Antibiotic policy and prescribing strategies for therapy of extended-spectrum β-lactamase-producing Enterobacteriaceae: the role of piperacillin–tazobactam

Abstract

Therapy of infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria with an antimicrobial to which they are resistant results in treatment failure, higher cost and increased mortality. The CLSI recommends reporting ESBL-producing strains of Escherichia coli, Klebsiella spp. and Proteus spp. as resistant to all penicillin, true cephalosporin and monobactam antimicrobials, but as susceptible to beta-lactam-beta-lactamase inhibitor combinations, including piperacillin-tazobactam, when they test as such. Current literature supports the action of piperacillin-tazobactam against susceptible strains of ESBL-producing bacteria based on the structure-activity relationship between inhibitors and the ESBLs, as well as on recent clinical outcome studies.

Isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species as urinary tract infection agents in Turkey: a systematic review

“…Piperacillintazobactam was noted as an antibiotic with a low resistance rate of 8% in inpatients. There are publications indicating that piperacillin-tazobactam may be used in the presence of ESBL-producing E. coli, and there are ongoing randomized controlled studies comparing its efficacy against these strains versus carbapenems (31)(32)(33)(34). The European Urology Association guidelines also describe piperacillin-tazobactam as an alternative antibiotic in the treatment of acute uncomplicated severe cases (30).…”

Ventriculitis Associated with Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae after Acupuncture

“…In the context of ESBL producers, a variety of antibiotic classes must be considered a risk for inducing selective pressure, not just β-lactams and cephalosporins [88,91] although limiting widespread use of third generation cephalosporins has been shown to be effective in limiting ESBL producers [92]. Some data supports the switch of cephalosporins to piperacillin/tazobactam to try and curb the rising rates of such organisms [92,93].…”

“…This again reinforces the importance of recognising local resistance patterns. An antibiotic policy which takes this into account and restricts the use of broad spectrum agents (especially third-generation cephalosporins) is well recognised as key [28,90,92,93].…”

The Changing Epidemiology of Extended Spectrum Beta-Lactamases (ESBL) Infections of the Urinary Tract Focusing on Clinical Resistance and Therapeutic Options

“…However, the results are conflicting due to study populations, geographical areas, selection of cases and controls and sample size. (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Despite these statistical differences, some generalizations can be made.…”

“…This may need to change with the advent of increasing antimicrobial resistance and increasing mortality associated with these CA-ESBL infections (44,59). Rodriguez-Bano examined CA-ESBL associated bacteremia and its features and found that in 95 patients with blood stream infections 7.3% were due to E.coli.…”