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β-Lactam/β-Lactam Inhibitor Combinations for the Treatment of Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia Coli: A Post Hoc Analysis of Prospective Cohorts
Rodrigues-Bano, J, Navarro MD, Retamar P, et al. CID. 2012;54(2):167-74.
Study Question: Does mortality or length of stay (LOS) differ in patients with bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) when treated with either a β-lactam/β-lactamase inhibitor combinations (BLBLI) or a carbapenem?
Study Description: This was a post-hoc analysis of six previously published prospective cohort studies of infections due to ESBL-EC. Patients included in this study were: > 17 years of age with a BSI; met criteria for sepsis; and received either a BLBLI (piperacillin/tazobactam or amoxicillin/clavulanate) or a carbapenem for > 48 hours. An empirical therapy cohort (ETC) was defined as patients who received empiric therapy with BLBLI or carbapenem within 24 hours of blood culture drawn and the isolate proved susceptible to empiric treatment. The definitive therapy cohort (DTC) was defined as patients who received therapy with BLBLI or carbapenem for > 50% of therapy duration.
Results: The ETC included 103 patients (BLBLI, 72; carbapenem 31) and DTC included 174 (BLBLI, 54; carbapenem 120). There were no differences between BLBLI or carbapenem in either mortality rates (ETC: 9.7% vs. 19.4%, DTC: 9.3% vs. 16.7%) or LOS (ETC: 12 d vs. 13 d; DTC: 13 d vs. 15 d).
Conclusions: BLBLIs are reasonable alternatives to carbapenems for treatment of ESBL-EC BSIs if active in-vitro.
Perspective: This study suggests that piperacillin/tazobactam 4.5 grams IV q 6 hours may be an acceptable alternative to carbapenems for ESBL-EC BSIs when the source bacteria inocula is low (e.g., the urinary tract) and mean inhibitory concentrations are < 4 mg/L.