Article ; Online: Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study.
The Journal of antimicrobial chemotherapy
2024 Volume 79, Issue 2, Page(s) 453–461
Abstract: Objectives: To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those ... ...
| Abstract | Objectives: To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems. Methods: A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality. Results: Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85-2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35-3.95)] and ≥16 mg/L [HR 3.69 (95% CI, 1.86-6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85-2.16)]. Conclusions: Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is <8 mg/L. |
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| MeSH term(s) | Humans ; Ceftriaxone ; Carbapenems/pharmacology ; Carbapenems/therapeutic use ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Piperacillin/therapeutic use ; Escherichia coli ; Retrospective Studies ; Propensity Score ; Penicillanic Acid/therapeutic use ; Piperacillin, Tazobactam Drug Combination ; Escherichia coli Infections/drug therapy ; Cohort Studies ; Sepsis/drug therapy | ||||||||||
| Chemical Substances | Ceftriaxone (75J73V1629) ; Carbapenems ; Anti-Bacterial Agents ; Piperacillin (X00B0D5O0E) ; Penicillanic Acid (87-53-6) ; Piperacillin, Tazobactam Drug Combination (157044-21-8) | ||||||||||
| Language | English | ||||||||||
| Publishing date | 2024-01-02 | ||||||||||
| Publishing country | England | ||||||||||
| Document type | Observational Study ; Journal Article | ||||||||||
| ZDB-ID | 191709-2 | ||||||||||
| ISSN | 1460-2091 ; 0305-7453 | ||||||||||
| ISSN (online) | 1460-2091 | ||||||||||
| ISSN | 0305-7453 | ||||||||||
| DOI | 10.1093/jac/dkad404 | ||||||||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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