Examining the Clinical Effectiveness of Non-Carbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae
Abstract
:1. Introduction
2. Piperacillin-Tazobactam
Author, Year | Study Design, Location | Type of Infection | Pathogen(s) | Study Groups | Outcomes | Comments |
---|---|---|---|---|---|---|
β-Lactam/β-Lactamase-Inhibitor Studies | ||||||
Rodríguez-Baño, J., 2011 [15] | Post-hoc analysis of 6 prospective cohort studies, Spain | Bacteremia from any source | E. coli | ET:
DT:
| 30-day mortality:
No association between ET or DT with a BLBLI and increased mortality. | Most patients with low inoculum infections (urinary or biliary sources). |
Kang, C.L., 2012 [16] | Retrospective observational cohort study, South Korea | Bacteremia from any source | E. coli, K. pneumonia, K. oxytoca | ET:
| 30-day mortality: CBP 26.9% vs. BLBLI 22.2%; p = 0.592. 3-day clinical response: CBP 81.4% vs. BLBLI 86.7%; p = 1.00. 7-day clinical response: CBP 64.7% vs. BLBLI 65%; p = 0.98. No association between empiric BLBLI and increased mortality. | Antimicrobial agent used for definitive therapy was not reported. |
Tamma, P.D., 2013 [17] | Retrospective observational cohort study, United States | Bacteremia from any source | E. coli, K. pneumoniae, K. oxytoca, P. mirabilis | ET:
DT:
| 14-day mortality: CBP 8.0% vs. BLBLI 17.0%. Empiric BLBLI shown to be associated with increased 14-day mortality (HR, 1.92; 95% CI, 1.07 to 3.45; p = 0.03) | Variable dosing strategies were used for BLBLI. |
Harris, P.N., 2015 [18] | Retrospective, observational cohort study, Singapore | Bacteremia from any source | E. coli, K. pneumoniae, K. oxytoca | DT:
| 30-day mortality: CBP 17.4% vs. BLBLI 8.3% (HR, 0.91; 95% CI, 0.13 to 6.28; p = 0.92); Length of stay: BLBLI 15 d vs. CBP 11 d (HR, 0.62; 95% CI, 0.27 to 1.42; p = 0.26) | The agent chosen for empiric therapy was not controlled by the study protocol. |
Ofer-Friedman, H., 2015 [19] | Retrospective observational cohort study, United States and Israel | Bacteremia from non-urinary sources | E. coli, K. pneumoniae, P. mirabilis | ET and DT:
| 90-day mortality: CBP 48% vs. BLBLI 80% (OR, 4.5; 95% CI, 1.01 to 34; p = 0.05). 30-day mortality: CBP 34% vs. BLBLI 60% (OR 3.0; p = 0.1). BLBLI shown to be associated with increased 90-day mortality (OR, 7.9; 95% CI, 1.2 to 53; p = 0.03) | Breakpoints for pathogens are not reported. |
Cefepime Studies | ||||||
Goethaert, K., 2005 [20] | Retrospective cohort study, Belgium | Pneumonia, 64%; bacteremia, 16%, and other | E. aerogenes | ET and DT:
| Infection-related mortality:
| All patients received combination therapy with another agent. Cefepime 2 g q8h or equivalent dosing used. |
Chopra, T., 2012 [1] | Retrospective cohort study, United States | Bacteremia from any source | E. coli, K. pneumoniae | ET:
DT:
| In-hospital mortality:
No association between choice of therapy and mortality or length of stay in multivariate analysis. | Data from patients receiving either monotherapy with either cefepime or carbapenem shown. Cefepime dosing not described. |
Lee, N.Y., 2013 [21] | Retrospective case-control study, Taiwan | Bacteremia from any source | E. coli, K. pneumoniae, E. cloacae | ET:
DT:
| 30-day mortality:
Propensity score-based matched analysis identified DT with cefepime as an independent predictor of 30-day mortality (adjusted OR, 6.8; 95% CI, 1.5–31.2) | Sepsis-related, 30-day, and crude mortality rates were greater as the cefepime MIC increased. Cefepime underdosed for patients infected with elevated MIC organisms; 1 g IV q8h or 2 g IV q12h used. |
3. Cefepime
4. Discussion
Author Contributions
Conflicts of Interest
References
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Gibble, A.M.; Gross, A.E.; Huang, A.M. Examining the Clinical Effectiveness of Non-Carbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae. Antibiotics 2015, 4, 653-666. https://doi.org/10.3390/antibiotics4040653
Gibble AM, Gross AE, Huang AM. Examining the Clinical Effectiveness of Non-Carbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae. Antibiotics. 2015; 4(4):653-666. https://doi.org/10.3390/antibiotics4040653
Chicago/Turabian StyleGibble, Allison M., Alan E. Gross, and Angela M. Huang. 2015. "Examining the Clinical Effectiveness of Non-Carbapenem β-Lactams for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae" Antibiotics 4, no. 4: 653-666. https://doi.org/10.3390/antibiotics4040653