Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection: a multi-site retrospective study
| Autor: | Céline Pulcini, Sofia Maraki, Christian G. Giske, V. Vitrat, Bojana Beović, Alba Rivera, Maria Zacharioudaki, Michal Landes, Lior Nesher, Michael Buhl, Mical Paul, Julie Gibbs, Alasdair P. MacGowan, Manal Abdel Fattah, Isabel Machuca, Justine Haquin, Adi Zaidman-Shimshovitz, Leonard Leibovici, Iris Gomez Alfaro, Yulia Weissman, Andreja Saje, Pontus Naucler, John Karlsson Valik, Monica Gozalo-Marguello, Susanna Mauer, Leonardo Pagani, Antonio Oliver, Bibiana Chazan, Luis Martinez Martinez, Yaakov Dickstein, Natividad Benito, Diamantis P. Kofteridis, Isabel Fernández Morales, Anna Yanovskay, K.L. McCarthy, Dafna Yahav, Tanya Babich, Angela Cano, Ronen Ben Ami, Sally Grier, Enrique Ruiz de Gopegui, Manica Mueller-Premru, Eva María González-Barberá, Ruben Cardona, Miguel Salavert, Jesús Rodríguez-Baño, David L. Paterson, Evelina Tacconelli |
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| Přispěvatelé: | Stockholm County Council, Tel Aviv University [Tel Aviv], Karolinska University Hospital [Stockholm], Universitat Autònoma de Barcelona (UAB), Hospital de la Santa Creu i Sant Pau, Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Southmead Hospital, Emek Medical Center, Tel Aviv Sourasky Medical Center [Te Aviv], Soroka University Medical Center [Beer Sheva, Israel], University of Queensland [Brisbane], University Hospital Tuebingen, University Hospital Virgen Macarena, Hospital Universitario Son Espases, University of Córdoba [Córdoba], Marqués de Valdecilla University Hospital, La Fe University Hospital, Hospital Universitario y Politécnico La Fe, University of Ljubljana, Central Hospital of Bolzano, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], University Hospital of Heraklion, Rambam Health Care Campus, Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel] |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
systolic blood pressure Carbapenem all cause mortality antibiotic resistance drug safety retrospective study Antibiotics diarrhea clinical outcome Ceftazidime Bacteremia rash functional status medicine.disease_cause intensive care unit assisted ventilation 0302 clinical medicine meropenem piperacillin antibiotic therapy heart rate polycyclic compounds Medicine 030212 general & internal medicine ceftazidime adult carbapenem derivative Anti-Bacterial Agents 3. Good health antiinfective agent microbial sensitivity test aged hospital patient female Infectious Diseases priority journal risk factor Pseudomonas aeruginosa Piperacillin/tazobactam Pseudomonas infection albumin blood level hospital infection Charlson Comorbidity Index geographic locations hospitalization immobility medicine.drug Microbiology (medical) bacteremia beta-lactam monotherapy pseudomonas medicine.medical_specialty medicine.drug_class seizure Beta-lactam 030106 microbiology education bloodstream infection tracheostomy piperacillin plus tazobactam Article 03 medical and health sciences male acute kidney failure Clostridium difficile infection Internal medicine Pseudomonas bacterium isolation parasitic diseases metastasis Sequential Organ Failure Assessment Score human Adverse effect albumin nonhuman business.industry Cefta Odds ratio biochemical phenomena metabolism and nutrition bacterial strain medicine.disease bacterial infections and mycoses Monotherapy major clinical study drug efficacy multicenter study Carbapenems bacteria septic shock [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie business penicillanic acid imipenem |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname Clinical Infectious Diseases Clinical Infectious Diseases, Oxford University Press (OUP), 2019, 70 (11), pp.2270-2280. ⟨10.1093/cid/ciz668⟩ CLINICAL INFECTIOUS DISEASES r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe |
| ISSN: | 1058-4838 1537-6591 |
| DOI: | 10.1093/cid/ciz668⟩ |
| Popis: | This study was presented as poster presentation at the European Society of Clinical Microbiology and Infectious Diseases annual conference, Madrid, Spain, 21–24 April 2018. [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. This study was conducted with no external funding. In Sweden only, the research was funded by grants from the Stockholm County Council and Emil and Wera Cornell Foundation. |
| Databáze: | OpenAIRE |
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