Assessing clinical cure of empirical piperacillin/tazobactam for ESBL urinary tract infections (ACCEPT—UTI)

Abstract

Background Data are limited regarding use of piperacillin/tazobactam for ESBL urinary tract infections (UTIs). The objective of this study was to compare clinical outcomes of patients treated empirically with piperacillin/tazobactam versus carbapenems for ESBL UTIs. Methods This retrospective, observational, propensity score-matched study evaluated adults with an ESBL on urine culture. Patients who had UTI symptoms or leukocytosis, and who received a carbapenem or piperacillin/tazobactam empirically for at least 48 h were included. The primary outcome was clinical success within 48 h, defined as resolution of temperature (36–38°C), resolution of symptoms or leukocytosis (WBC <12 × 103/μL) in the absence of documented symptoms, and the absence of readmission for an ESBL UTI within 6 months. Secondary outcomes included time to clinical resolution, hospital length of stay, and in-hospital and 30 day all-cause mortality. Results Overall, 223 patients were included in the full cohort and 200 patients in the matched cohort (piperacillin/tazobactam = 100, carbapenem = 100). Baseline characteristics were similar between the groups. There was no difference in the primary outcome of clinical success between the carbapenem and piperacillin/tazobactam groups (58% versus 56%, respectively; P = 0.76). Additionally, there was no difference in median (IQR) time to clinical resolution [38.9 h (21.5, 50.9 h) versus 40.3 h (27.4, 57.5 h); P = 0.37], in-hospital all-cause mortality (3% versus 3%; P = 1.00), or 30 day all-cause mortality (4% versus 2%; P = 0.68) between the carbapenem and piperacillin/tazobactam groups, respectively. Conclusions There was no significant difference in clinical success for patients treated empirically with piperacillin/tazobactam compared with carbapenems for ESBL UTIs.

Analysis of bacterial spectrum and drug sensitivity in preoperative urine culture of upper urinary calculi

“…Gbacteria had very low sensitivity to β-lactam antibiotics (ampicillin, piperacillin), but showed good sensitivity to β-lactam antibiotics combined with βlactamase inhibitors-sulbactam/tazobactam The combination showed good sensitivity and signi cantly reduced resistance. Moreover, it has been shown that the success rate of piperacillin/tazobactam in the treatment of urinary tract infections with ESBL(+) infections was not signi cantly different compared to carbapenems [13] . The current study found higher susceptibility to cefotetan, cefepime and ceftazidime among the three generations of cephalosporins but lower susceptibility to ceftriaxone.…”

Real-Time TDM-Guided Optimal Joint PK/PD Target Attainment of Continuous Infusion Piperacillin–Tazobactam Monotherapy Is an Effective Carbapenem-Sparing Strategy for Treating Non-Severe ESBL-Producing Enterobacterales Secondary Bloodstream Infections: Findings from a Prospective Pilot Study

“…On the other hand, the worrisome ever-growing increase in carbapenem-resistant Gram-negative infections promoted by the selective pressure deriving from extensive carbapenem use [ 16 , 17 ] may call into question the potential role that carbapenem-sparing strategies based on piperacillin–tazobactam could have in some non-severe clinical scenarios of ESBL-producing Enterobacterales infections [ 10 ]. In this latter regard, several well-designed observational studies have shown that no significant difference exists in terms of the mortality rate between piperacillin–tazobactam and carbapenems in the treatment of secondary BSIs caused by ESBL-producing Enterobacterales [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Additionally, the use of piperacillin–tazobactam compared with that of carbapenems was associated with a lower occurrence of colonization and/or infection caused by multidrug-resistant (MDR) or carbapenem-resistant Gram-negative pathogens.…”