TY - JOUR
T1 - Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for pseudomonas aeruginosa bloodstream infection
T2 - A multisite retrospective study
AU - Babich, Tanya
AU - Naucler, Pontus
AU - Valik, John Karlsson
AU - Giske, Christian G.
AU - Benito, Natividad
AU - Cardona, Ruben
AU - Rivera, Alba
AU - Pulcini, Celine
AU - Fattah, Manal Abdel
AU - Haquin, Justine
AU - Macgowan, Alasdair
AU - Grier, Sally
AU - Gibbs, Julie
AU - Chazan, Bibiana
AU - Yanovskay, Anna
AU - Ami, Ronen Ben
AU - Landes, Michal
AU - Nesher, Lior
AU - Zaidman-Shimshovitz, Adi
AU - McCarthy, Kate
AU - Paterson, David L.
AU - Tacconelli, Evelina
AU - Buhl, Michael
AU - Mauer, Susanna
AU - Rodriguez-Bano, Jesus
AU - Morales, Isabel
AU - Oliver, Antonio
AU - de Gopegui, Enrique Ruiz
AU - Cano, Angela
AU - Machuca, Isabel
AU - Gozalo-Marguello, Monica
AU - Martinez, Luis Martinez
AU - Gonzalez-Barbera, Eva M.
AU - Alfaro, Iris Gomez
AU - Salavert, Miguel
AU - Beovic, Bojana
AU - Saje, Andreja
AU - Mueller-Premru, Manica
AU - Pagani, Leonardo
AU - Vitrat, Virginie
AU - Kofteridis, Diamantis
AU - Zacharioudaki, Maria
AU - Maraki, Sofia
AU - Weissman, Yulia
AU - Paul, Mical
AU - Dickstein, Yaakov
AU - Leibovici, Leonard
AU - Yahav, Dafna
N1 - Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
AB - 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.
KW - Bacteremia
KW - Beta-lactam
KW - Monotherapy
KW - Pseudomonas
UR - http://www.scopus.com/inward/record.url?scp=85075838578&partnerID=8YFLogxK
U2 - 10.1093/cid/ciz668
DO - 10.1093/cid/ciz668
M3 - Article
C2 - 31323088
AN - SCOPUS:85075838578
SN - 1058-4838
VL - 70
SP - 2270
EP - 2280
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -