Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

Hadas Ofer-Friedman, Coral Shefler, Sarit Sharma, Amit Tirosh, Ruthy Tal-Jasper, Deepthi Kandipalli, Shruti Sharma, Pradeep Bathina, Tamir Kaplansky, Moran Maskit, Tal Azouri, Tsilia Lazarovitch, Ronit Zaidenstein, Keith S Kaye, Dror Marchaim
Infection Control and Hospital Epidemiology 2015, 36 (8): 981-5
A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.

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