Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam
Background : The pathogenicity of Enterococcus in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of Enterococcus on clinical outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI)...
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| Veröffentlicht in: | Surgical infections 2002, Vol.3 (4), p.337-349 |
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| creator | Teppler, Hedy McCarroll, Kathleen Gesser, Richard M. Woods, Gail L. |
| description | Background
: The pathogenicity of
Enterococcus
in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of
Enterococcus
on clinical
outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI) infection treated with ertapenem or piperacillin-tazobactam, which
is more active
in vitro
against enterococci than ertapenem. Baseline characteristics were identified that were associated with
Enterococcus
infection and with treatment failure.
Methods
:
This analysis included 1,558 patients treated in three randomized, triple-blind studies. Of these patients, 223 had
Enterococcus
in initial cultures: 125 of 623 (20%) with IAI, 28 of 529 (5%) with
CSSSI, and 70 of 406 (17%) with PI. Logistic regression models were fit to assess each objective.
Results
: The cure rates for the two treatment groups were similar in each of the three studies,
regardless of the presence or absence of
Enterococcus
. Cure rates for both treatment groups combined were significantly lower in patients with
Enterococcus
than without
Enterococcus
for IAI (76% [69/91] versus 87% [264/305], OR 2.3 [95% CI, 1.2-4.1],
P
= 0.009) and CSSSI (58% [11/19] versus 84% [241/287], OR 3.8 [95% CI, 1.5-10.0],
P
= 0.010); but for PI,
rates were similar (96% [50/52] versus 92% [188/205], OR 0.4 [95% CI, 0.1-1.9],
P
= 0.220). Characteristics predictive of the presence of
Enterococcus
were
Pseudomonas aeruginosa
as a baseline pathogen for IAI, older age, and the presence of a complicating underlying disease for CSSSI, and infection severity rated moderate rather than severe for PI. The strongest predictors of treatment
failure were >2 days postoperative infection at study entry for patients with IAI and older age for patients with CSSSI.
Conclusion
: Choice of antimicrobial therapy did not affect cure rates
in patients with or without
Enterococcus
. The strongest predictors of failure were postoperative infection at study entry in patients with IAI and older age in patients with CSSSI. |
| doi_str_mv | 10.1089/109629602762539553 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_72881430</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>72881430</sourcerecordid><originalsourceid>FETCH-LOGICAL-c263t-58ea6a8dd8b0d358b4a79bbd29a207bca7aedacca09b296e66647c35ceb7bff33</originalsourceid><addsrcrecordid>eNqNkE1LxDAQhoMo7vrxBzxITt6qadomqTdZ1g9YUHA9l0k61Uib1iRV9Ndb2QUPXjzNMDzvC_MQcpKy85Sp8iJlpeClYFwKXmRlUWQ7ZJ4WhUyUkPnutE9AMhH5jByE8MpYKrkQ-2SWclFKpticDI-jf7YGWnrnGjTR9i7QDxtf6NJF9L3pjRnDJb0fo-k7pNbRB4gWXQx07REi1lvcRxjQYUff0Ycx0Ac7oAdj29a6ZA1fvQYToTsiew20AY-385A8XS_Xi9tkdX9zt7haJYaLLCaFQhCg6lppVmeF0jnIUuual8CZ1AYkYA3GACv19CEKIXJpssKglrppsuyQnG16B9-_jRhi1dlgsG3BYT-GSnKl0jxjE8g3oPF9CB6bavC2A_9Zpaz68Vz99TyFTrfto-6w_o1sxU6A2gA_Z3CutajRx_90fwNRAYzn</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>72881430</pqid></control><display><type>article</type><title>Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam</title><source>Mary Ann Liebert Online Subscription</source><source>MEDLINE</source><creator>Teppler, Hedy ; McCarroll, Kathleen ; Gesser, Richard M. ; Woods, Gail L.</creator><creatorcontrib>Teppler, Hedy ; McCarroll, Kathleen ; Gesser, Richard M. ; Woods, Gail L.</creatorcontrib><description>Background
: The pathogenicity of
Enterococcus
in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of
Enterococcus
on clinical
outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI) infection treated with ertapenem or piperacillin-tazobactam, which
is more active
in vitro
against enterococci than ertapenem. Baseline characteristics were identified that were associated with
Enterococcus
infection and with treatment failure.
Methods
:
This analysis included 1,558 patients treated in three randomized, triple-blind studies. Of these patients, 223 had
Enterococcus
in initial cultures: 125 of 623 (20%) with IAI, 28 of 529 (5%) with
CSSSI, and 70 of 406 (17%) with PI. Logistic regression models were fit to assess each objective.
Results
: The cure rates for the two treatment groups were similar in each of the three studies,
regardless of the presence or absence of
Enterococcus
. Cure rates for both treatment groups combined were significantly lower in patients with
Enterococcus
than without
Enterococcus
for IAI (76% [69/91] versus 87% [264/305], OR 2.3 [95% CI, 1.2-4.1],
P
= 0.009) and CSSSI (58% [11/19] versus 84% [241/287], OR 3.8 [95% CI, 1.5-10.0],
P
= 0.010); but for PI,
rates were similar (96% [50/52] versus 92% [188/205], OR 0.4 [95% CI, 0.1-1.9],
P
= 0.220). Characteristics predictive of the presence of
Enterococcus
were
Pseudomonas aeruginosa
as a baseline pathogen for IAI, older age, and the presence of a complicating underlying disease for CSSSI, and infection severity rated moderate rather than severe for PI. The strongest predictors of treatment
failure were >2 days postoperative infection at study entry for patients with IAI and older age for patients with CSSSI.
Conclusion
: Choice of antimicrobial therapy did not affect cure rates
in patients with or without
Enterococcus
. The strongest predictors of failure were postoperative infection at study entry in patients with IAI and older age in patients with CSSSI.</description><identifier>ISSN: 1096-2964</identifier><identifier>EISSN: 1557-8674</identifier><identifier>DOI: 10.1089/109629602762539553</identifier><identifier>PMID: 12697080</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject><![CDATA[Abdomen - microbiology ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - therapeutic use ; beta-Lactams ; Double-Blind Method ; Drug Administration Schedule ; Drug Therapy, Combination - administration & dosage ; Drug Therapy, Combination - therapeutic use ; Enterococcus - isolation & purification ; Female ; Gram-Positive Bacterial Infections - drug therapy ; Gram-Positive Bacterial Infections - microbiology ; Humans ; Lactams ; Male ; Middle Aged ; Original Papers ; Pelvic Infection - drug therapy ; Pelvic Infection - microbiology ; Penicillanic Acid - administration & dosage ; Penicillanic Acid - analogs & derivatives ; Penicillanic Acid - therapeutic use ; Piperacillin - administration & dosage ; Piperacillin - therapeutic use ; Prospective Studies ; Skin Diseases, Bacterial - drug therapy ; Skin Diseases, Bacterial - microbiology ; Surgical Wound Infection - drug therapy ; Surgical Wound Infection - microbiology ; Treatment Outcome]]></subject><ispartof>Surgical infections, 2002, Vol.3 (4), p.337-349</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c263t-58ea6a8dd8b0d358b4a79bbd29a207bca7aedacca09b296e66647c35ceb7bff33</citedby><cites>FETCH-LOGICAL-c263t-58ea6a8dd8b0d358b4a79bbd29a207bca7aedacca09b296e66647c35ceb7bff33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.liebertpub.com/doi/epdf/10.1089/109629602762539553$$EPDF$$P50$$Gmaryannliebert$$H</linktopdf><linktohtml>$$Uhttps://www.liebertpub.com/doi/full/10.1089/109629602762539553$$EHTML$$P50$$Gmaryannliebert$$H</linktohtml><link.rule.ids>315,782,786,3046,4028,21732,27932,27933,27934,55300,55312</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12697080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Teppler, Hedy</creatorcontrib><creatorcontrib>McCarroll, Kathleen</creatorcontrib><creatorcontrib>Gesser, Richard M.</creatorcontrib><creatorcontrib>Woods, Gail L.</creatorcontrib><title>Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam</title><title>Surgical infections</title><addtitle>Surg Infect (Larchmt)</addtitle><description>Background
: The pathogenicity of
Enterococcus
in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of
Enterococcus
on clinical
outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI) infection treated with ertapenem or piperacillin-tazobactam, which
is more active
in vitro
against enterococci than ertapenem. Baseline characteristics were identified that were associated with
Enterococcus
infection and with treatment failure.
Methods
:
This analysis included 1,558 patients treated in three randomized, triple-blind studies. Of these patients, 223 had
Enterococcus
in initial cultures: 125 of 623 (20%) with IAI, 28 of 529 (5%) with
CSSSI, and 70 of 406 (17%) with PI. Logistic regression models were fit to assess each objective.
Results
: The cure rates for the two treatment groups were similar in each of the three studies,
regardless of the presence or absence of
Enterococcus
. Cure rates for both treatment groups combined were significantly lower in patients with
Enterococcus
than without
Enterococcus
for IAI (76% [69/91] versus 87% [264/305], OR 2.3 [95% CI, 1.2-4.1],
P
= 0.009) and CSSSI (58% [11/19] versus 84% [241/287], OR 3.8 [95% CI, 1.5-10.0],
P
= 0.010); but for PI,
rates were similar (96% [50/52] versus 92% [188/205], OR 0.4 [95% CI, 0.1-1.9],
P
= 0.220). Characteristics predictive of the presence of
Enterococcus
were
Pseudomonas aeruginosa
as a baseline pathogen for IAI, older age, and the presence of a complicating underlying disease for CSSSI, and infection severity rated moderate rather than severe for PI. The strongest predictors of treatment
failure were >2 days postoperative infection at study entry for patients with IAI and older age for patients with CSSSI.
Conclusion
: Choice of antimicrobial therapy did not affect cure rates
in patients with or without
Enterococcus
. The strongest predictors of failure were postoperative infection at study entry in patients with IAI and older age in patients with CSSSI.</description><subject>Abdomen - microbiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>beta-Lactams</subject><subject>Double-Blind Method</subject><subject>Drug Administration Schedule</subject><subject>Drug Therapy, Combination - administration & dosage</subject><subject>Drug Therapy, Combination - therapeutic use</subject><subject>Enterococcus - isolation & purification</subject><subject>Female</subject><subject>Gram-Positive Bacterial Infections - drug therapy</subject><subject>Gram-Positive Bacterial Infections - microbiology</subject><subject>Humans</subject><subject>Lactams</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Papers</subject><subject>Pelvic Infection - drug therapy</subject><subject>Pelvic Infection - microbiology</subject><subject>Penicillanic Acid - administration & dosage</subject><subject>Penicillanic Acid - analogs & derivatives</subject><subject>Penicillanic Acid - therapeutic use</subject><subject>Piperacillin - administration & dosage</subject><subject>Piperacillin - therapeutic use</subject><subject>Prospective Studies</subject><subject>Skin Diseases, Bacterial - drug therapy</subject><subject>Skin Diseases, Bacterial - microbiology</subject><subject>Surgical Wound Infection - drug therapy</subject><subject>Surgical Wound Infection - microbiology</subject><subject>Treatment Outcome</subject><issn>1096-2964</issn><issn>1557-8674</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE1LxDAQhoMo7vrxBzxITt6qadomqTdZ1g9YUHA9l0k61Uib1iRV9Ndb2QUPXjzNMDzvC_MQcpKy85Sp8iJlpeClYFwKXmRlUWQ7ZJ4WhUyUkPnutE9AMhH5jByE8MpYKrkQ-2SWclFKpticDI-jf7YGWnrnGjTR9i7QDxtf6NJF9L3pjRnDJb0fo-k7pNbRB4gWXQx07REi1lvcRxjQYUff0Ycx0Ac7oAdj29a6ZA1fvQYToTsiew20AY-385A8XS_Xi9tkdX9zt7haJYaLLCaFQhCg6lppVmeF0jnIUuual8CZ1AYkYA3GACv19CEKIXJpssKglrppsuyQnG16B9-_jRhi1dlgsG3BYT-GSnKl0jxjE8g3oPF9CB6bavC2A_9Zpaz68Vz99TyFTrfto-6w_o1sxU6A2gA_Z3CutajRx_90fwNRAYzn</recordid><startdate>2002</startdate><enddate>2002</enddate><creator>Teppler, Hedy</creator><creator>McCarroll, Kathleen</creator><creator>Gesser, Richard M.</creator><creator>Woods, Gail L.</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2002</creationdate><title>Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam</title><author>Teppler, Hedy ; McCarroll, Kathleen ; Gesser, Richard M. ; Woods, Gail L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c263t-58ea6a8dd8b0d358b4a79bbd29a207bca7aedacca09b296e66647c35ceb7bff33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Abdomen - microbiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>beta-Lactams</topic><topic>Double-Blind Method</topic><topic>Drug Administration Schedule</topic><topic>Drug Therapy, Combination - administration & dosage</topic><topic>Drug Therapy, Combination - therapeutic use</topic><topic>Enterococcus - isolation & purification</topic><topic>Female</topic><topic>Gram-Positive Bacterial Infections - drug therapy</topic><topic>Gram-Positive Bacterial Infections - microbiology</topic><topic>Humans</topic><topic>Lactams</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Papers</topic><topic>Pelvic Infection - drug therapy</topic><topic>Pelvic Infection - microbiology</topic><topic>Penicillanic Acid - administration & dosage</topic><topic>Penicillanic Acid - analogs & derivatives</topic><topic>Penicillanic Acid - therapeutic use</topic><topic>Piperacillin - administration & dosage</topic><topic>Piperacillin - therapeutic use</topic><topic>Prospective Studies</topic><topic>Skin Diseases, Bacterial - drug therapy</topic><topic>Skin Diseases, Bacterial - microbiology</topic><topic>Surgical Wound Infection - drug therapy</topic><topic>Surgical Wound Infection - microbiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Teppler, Hedy</creatorcontrib><creatorcontrib>McCarroll, Kathleen</creatorcontrib><creatorcontrib>Gesser, Richard M.</creatorcontrib><creatorcontrib>Woods, Gail L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical infections</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Teppler, Hedy</au><au>McCarroll, Kathleen</au><au>Gesser, Richard M.</au><au>Woods, Gail L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam</atitle><jtitle>Surgical infections</jtitle><addtitle>Surg Infect (Larchmt)</addtitle><date>2002</date><risdate>2002</risdate><volume>3</volume><issue>4</issue><spage>337</spage><epage>349</epage><pages>337-349</pages><issn>1096-2964</issn><eissn>1557-8674</eissn><abstract>Background
: The pathogenicity of
Enterococcus
in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of
Enterococcus
on clinical
outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI) infection treated with ertapenem or piperacillin-tazobactam, which
is more active
in vitro
against enterococci than ertapenem. Baseline characteristics were identified that were associated with
Enterococcus
infection and with treatment failure.
Methods
:
This analysis included 1,558 patients treated in three randomized, triple-blind studies. Of these patients, 223 had
Enterococcus
in initial cultures: 125 of 623 (20%) with IAI, 28 of 529 (5%) with
CSSSI, and 70 of 406 (17%) with PI. Logistic regression models were fit to assess each objective.
Results
: The cure rates for the two treatment groups were similar in each of the three studies,
regardless of the presence or absence of
Enterococcus
. Cure rates for both treatment groups combined were significantly lower in patients with
Enterococcus
than without
Enterococcus
for IAI (76% [69/91] versus 87% [264/305], OR 2.3 [95% CI, 1.2-4.1],
P
= 0.009) and CSSSI (58% [11/19] versus 84% [241/287], OR 3.8 [95% CI, 1.5-10.0],
P
= 0.010); but for PI,
rates were similar (96% [50/52] versus 92% [188/205], OR 0.4 [95% CI, 0.1-1.9],
P
= 0.220). Characteristics predictive of the presence of
Enterococcus
were
Pseudomonas aeruginosa
as a baseline pathogen for IAI, older age, and the presence of a complicating underlying disease for CSSSI, and infection severity rated moderate rather than severe for PI. The strongest predictors of treatment
failure were >2 days postoperative infection at study entry for patients with IAI and older age for patients with CSSSI.
Conclusion
: Choice of antimicrobial therapy did not affect cure rates
in patients with or without
Enterococcus
. The strongest predictors of failure were postoperative infection at study entry in patients with IAI and older age in patients with CSSSI.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>12697080</pmid><doi>10.1089/109629602762539553</doi><tpages>13</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Surgical infections, 2002, Vol.3 (4), p.337-349 |
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| source | Mary Ann Liebert Online Subscription; MEDLINE |
| subjects | Abdomen - microbiology Adolescent Adult Aged Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - therapeutic use beta-Lactams Double-Blind Method Drug Administration Schedule Drug Therapy, Combination - administration & dosage Drug Therapy, Combination - therapeutic use Enterococcus - isolation & purification Female Gram-Positive Bacterial Infections - drug therapy Gram-Positive Bacterial Infections - microbiology Humans Lactams Male Middle Aged Original Papers Pelvic Infection - drug therapy Pelvic Infection - microbiology Penicillanic Acid - administration & dosage Penicillanic Acid - analogs & derivatives Penicillanic Acid - therapeutic use Piperacillin - administration & dosage Piperacillin - therapeutic use Prospective Studies Skin Diseases, Bacterial - drug therapy Skin Diseases, Bacterial - microbiology Surgical Wound Infection - drug therapy Surgical Wound Infection - microbiology Treatment Outcome |
| title | Surgical Infections with Enterococcus: Outcome in Patients Treated with Ertapenem versus Piperacillin-Tazobactam |
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