Piperacillin/tazobactam versus carbapenems in patients with severe bacterial infections: A systematic review with meta‐analysis

Abstract

Background Piperacillin/tazobactam or meropenem are often used to treat patients with severe bacterial infections. We aimed to compare the desirable and undesirable effects of empirical and/or definitive piperacillin/tazobactam versus carbapenems in patients with severe bacterial infections. Methods We searched PubMed, Embase, CENTRAL, Epistemonikos, and trial registers for randomised clinical trials of empirical and/or definitive piperacillin/tazobactam versus carbapenems in adult patients with severe bacterial infection (i.e., any bacterial infection requiring hospitalisation). The primary outcome was all‐cause short‐term mortality within 90 days. Secondary outcomes were all‐cause long‐term mortality, adverse events, quality of life, days alive without or duration of life support, secondary infections, selection of fungi or resistant bacteria, and days alive and out of hospital or hospital length of stay. We calculated relative risks (RRs) using random effects and fixed effect meta‐analyses along with trial sequential analyses. Results We included 31 trials (n = 8790 patients) with overall high risk of bias. The RR for all‐cause short‐term mortality was 1.16 (95% confidence interval [CI]: 0.94–1.43, low certainty evidence), for adverse events 1.00 (98% CI: 0.96–1.04, moderate certainty evidence), for secondary infections 1.13 (98% CI: 0.76–1.68, very low certainty evidence), and for selection of fungi or resistant bacteria 1.61 (98% CI: 0.89–2.89, very low certainty evidence). There were no or limited data for the remaining outcomes. Conclusions Based on very low or low certainty evidence, piperacillin/tazobactam may be associated with less favourable outcomes in patients with severe bacterial infections as compared with carbapenems, but the information size for a robust conclusion has not been reached.

Empirical carbapenems or piperacillin/tazobactam for infections in intensive care: An international retrospective cohort study

“… b In the ADRENAL trial defined as the following chronic health categories from the APACHE II score: respiratory, cardiovascular, liver, renal, immunocompromised, and none 17,20 . In the DIANA study defined as: chronic pulmonary disease, cardiovascular disease, chronic hepatic disease, chronic renal failure, no chronic illnesses, and no data available 18 …”

“…This retrospective cohort study used prospectively collected data from the ADRENAL trial (NCT01448109) and the DIANA study (NCT02920463) for this descriptive post hoc analysis 14,19 . This study was performed according to a protocol, which was publicly registered after the primary results of the two studies were known, but before any of the analyses in this study were conducted 20 . The manuscript was prepared in accordance with the “Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)” statement 21 (completed checklist included in the Supplements).…”

“…This study comes with some strengths. First, we followed the publicly registered protocol, 20 which was developed before conducting the analyses.…”

A Single Dose of Piperacillin Plus Tazobactam Gel as an Adjunct to Professional Mechanical Plaque Removal (PMPR) in Patients with Peri-Implant Mucositis: A 6-Month Double-Blind Randomized Clinical Trial

“…Piperacillin/tazobactam is a blend of β-lactam and β-lactamase inhibitors that effectively eliminate a broad spectrum of bacteria, including numerous pathogens that produce β-lactamases. It is effective against a wide range of aerobic and anaerobic bacteria, including both Gram-positive and Gram-negative types [ 36 ]. This medication is beneficial for treating patients with polymicrobial infections caused by aerobic or anaerobic β-lactamase-producing bacteria.…”

Comparative Impact of an Optimized PK/PD Target Attainment of Piperacillin-Tazobactam vs. Meropenem on the Trend over Time of SOFA Score and Inflammatory Biomarkers in Critically Ill Patients Receiving Continuous Infusion Monotherapy for Treating Documented Gram-Negative BSIs and/or VAP

“…Piperacillin-tazobactam, a traditional beta-lactam/beta-lactamase inhibitor combination (BL/BLIc), and meropenem, a carbapenem, represent the cornerstone of empirical and targeted therapy of Gram-negative BSIs and VAP in the critically ill patients [6][7][8][9][10][11][12]. Several studies showed no significant difference between piperacillin-tazobactam or meropenem monotherapy in the clinical outcome of patients with severe Gram-negative bacterial infections, including those caused by extended-spectrum beta-lactamase (EBSL)-producing Enterobacterales [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”