Re-evaluation of cefepime or piperacillin-tazobactam to decrease use of carbapenems in extended-spectrum beta-lactamase–producing Enterobacterales bloodstream infections (REDUCE-BSI). Issue 1 (11th March 2022)

• Record Type: Journal Article
• Authors: Vu, Catherine H.; Venugopalan, Veena; Santevecchi, Barbara A.; Voils, Stacy A.; Ramphal, Reuben; Cherabuddi, Kartikeya; DeSear, Kathryn
• Is Part Of: Antimicrobial stewardship & healthcare epidemiology. Volume 2:Issue 1(2022)
• Publication Date: 2022-03-11
• Subjects: Anti-infective agents -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Epidemiology -- Periodicals; 614.44
• DOI: 10.1017/ash.2022.21
• Languages: English
• ISSNs: 2732-494X

Abstract

Abstract: Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase–producing Enterobacterales bloodstream infections (ESBL-E BSIs). Design: Retrospective cohort study. Setting: Tertiary-care, academic medical center. Patients: The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection. Methods: We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development. Results: Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups. Conclusion: Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms.