Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study
Abstract Objectives To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems. Methods A mult...
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Veröffentlicht in: | Journal of antimicrobial chemotherapy 2024-02, Vol.79 (2), p.453-461 |
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creator | Rando, Emanuele Salvati, Federica Sangiorgi, Flavio Catania, Francesca Leone, Elisa Oliva, Alessandra Di Gennaro, Francesco Fiori, Barbara Cancelli, Francesca Figliomeni, Sara Bobbio, Francesca Sacco, Federica Bavaro, Davide Fiore Diella, Lucia Belati, Alessandra Saracino, Annalisa Mastroianni, Claudio Maria Fantoni, Massimo Murri, Rita |
description | Abstract
Objectives
To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.
Methods
A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.
Results
Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85–2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35–3.95)] and ≥16 mg/L [HR 3.69 (95% CI, 1.86–6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85–2.16)].
Conclusions
Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is |
doi_str_mv | 10.1093/jac/dkad404 |
format | Article |
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Objectives
To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.
Methods
A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.
Results
Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85–2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35–3.95)] and ≥16 mg/L [HR 3.69 (95% CI, 1.86–6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85–2.16)].
Conclusions
Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is <8 mg/L.</description><identifier>ISSN: 0305-7453</identifier><identifier>ISSN: 1460-2091</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkad404</identifier><identifier>PMID: 38169441</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Carbapenems - pharmacology ; Carbapenems - therapeutic use ; Ceftriaxone ; Cohort Studies ; Escherichia coli ; Escherichia coli Infections - drug therapy ; Humans ; Original Research ; Penicillanic Acid - therapeutic use ; Piperacillin - therapeutic use ; Piperacillin, Tazobactam Drug Combination ; Propensity Score ; Retrospective Studies ; Sepsis - drug therapy</subject><ispartof>Journal of antimicrobial chemotherapy, 2024-02, Vol.79 (2), p.453-461</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c371t-af6bf3ffc8e35e4dd92a7c1be3039f0c020606c07d7b9ca4c8c2cb7a8664b12a3</cites><orcidid>0000-0001-6573-9584 ; 0000-0002-2273-0683 ; 0000-0003-0832-7975</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38169441$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rando, Emanuele</creatorcontrib><creatorcontrib>Salvati, Federica</creatorcontrib><creatorcontrib>Sangiorgi, Flavio</creatorcontrib><creatorcontrib>Catania, Francesca</creatorcontrib><creatorcontrib>Leone, Elisa</creatorcontrib><creatorcontrib>Oliva, Alessandra</creatorcontrib><creatorcontrib>Di Gennaro, Francesco</creatorcontrib><creatorcontrib>Fiori, Barbara</creatorcontrib><creatorcontrib>Cancelli, Francesca</creatorcontrib><creatorcontrib>Figliomeni, Sara</creatorcontrib><creatorcontrib>Bobbio, Francesca</creatorcontrib><creatorcontrib>Sacco, Federica</creatorcontrib><creatorcontrib>Bavaro, Davide Fiore</creatorcontrib><creatorcontrib>Diella, Lucia</creatorcontrib><creatorcontrib>Belati, Alessandra</creatorcontrib><creatorcontrib>Saracino, Annalisa</creatorcontrib><creatorcontrib>Mastroianni, Claudio Maria</creatorcontrib><creatorcontrib>Fantoni, Massimo</creatorcontrib><creatorcontrib>Murri, Rita</creatorcontrib><title>Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Abstract
Objectives
To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.
Methods
A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.
Results
Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85–2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35–3.95)] and ≥16 mg/L [HR 3.69 (95% CI, 1.86–6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85–2.16)].
Conclusions
Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is <8 mg/L.</description><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Carbapenems - pharmacology</subject><subject>Carbapenems - therapeutic use</subject><subject>Ceftriaxone</subject><subject>Cohort Studies</subject><subject>Escherichia coli</subject><subject>Escherichia coli Infections - drug therapy</subject><subject>Humans</subject><subject>Original Research</subject><subject>Penicillanic Acid - therapeutic use</subject><subject>Piperacillin - therapeutic use</subject><subject>Piperacillin, Tazobactam Drug Combination</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Sepsis - drug therapy</subject><issn>0305-7453</issn><issn>1460-2091</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9kkFv1DAQhSMEokvhxB35hJBQWDvOOgkXVK3aUqmIC5yjyWTSuDh2sJ2W5c9D0t1WcICTpZnP772RXpK8FPyd4JVcXwOu22_Q5jx_lKxErnia8Uo8TlZc8k1a5Bt5lDwL4ZpzrjaqfJocyVKoKs_FKvl1EoJDDVE7y1zHRj2SB9TGaLuO8NM1gBEG9uliy8C2bHA-gtFxx7RlwND182D5iNRFr-GHs5R6CjpEsJGdBuzJa-z1whrNGuNcG6KnWVPbjnAxDmwZRGrZrY79PzMs_gi-gZEsDeH97D9MJmokO1sjG72bN2EJF9B5Sm9JX_WLrGsC-Zu7I8Hchw5xanfPkycdmEAvDu9x8vXs9Mv2Y3r5-fxie3KZoixETKFTTSe7DkuSG8rbtsqgQNGQ5LLqOPKMK66QF23RVAg5lphhU0CpVN6IDORx8mGvO07NQO1dZDD16PUAflc70PXfG6v7-srd1IKXMttUxazw5qDg3feJQqwHHZCMAUtuCnVWCS6qrCrUjL7do-hdCJ66Bx_B66Uz9dyZ-tCZmX71Z7QH9r4kM_B6D7hp_K_Sb9P51u4</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Rando, Emanuele</creator><creator>Salvati, Federica</creator><creator>Sangiorgi, Flavio</creator><creator>Catania, Francesca</creator><creator>Leone, Elisa</creator><creator>Oliva, Alessandra</creator><creator>Di Gennaro, Francesco</creator><creator>Fiori, Barbara</creator><creator>Cancelli, Francesca</creator><creator>Figliomeni, Sara</creator><creator>Bobbio, Francesca</creator><creator>Sacco, Federica</creator><creator>Bavaro, Davide Fiore</creator><creator>Diella, Lucia</creator><creator>Belati, Alessandra</creator><creator>Saracino, Annalisa</creator><creator>Mastroianni, Claudio Maria</creator><creator>Fantoni, Massimo</creator><creator>Murri, Rita</creator><general>Oxford University Press</general><scope>TOX</scope><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><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6573-9584</orcidid><orcidid>https://orcid.org/0000-0002-2273-0683</orcidid><orcidid>https://orcid.org/0000-0003-0832-7975</orcidid></search><sort><creationdate>20240201</creationdate><title>Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study</title><author>Rando, Emanuele ; Salvati, Federica ; Sangiorgi, Flavio ; Catania, Francesca ; Leone, Elisa ; Oliva, Alessandra ; Di Gennaro, Francesco ; Fiori, Barbara ; Cancelli, Francesca ; Figliomeni, Sara ; Bobbio, Francesca ; Sacco, Federica ; Bavaro, Davide Fiore ; Diella, Lucia ; Belati, Alessandra ; Saracino, Annalisa ; Mastroianni, Claudio Maria ; Fantoni, Massimo ; Murri, Rita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-af6bf3ffc8e35e4dd92a7c1be3039f0c020606c07d7b9ca4c8c2cb7a8664b12a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Carbapenems - pharmacology</topic><topic>Carbapenems - therapeutic use</topic><topic>Ceftriaxone</topic><topic>Cohort Studies</topic><topic>Escherichia coli</topic><topic>Escherichia coli Infections - drug therapy</topic><topic>Humans</topic><topic>Original Research</topic><topic>Penicillanic Acid - therapeutic use</topic><topic>Piperacillin - therapeutic use</topic><topic>Piperacillin, Tazobactam Drug Combination</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Sepsis - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rando, Emanuele</creatorcontrib><creatorcontrib>Salvati, Federica</creatorcontrib><creatorcontrib>Sangiorgi, Flavio</creatorcontrib><creatorcontrib>Catania, Francesca</creatorcontrib><creatorcontrib>Leone, Elisa</creatorcontrib><creatorcontrib>Oliva, Alessandra</creatorcontrib><creatorcontrib>Di Gennaro, Francesco</creatorcontrib><creatorcontrib>Fiori, Barbara</creatorcontrib><creatorcontrib>Cancelli, Francesca</creatorcontrib><creatorcontrib>Figliomeni, Sara</creatorcontrib><creatorcontrib>Bobbio, Francesca</creatorcontrib><creatorcontrib>Sacco, Federica</creatorcontrib><creatorcontrib>Bavaro, Davide Fiore</creatorcontrib><creatorcontrib>Diella, Lucia</creatorcontrib><creatorcontrib>Belati, Alessandra</creatorcontrib><creatorcontrib>Saracino, Annalisa</creatorcontrib><creatorcontrib>Mastroianni, Claudio Maria</creatorcontrib><creatorcontrib>Fantoni, Massimo</creatorcontrib><creatorcontrib>Murri, Rita</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rando, Emanuele</au><au>Salvati, Federica</au><au>Sangiorgi, Flavio</au><au>Catania, Francesca</au><au>Leone, Elisa</au><au>Oliva, Alessandra</au><au>Di Gennaro, Francesco</au><au>Fiori, Barbara</au><au>Cancelli, Francesca</au><au>Figliomeni, Sara</au><au>Bobbio, Francesca</au><au>Sacco, Federica</au><au>Bavaro, Davide Fiore</au><au>Diella, Lucia</au><au>Belati, Alessandra</au><au>Saracino, Annalisa</au><au>Mastroianni, Claudio Maria</au><au>Fantoni, Massimo</au><au>Murri, Rita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>79</volume><issue>2</issue><spage>453</spage><epage>461</epage><pages>453-461</pages><issn>0305-7453</issn><issn>1460-2091</issn><eissn>1460-2091</eissn><abstract>Abstract
Objectives
To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.
Methods
A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.
Results
Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85–2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35–3.95)] and ≥16 mg/L [HR 3.69 (95% CI, 1.86–6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85–2.16)].
Conclusions
Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is <8 mg/L.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>38169441</pmid><doi>10.1093/jac/dkad404</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6573-9584</orcidid><orcidid>https://orcid.org/0000-0002-2273-0683</orcidid><orcidid>https://orcid.org/0000-0003-0832-7975</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Carbapenems - pharmacology Carbapenems - therapeutic use Ceftriaxone Cohort Studies Escherichia coli Escherichia coli Infections - drug therapy Humans Original Research Penicillanic Acid - therapeutic use Piperacillin - therapeutic use Piperacillin, Tazobactam Drug Combination Propensity Score Retrospective Studies Sepsis - drug therapy |
title | Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study |
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