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Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae
- Source :
- PLoS ONE, PLoS ONE, Vol 11, Iss 4, p e0153696 (2016)
- Publication Year :
- 2015
-
Abstract
- Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), P
- Subjects :
- 0301 basic medicine
Male
Carbapenem
Nosocomial Infections
Physiology
medicine.medical_treatment
Antibiotics
lcsh:Medicine
Penicillanic Acid
Bacteremia
Pathology and Laboratory Medicine
Klebsiella Pneumoniae
0302 clinical medicine
Klebsiella
polycyclic compounds
Medicine and Health Sciences
030212 general & internal medicine
lcsh:Science
Aged, 80 and over
Multidisciplinary
Antimicrobials
Mortality rate
Fungal Diseases
Drugs
Hematology
Anti-Bacterial Agents
Bacterial Pathogens
Body Fluids
Piperacillin, Tazobactam Drug Combination
Infectious Diseases
Blood
Medical Microbiology
Piperacillin/tazobactam
Female
Pathogens
Anatomy
beta-Lactamase Inhibitors
medicine.drug
Research Article
medicine.medical_specialty
medicine.drug_class
Death Rates
030106 microbiology
Microbiology
beta-Lactamases
03 medical and health sciences
Antibiotic resistance
Enterobacteriaceae
Population Metrics
Internal medicine
Microbial Control
medicine
Humans
Intensive care medicine
Microbial Pathogens
Aged
Retrospective Studies
Demography
Piperacillin
Pharmacology
Bacteria
Population Biology
business.industry
lcsh:R
Organisms
Biology and Life Sciences
Health Risk Analysis
Retrospective cohort study
biochemical phenomena, metabolism, and nutrition
bacterial infections and mycoses
Health Care
Carbapenems
People and Places
Beta-lactamase
bacteria
lcsh:Q
business
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 11
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....3c9ff771e9505dea22ff952a4f441552