Mercedes Delgado-Valverde1, Eva Torres1, Adoración Valiente-Mendez1, Benito Almirante2, Silvia Gómez-Zorrilla3, Núria Borrell4, Juan E Corzo5, Mercedes Gurgui6, Manuel Almela7, Lara García-Álvarez8, María Cruz Fontecoba-Sánchez9, Luis Martínez-Martínez10, Rafael Cantón11, Julia Praena12, Manuel Causse13, Belén Gutiérrez-Gutiérrez1, Jason A Roberts14, Andras Farkas15, Álvaro Pascual16, Jesús Rodríguez-Baño17. 1. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain. 2. Departamento de Enfermedades Infecciosas, Hospital Universitari Valld'Hebron, Barcelona, Spain. 3. Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 4. Servicio de Microbiología, Hospital Son Espases, Palma de Mallorca, Spain. 5. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain. 6. Servicio de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. 7. Servicio de Microbiología, Hospital Clínic, Barcelona, Spain. 8. Servicio de Enfermedades Infecciosas, Hospital San Pedro-CIBIR, Logroño, Spain. 9. Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 10. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain. 11. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. 12. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain. 13. Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain. 14. Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia. 15. Department of Pharmacy, Vassar Brothers Medical Center, Poughkeepsie, NY, USA Optimum Dosing Strategies, Bloomingdale, NJ, USA. 16. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Departamento de Microbiología, Universidad de Sevilla, Seville, Spain. 17. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Departamento de Medicina, Universidad de Sevilla, Seville, Spain jesusrb@us.es.
Abstract
OBJECTIVE: Our objective was to evaluate the impact of low versus borderline MIC of piperacillin/tazobactam on the clinical outcomes of patients with bacteraemia caused by Enterobacteriaceae who were treated with that antimicrobial. PATIENTS AND METHODS: A prospective observational multicentre cohort study was conducted in 13 Spanish university hospitals. Patients >17 years old with bacteraemia due to Enterobacteriaceae who received empirical piperacillin/tazobactam treatment for at least 48 h were included. Outcome variables were clinical response at day 21, clinical response at end of treatment with piperacillin/tazobactam and all-cause 30 day mortality. Univariate and multivariate logistic regression analyses were performed. RESULTS: Overall, 275 patients were included in the analysis; 248 (90.2%) in the low MIC group (≤ 4 mg/L) and 27 (9.8%) in the borderline MIC group (8-16 mg/L). The biliary tract was the most common source of infection (48.4%) and Escherichia coli was the most frequent pathogen (63.3%). Crude 30 day mortality rates were 10.5% and 11.1% for the low MIC group and the borderline MIC group, respectively (relative risk = 1.06, 95% CI = 0.34-3.27, P = 1). Multivariate analysis of failure at day 21 and at end of treatment with piperacillin/tazobactam and 30 day mortality showed no trend towards increased clinical failure or mortality with borderline MICs (OR = 0.96, 95% CI = 0.18-4.88, P = 0.96; OR = 0.47, 95% CI = 0.10-2.26, P = 0.35; OR = 1.48, 95% CI = 0.33-6.68, P = 0.6). CONCLUSIONS: We did not find that higher piperacillin/tazobactam MIC within the susceptible or intermediate susceptibility range had a significant influence on the outcome for patients with bacteraemia due to Enterobacteriaceae.
OBJECTIVE: Our objective was to evaluate the impact of low versus borderline MIC of piperacillin/tazobactam on the clinical outcomes of patients with bacteraemia caused by Enterobacteriaceae who were treated with that antimicrobial. PATIENTS AND METHODS: A prospective observational multicentre cohort study was conducted in 13 Spanish university hospitals. Patients >17 years old with bacteraemia due to Enterobacteriaceae who received empirical piperacillin/tazobactam treatment for at least 48 h were included. Outcome variables were clinical response at day 21, clinical response at end of treatment with piperacillin/tazobactam and all-cause 30 day mortality. Univariate and multivariate logistic regression analyses were performed. RESULTS: Overall, 275 patients were included in the analysis; 248 (90.2%) in the low MIC group (≤ 4 mg/L) and 27 (9.8%) in the borderline MIC group (8-16 mg/L). The biliary tract was the most common source of infection (48.4%) and Escherichia coli was the most frequent pathogen (63.3%). Crude 30 day mortality rates were 10.5% and 11.1% for the low MIC group and the borderline MIC group, respectively (relative risk = 1.06, 95% CI = 0.34-3.27, P = 1). Multivariate analysis of failure at day 21 and at end of treatment with piperacillin/tazobactam and 30 day mortality showed no trend towards increased clinical failure or mortality with borderline MICs (OR = 0.96, 95% CI = 0.18-4.88, P = 0.96; OR = 0.47, 95% CI = 0.10-2.26, P = 0.35; OR = 1.48, 95% CI = 0.33-6.68, P = 0.6). CONCLUSIONS: We did not find that higher piperacillin/tazobactam MIC within the susceptible or intermediate susceptibility range had a significant influence on the outcome for patients with bacteraemia due to Enterobacteriaceae.
Authors: Andras Farkas; Gergely Daroczi; Phillip Villasurda; Michael Dolton; Midori Nakagaki; Jason A Roberts Journal: Antimicrob Agents Chemother Date: 2016-10-21 Impact factor: 5.191
Authors: F Scasso; G Ferrari; G C DE Vincentiis; A Arosio; S Bottero; M Carretti; A Ciardo; S Cocuzza; A Colombo; B Conti; A Cordone; M DE Ciccio; E Delehaye; L Della Vecchia; I DE Macina; C Dentone; P DI Mauro; R Dorati; R Fazio; A Ferrari; G Ferrea; S Giannantonio; I Genta; M Giuliani; D Lucidi; L Maiolino; G Marini; P Marsella; D Meucci; T Modena; B Montemurri; A Odone; S Palma; M L Panatta; M Piemonte; P Pisani; S Pisani; L Prioglio; A Scorpecci; L Scotto DI Santillo; A Serra; C Signorelli; E Sitzia; M L Tropiano; M Trozzi; F M Tucci; L Vezzosi; B Viaggi Journal: Acta Otorhinolaryngol Ital Date: 2018-04 Impact factor: 2.124