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Clinical Question
Can piperacillin-tazobactam be used as a carbapenem-sparing treatment for bloodstream infections with extended-spectrum beta-lactamase–producing gram-negative bacteria?
Bottom line
Piperacillin-tazobactam leads to higher mortality and should not be used as an alternative to carbapenems for bloodstream infections due to extended-spectrum beta-lactamase (ESBL)–producing gram-negative bacteria. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
The increased use of carbapenems for the treatment of infections due to ESBL-producing bacteria may lead to carbapenem-resistant gram-negative bacilli. As such, a search for an alternative agent with similar efficacy is important. ESBL-producing bacteria can be susceptible to beta-lactam/beta-lactamase inhibitor antibiotics, such as piperacillin-tazobactam, at least in vitro. These authors tested the efficacy of an extended-spectrum penicillin (piperacillin-tazobactam) as compared with meropenem for the treatment of bloodstream infections due to Escherichia coli and Klebsiella pneumoniae species resistant to ceftriaxone or cefotaxime, but susceptible to piperacillin-tazobactam and meropenem. Adults with at least one blood culture positive for ESBL E coli or K pneumoniae were randomized to receive either piperacillin-tazobactam (n = 188) or meropenem (n = 191). Patients in each group received the study drug for 4 to 14 days as determined by the treating clinician. The 2 groups were balanced, except for greater incidence of diabetes, urosepsis, and higher APACHE II scores in the meropenem group, and more immunocompromised patients in the piperacillin-tazobactam group. For the primary outcome of 30-day mortality, there were more deaths in the piperacillin-tazobactam group than in the meropenem group with an intention-to-treat analysis (12.3% vs 3.7%; risk difference 8.6%; P = 0.90 for noninferiority) and comparable results with a per-protocol analysis. In fact, the study was suspended early because of harm and futility.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
This is not the common treatment in family practice. But it is good to know that increase mortality with piperacllin - tazobactam for carbapenem-sparing treatment for bloodstream infection
Good poem