Point-Counterpoint: Piperacillin-Tazobactam Should Be Used To Treat Infections with Extended-Spectrum-Beta-Lactamase-Positive Organisms

Schuetz, Audrey N.; Reyes, Sergio

doi:10.1128/jcm.01917-17

Cited by 32 publications

(18 citation statements)

References 26 publications

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“…According to a study piperacillin-tazobactam can be used alternatively in some infections but not widely recommended. 13,14 A study reported ESBL maximum resistance against ampicillin (100%) followed by cephalosporins as 94.12% resistant against cefuroxime, 61.76% resistant for ceftriaxone. 15…”

Section: Resultsmentioning

confidence: 99%

Frequency of extended spectrum beta lactamase in E.CoIi and klebsiella pneumoniae in bacterial cultures.

Hassan¹,

Bhutta²,

Farva³

2021

TPMJ

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Objective: To determine frequency and pattern of extended spectrum beta lactamase in Klebsiella pneumoniae and E. coli in bacterial cultures. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Total 1100 bacterial isolates were studied out of them 655 E.coli and 445 of klebsiella pneumoniae. All samples were subjected to double disc diffusion method using third generation cephalosporin and amoxacillin-clavulanic acid for detection of ESBL. Data was analyzed using SPSS software version 24, and results were calculated in the form of frequency, percentage and standard deviation. P-value ≤0.05 was taken as statistically non-significant. Results: There were 48.9% male and 51.1% female subjects out of 1100 total cases. E.coli was detected in 59.5% and klebsiella in 40.5% samples. Total 44.2% samples were positive for ESBL enzyme. Of 655 E.coli samples 40.8% and of 445 Klebsiella pneumoniae samples 49.2% were positive for ESBL enzyme. Conclusion: It is necessary to detect ESBL positive Klebsiella pneumoniae and E.coli in laboratory workflow to avoid unnecessary use of antibiotics and development of resistance against them.

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Section: Resultsmentioning

confidence: 99%

Frequency of extended spectrum beta lactamase in E.CoIi and klebsiella pneumoniae in bacterial cultures.

Hassan¹,

Bhutta²,

Farva³

2021

TPMJ

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“…Second, although we conducted propensity score matching and multivariate analysis to adjust for selection bias and potential confounders, adverse effects from non-matched confounding factors could remain. Third, caution should be exercised when generalising the results of this study to other ESBL-producing Enterobacteriaceae infections, because most patients in our cohort had BSI due to E. coli , which is usually related to better outcomes than other Enterobacteriaceae [ 15 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of therapy with β-lactam/β-lactamase inhibitor combinations or carbapenems for bacteraemia of nonurinary source caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae

Luo

Xiao

Hang

et al. 2021

Ann Clin Microbiol Antimicrob

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Background Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has become a public health concern. This study aimed to compare the clinical outcomes of patients with nonurinary source bacteraemia caused by ESBL-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (ESBL-producing EK) receiving β-lactam/β-lactamase inhibitor combinations (BLICs) versus carbapenem treatment and assess the risk factors of mortality with these two drugs. Methods We conducted a retrospective single-centre study of adult hospitalised patients with ESBL-producing EK bloodstream infection (BSI) from nonurinary source at our centre over a 4-year period. One hundred and eighty patients who received BLICs or carbapenems were included in the analysis. The outcome variables were 14-day treatment failure and 30-day mortality. For more reliable results, propensity score analysis was performed to compare the efficacy of the two drugs and analyse their risk factors for 30-day mortality. Results Out of 180 patients, 114 received BLICs, and 66 received carbapenem therapy. Compared to carbapenem-treated patients, those treated with BLICs were older and had higher age-adjusted Charlson comorbidity index, but they had shorter stay in the hospital. Additionally, their Pitt bacteraemia score, SOFA score, rate of leukaemia, and immune compromise were lower. After propensity score matching (PSM), the baseline characteristics of patients in the two treatment groups were balanced. BLICs were associated with a higher 14-day treatment failure rate (20.6%, 13/63) than carbapenems (16.3%, 7/43), although the difference was not significant in either univariate analysis (P = 0.429) or multivariate analysis (P = 0.122). And the 30-day mortality rate in BTG (11.1%, 7/63) and CTG (11.6%, 5/43) did not significantly differ (univariate analysis, P = 0.926; multivariate analysis, P = 0.420). In the multivariate analysis, after PSM, leukaemia was the only independent predictor of mortality in both BTG and CTG. Conclusions Our study showed that BLICs had higher 14-day treatment failure rate compared with carbapenems, although there were no statistically significant differences because of the small number of patients, therefore, further evaluation of the efficacy of BLICs is needed.

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“…The effectiveness of PTZ therapy against certain MRE strains (i.e., those producing ESBL) differs significantly depending on the study. Thus, its utility to treat infections by these pathogens remains controversial (20). Indeed, in the only randomized clinical trial performed, PTZ was shown to be less effective than meropenem in the treatment of bloodstream infections produced by Enterobacteriaceae ESBL-producer strains (21).…”

Section: Discussionmentioning

confidence: 99%

High Heterogeneity of Multidrug-Resistant Enterobacteriaceae Fecal Levels in Hospitalized Patients Is Partially Driven by Intravenous β-Lactams

Djukovic

González-Barberá

Sanz

et al. 2020

Antimicrob Agents Chemother

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Multidrug-resistant Enterobacteriaceae (MRE) colonize the intestine asymptomatically from where they can breach into the bloodstream and cause life-threatening infections, especially in heavily colonized patients. Despite the clinical relevance of MRE colonization levels, we know little about how they vary in hospitalized patients and the clinical factors that determine those levels. Here, we conducted one of the largest studies of MRE fecal levels by tracking longitudinally 133 acute leukemia patients and monitoring their MRE levels over time through extensive culturing. MRE were defined as Enterobacteriaceae species that acquired nonsusceptibility to ≥1 agent in ≥3 antimicrobial categories. In addition, due to the selective media used, the MRE had to be resistant to third-generation cephalosporins. MRE were detected in 60% of the patients, but their fecal levels varied considerably among patients and within the same patient (>6 and 4 orders of magnitude, respectively). Multivariate analysis of clinical metadata revealed an impact of intravenous beta-lactams (i.e., meropenem and piperacillin-tazobactam), which significantly diminished the fecal MRE levels in hospitalized patients. Consistent with a direct action of beta-lactams, we found an effect only when the patient was colonized with strains sensitive to the administered beta-lactam (P < 0.001) but not with nonsusceptible strains. We report previously unobserved inter- and intraindividual heterogeneity in MRE fecal levels, suggesting that quantitative surveillance is more informative than qualitative surveillance of hospitalized patients. In addition, our study highlights the relevance of incorporating antibiotic treatment and susceptibility data of gut-colonizing pathogens for future clinical studies and in clinical decision-making.

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Point-Counterpoint: Piperacillin-Tazobactam Should Be Used To Treat Infections with Extended-Spectrum-Beta-Lactamase-Positive Organisms

Cited by 32 publications

References 26 publications

Frequency of extended spectrum beta lactamase in E.CoIi and klebsiella pneumoniae in bacterial cultures.

Frequency of extended spectrum beta lactamase in E.CoIi and klebsiella pneumoniae in bacterial cultures.

Comparison of therapy with β-lactam/β-lactamase inhibitor combinations or carbapenems for bacteraemia of nonurinary source caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae

High Heterogeneity of Multidrug-Resistant Enterobacteriaceae Fecal Levels in Hospitalized Patients Is Partially Driven by Intravenous β-Lactams

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