Comparable outcomes for β-lactam/β-lactamase inhibitor combinations and carbapenems in definitive treatment of bloodstream infections caused by cefotaxime-resistant Escherichia coli or Klebsiella pneumoniae

Antimicrobial Resistance and Infection Control

Patrick N A Harris¹  Mo Yin¹  Roland Jureen⁵  Jonathan Chew⁴  Jaminah Ali³  Stuart Paynter⁶  David L Paterson²  Paul A Tambyah¹ 

[1] Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

[2] University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia

[3] Department of Infectious Diseases, National University Hospital, Singapore, Singapore

[4] International Medical University, Kuala Lumpur, Malaysia

[5] Department of Laboratory Medicine, National University Hospital, Singapore, Singapore

[6] School of Population Health, University of Queensland, Brisbane, QLD, Australia

关键词: Carbapenem;    Piperacillin-tazobactam;    Enterobacteriaceae;    Extended-spectrum β-lactamase;   

Others  :  1183512
DOI  :  10.1186/s13756-015-0055-6

 received in 2014-12-07, accepted in 2015-04-01,  发布年份 2015

【 摘 要 】

Background

Extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are often susceptible in vitro to β-lactam/β-lactamase inhibitor (BLBLI) combination antibiotics, but their use has been limited by concerns of clinical inefficacy. We aimed to compare outcomes between patients treated with BLBLIs and carbapenems for bloodstream infection (BSI) caused by cefotaxime non-susceptible (likely ESBL- or AmpC β-lactamase-producing) Escherichia coli and Klebsiella pneumoniae.

Methods

All adult patients with a BSI caused by cefotaxime non-susceptible E. coli or K. pneumoniae were included from May 2012-May 2013. We compared outcomes between patients who had definitive monotherapy with a carbapenem to those who had definitive monotherapy with a BLBLI.

Results

There were 92 BSIs that fulfilled the microbiological inclusion criteria. 79 (85.9%) were caused by E. coli and 13 (14.1%) by K. pneumoniae. Four out of 23 (17.4%) patients treated with carbapenem monotherapy and 2 out of 24 (8.3%) patients treated with BLBLI monotherapy died (adjusted HR for survival 0.91, 95% CI 0.13 to 6.28; p = 0.92). The time to resolution of systemic inflammatory response syndrome (SIRS) criteria did not vary between the treatment groups (adjusted HR 0.91, 95% CI 0.32 to 2.59; p = 0.97). The length of hospital admission post-positive blood culture was slightly longer in patients treated with BLBLIs (median duration 15 vs. 11 days), although this was not significant (adjusted HR 0.62; 95% CI 0.27 to 1.42; p = 0.26). There were no significant differences in subsequent isolation of carbapenem resistant organisms (4.3% vs. 4.2%, p = 1.0), C. difficile infection (13.0% vs. 8.3%, p = 0.67) or relapsed BSI (0% vs. 2%, p = 0.23).

Conclusions

BLBLIs appear to have a similar efficacy to carbapenems in the treatment of cefotaxime-resistant E. coli and K. pneumoniae bloodstream infections. Directed therapy with a BLBLI, when susceptibility is proven, may represent an appropriate carbapenem-sparing option.

【 授权许可】

   
2015 Harris et al.; licensee BioMed Central.

【 图 表 】

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