group, and 55/344 (16%) in the piperacillin-tazobactam group. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate or propensity adjusted analyses (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.52-2.46 for ceftazidime, OR 1.3, 95% CI 0.67-2.51 for piperacillin-tazobactam with Carbapenems as reference in propensity adjusted multivariate analysis, 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequently with Carbapenems (36/206, 17.5% versus ceftazidime 25/201, 12.4% and piperacillin-tazobactam 28/332, 8.4%, p=0.007). CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, Carbapenems and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with Carbapenems, along with the general preference for Carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
Patrick N A Harris - One of the best experts on this subject based on the ideXlab platform.
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Global prevalence of Carbapenem resistance in neutropenic patients and association with mortality and Carbapenem use: systematic review and meta-analysis
Journal of Antimicrobial Chemotherapy, 2016Co-Authors: Elda Righi, Patrick N A Harris, Anna Maria Peri, Alexander M. Wailan, Mariana Liborio, Steven W. Lane, David L. PatersonAbstract:Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality. Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with Carbapenem-resistant bloodstream infections in adult neutropenic patients. Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between Carbapenem resistance and mortality and between Carbapenem exposure and resistance. Results: A total of 30 studies from 21 countries were included. Overall Carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to Carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all Carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to Carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with Carbapenem-resistant infections. Carbapenemresistance appeared to correlate with mortality (OR 4.89, 95% CI 3.30-7.26) and previous exposure to Carbapenems (OR 4.63, 95% CI 3.08-6.96). Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous Carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to Carbapenem-based regimens.
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empiric piperacillin tazobactam versus Carbapenems in the treatment of bacteraemia due to extended spectrum beta lactamase producing enterobacteriaceae
PLOS ONE, 2016Co-Authors: Tat Ming Ng, Wendy X Khong, Patrick N A Harris, Partha Pratim De, Angela Chow, Paul Anantharajah TambyahAbstract: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.
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meropenem versus piperacillin tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non susceptible escherichia coli and klebsiella spp the merino trial study protocol for a randomised controlled trial
Trials, 2015Co-Authors: Patrick N A Harris, Anton Y Peleg, Jon Iredell, Paul R Ingram, Spiros Miyakis, Andrew J Stewardson, Benjamin A Rogers, Emma S Mcbryde, Jason A RobertsAbstract:Background Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for Carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding Carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to Carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define Carbapenem-sparing alternatives for these infections.
Tanya Babich - One of the best experts on this subject based on the ideXlab platform.
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ceftazidime Carbapenems or piperacillin tazobactam as single definitive therapy for pseudomonas aeruginosa bloodstream infection a multisite retrospective study
Clinical Infectious Diseases, 2020Co-Authors: Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, Ruben Cardona, Alba Rivera, Céline Pulcini, Manal Abdel Fattah, Justine HaquinAbstract:BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Although β-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS: A multinational retrospective study (9 countries, 25 centers) including 767 hospitalized patients with P. aeruginosa bacteremia treated with β-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate, including propensity-adjusted, analyses were conducted introducing monotherapy type as an independent variable. RESULTS: Thirty-day mortality was 37/213 (17.4%), 42/210 (20%), and 55/344 (16%) in the ceftazidime, Carbapenem, and piperacillin-tazobactam groups, respectively. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate, or propensity-adjusted analyses (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.52-2.46, for ceftazidime; OR, 1.3; 95% CI, 0.67-2.51, for piperacillin-tazobactam, with Carbapenems as reference in propensity adjusted multivariate analysis; 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with Carbapenems (36/206 [17.5%]) versus ceftazidime (25/201 [12.4%]) and piperacillin-tazobactam (28/332 [8.4%] (P = .007). CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with Carbapenems, along with the general preference for Carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
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Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study
Clinical Infectious Diseases, 2019Co-Authors: Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, Ruben Cardona, Alba Rivera, Céline Pulcini, Manal Abdel Fattah, Justine HaquinAbstract:BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Though beta-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, Carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS: A multinational retrospective study (9 countries, 25 centers), including hospitalized patients with P . aeruginosa bacteremia treated with beta-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses, including propensity adjusted analysis, were conducted introducing monotherapy type as an independent variable. RESULTS: We included 767 patients. Thirty-day mortality was 37/213 (17.4%) in the ceftazidime group; 42/210 (20%) in the Carbapenem group, and 55/344 (16%) in the piperacillin-tazobactam group. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate or propensity adjusted analyses (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.52-2.46 for ceftazidime, OR 1.3, 95% CI 0.67-2.51 for piperacillin-tazobactam with Carbapenems as reference in propensity adjusted multivariate analysis, 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequently with Carbapenems (36/206, 17.5% versus ceftazidime 25/201, 12.4% and piperacillin-tazobactam 28/332, 8.4%, p=0.007). CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, Carbapenems and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with Carbapenems, along with the general preference for Carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
Jun Yong Choi - One of the best experts on this subject based on the ideXlab platform.
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1452. Is Carbapenem-Sparing Therapy as Effective as Carbapenems Against Extended-Spectrum β-Lactamase Producing Enterobacteriaceae in UTI?
Open Forum Infectious Diseases, 2019Co-Authors: Jonghoon Hyun, Jun Yong Choi, Yongseop Lee, Hye Seong, Jung Ho Kim, Joon-sup Yeom, Su Jin JeongAbstract:Abstract Background With the emergence of Carbapenem-resistant strains of Enterobacteriaceae, non-Carbapenem antibiotics are suggested as the alternative treatment of extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infection. In this study, efficacy of non-Carbapenem antibiotics on acute pyelonephritis (APN) with ESBL-producing Enterobacteriaceae was compared with that of Carbapenems. Methods The medical records of patients who had diagnosed to have acute pyelonephritis with ESBL-producing Enterobacteriaceae on their urine culture, from January 2011 to December 2018, were reviewed retrospectively. Patients were classified as Carbapenem and non-Carbapenem group according to the definitive antibiotics they had treated with. Results Total number of patients was 141, including 112 (79.4%) who had received Carbapenem, and 29 (20.6%) received non-Carbapenem as definitive therapy against to APN with ESBL-producing Enterobacteriaceae. The duration of hospitalization was shorter for non-Carbapenem group (median 9.93 days) than for Carbapenem group (median 14.39 days) (P < 0.001). The duration of negative conversion of culture was shorter for Carbapenem group (median 40.73 hours) than for non-Carbapenem group (median 56.79 hours). There was no significant difference in time to febrile period and duration of definitive therapy between two groups. Conclusion Non-Carbapenem therapy against APN with ESBL-producing Enterobacteriaceae has no significant difference in clinical outcome compared with Carbapenem therapy. Disclosures All authors: No reported disclosures.
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risk factors for the acquisition of Carbapenem resistant escherichia coli at a tertiary care center in south korea a matched case control study
American Journal of Infection Control, 2014Co-Authors: Je Eun Song, Heun Choi, Yongduk Jeon, Su Jin Jeong, Nam Su Ku, Young Goo Song, Dongeun Yong, Jun Yong ChoiAbstract:Background Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of Carbapenem-resistant Escherichia coli (CRE). Methods We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of Carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea. Results On univariate analysis, previous use of Carbapenem ( P P P P P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors. Conclusions At this institute, the antibiotic selective pressure of Carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE.
Paul Anantharajah Tambyah - One of the best experts on this subject based on the ideXlab platform.
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empiric piperacillin tazobactam versus Carbapenems in the treatment of bacteraemia due to extended spectrum beta lactamase producing enterobacteriaceae
PLOS ONE, 2016Co-Authors: Tat Ming Ng, Wendy X Khong, Patrick N A Harris, Partha Pratim De, Angela Chow, Paul Anantharajah TambyahAbstract: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.