1809. Treatment Outcomes in Piperacillin-tazobactam Non-susceptible (TZP-NS)/Ceftriaxone Susceptible (CRO-S) Infections. (15th December 2022)

• Record Type: Journal Article
• Authors: Dubrovskaya, Yanina; Cao, John; Siegfried, Justin; Decano, Arnold; Mazo, Dana; Hochman, Sarah; Zacharioudakis, Ioannis; Solomon, Sadie; Papadopoulos, John
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.1439
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Piperacillin-tazobactam-non-susceptible/ceftriaxone-susceptible (TZP-NS/CRO-S) Escherichia coli ( Ec) and Klebsiella pneumoniae ( Kp) phenotypes are hypothesized to be due to hyperproduction of TEM-1/2 and SHV-1 penicillinases. Limited available literature evaluating treatment outcomes in patients with TZP-NS/CRO-S infections may lead to unnecessary carbapenem use. Methods: This was a retrospective study of non-critically ill adults hospitalized between 2013-2021, and treated for at least 48 hours for TZP-NS/CRO-S Ec or Kp infections. Patients with concomitant multi-drug resistant gram-negative infections were excluded. The primary composite endpoint included the need for escalation to intensive care unit (ICU), infection- or treatment-related readmission, mortality, and infection recurrence. Outcomes were compared between groups who received carbapenem (CG) vs carbapenem-sparing agents (CSG) as targeted therapy. Results: Out of 1062 patients screened, 200 were included, with 51 in the CG and 149 in the CSG. Baseline characteristics, including Charlson Comorbidity Index (6 [IQR 3-10] vs 6 [4-9], p=0.64), were similar between groups, except for more immunocompromised patients in the CG (29% vs 11%, p=0.001). The most common infection sources were urinary (31% vs 57%, p=0.002), bloodstream (BSI) (18% vs 17%, p=0.887) and intra-abdominal (IAI) (20% vs 8%, p=0.023). Eighty-eight percent of the CG received meropenem, while the most common targeted therapy in the CSG was ceftriaxone (58%) followed by cefepime (24%). The primary composite endpoint was numerically higher in the CG (27% vs 17%, p=0.123), with no differences based on infection type (urine 25% vs 18%, p=0.495; BSI 33% vs 16%, p=0.348; IAI 40% vs 33%, p=1). More patients in the CSG were switched to oral therapy (15 [29%] vs 100 [67%], p< 0.001), with numerically 2 days shorter time to oral switch (6 [3-9] vs 4 [3-7] days, p=0.196). Out of those switched to oral therapy, most had a urinary source (8/15 [53%] vs 59/100 [59%]). Conclusion: Our study did not find better clinical outcomes with carbapenem therapy for TZP-NS/CRO-S infections, thus CS agents may be considered to spare carbapenems in non-critically ill patients. Further studies are warranted to compare these outcomes in the critically ill. Disclosures: All Authors : No reported disclosures.