1. Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection: a multi-site retrospective study
- Author
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Céline Pulcini, Sofia Maraki, Christian G. Giske, V. Vitrat, Bojana Beović, Alba Rivera, Maria Zacharioudaki, Michal Landes, Lior Nesher, Michael Buhl, Mical Paul, Julie Gibbs, Alasdair P. MacGowan, Manal Abdel Fattah, Isabel Machuca, Justine Haquin, Adi Zaidman-Shimshovitz, Leonard Leibovici, Iris Gomez Alfaro, Yulia Weissman, Andreja Saje, Pontus Naucler, John Karlsson Valik, Monica Gozalo-Marguello, Susanna Mauer, Leonardo Pagani, Antonio Oliver, Bibiana Chazan, Luis Martinez Martinez, Yaakov Dickstein, Natividad Benito, Diamantis P. Kofteridis, Isabel Fernández Morales, Anna Yanovskay, K.L. McCarthy, Dafna Yahav, Tanya Babich, Angela Cano, Ronen Ben Ami, Sally Grier, Enrique Ruiz de Gopegui, Manica Mueller-Premru, Eva María González-Barberá, Ruben Cardona, Miguel Salavert, Jesús Rodríguez-Baño, David L. Paterson, Evelina Tacconelli, Stockholm County Council, Tel Aviv University [Tel Aviv], Karolinska University Hospital [Stockholm], Universitat Autònoma de Barcelona (UAB), Hospital de la Santa Creu i Sant Pau, Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Southmead Hospital, Emek Medical Center, Tel Aviv Sourasky Medical Center [Te Aviv], Soroka University Medical Center [Beer Sheva, Israel], University of Queensland [Brisbane], University Hospital Tuebingen, University Hospital Virgen Macarena, Hospital Universitario Son Espases, University of Córdoba [Córdoba], Marqués de Valdecilla University Hospital, La Fe University Hospital, Hospital Universitario y Politécnico La Fe, University of Ljubljana, Central Hospital of Bolzano, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], University Hospital of Heraklion, Rambam Health Care Campus, and Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
- Subjects
0301 basic medicine ,systolic blood pressure ,Carbapenem ,all cause mortality ,antibiotic resistance ,drug safety ,retrospective study ,Antibiotics ,diarrhea ,clinical outcome ,Ceftazidime ,Bacteremia ,rash ,functional status ,medicine.disease_cause ,intensive care unit ,assisted ventilation ,0302 clinical medicine ,meropenem ,piperacillin ,antibiotic therapy ,heart rate ,polycyclic compounds ,Medicine ,030212 general & internal medicine ,ceftazidime ,adult ,carbapenem derivative ,Anti-Bacterial Agents ,3. Good health ,antiinfective agent ,microbial sensitivity test ,aged ,hospital patient ,female ,Infectious Diseases ,priority journal ,risk factor ,Pseudomonas aeruginosa ,Piperacillin/tazobactam ,Pseudomonas infection ,albumin blood level ,hospital infection ,Charlson Comorbidity Index ,geographic locations ,hospitalization ,immobility ,medicine.drug ,Microbiology (medical) ,bacteremia, beta-lactam, monotherapy, pseudomonas ,medicine.medical_specialty ,medicine.drug_class ,seizure ,Beta-lactam ,030106 microbiology ,education ,bloodstream infection ,tracheostomy ,piperacillin plus tazobactam ,Article ,03 medical and health sciences ,male ,acute kidney failure ,Clostridium difficile infection ,Internal medicine ,Pseudomonas ,bacterium isolation ,parasitic diseases ,metastasis ,Sequential Organ Failure Assessment Score ,human ,Adverse effect ,albumin ,nonhuman ,business.industry ,Cefta ,Odds ratio ,biochemical phenomena, metabolism, and nutrition ,bacterial strain ,medicine.disease ,bacterial infections and mycoses ,Monotherapy ,major clinical study ,drug efficacy ,multicenter study ,Carbapenems ,bacteria ,septic shock ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,penicillanic acid ,imipenem - Abstract
This study was presented as poster presentation at the European Society of Clinical Microbiology and Infectious Diseases annual conference, Madrid, Spain, 21–24 April 2018., [Background] The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Although β-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, carbapenems, and piperacillin-tazobactam as definitive monotherapy. [Methods] A multinational retrospective study (9 countries, 25 centers) including 767 hospitalized patients with P. aeruginosa bacteremia treated with β-lactam monotherapy during 2009–2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate, including propensity-adjusted, analyses were conducted introducing monotherapy type as an independent variable. [Results] Thirty-day mortality was 37/213 (17.4%), 42/210 (20%), and 55/344 (16%) in the ceftazidime, carbapenem, and piperacillin-tazobactam groups, respectively. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate, or propensity-adjusted analyses (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.52–2.46, for ceftazidime; OR, 1.3; 95% CI, 0.67–2.51, for piperacillin-tazobactam, with carbapenems as reference in propensity adjusted multivariate analysis; 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with carbapenems (36/206 [17.5%]) versus ceftazidime (25/201 [12.4%]) and piperacillin-tazobactam (28/332 [8.4%] (P = .007). [Conclusions] No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, carbapenems, and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with carbapenems, along with the general preference for carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection., This study was conducted with no external funding. In Sweden only, the research was funded by grants from the Stockholm County Council and Emil and Wera Cornell Foundation.
- Published
- 2020
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