Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis
ABSTRACT Although piperacillin-tazobactam (TZP) was shown to be less effective than carbapenems in treating bacteremia due to extended-spectrum β-lactamase-producing (ESBL)-producing organisms in a randomized controlled trial, the fact that many of the causative organisms co-produced inhibitor-resis...
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| Format: | Article |
| Language: | English |
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American Society for Microbiology
2022-08-01
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| Series: | Microbiology Spectrum |
| Subjects: | |
| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.02206-22 |
| _version_ | 1811214538562863104 |
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| author | Kosuke Hoashi Brian Hayama Masahiro Suzuki Aki Sakurai Kazumi Takehana Taisuke Enokida Koichi Takeda Daisuke Ohkushi Yohei Doi Sohei Harada |
| author_facet | Kosuke Hoashi Brian Hayama Masahiro Suzuki Aki Sakurai Kazumi Takehana Taisuke Enokida Koichi Takeda Daisuke Ohkushi Yohei Doi Sohei Harada |
| author_sort | Kosuke Hoashi |
| collection | DOAJ |
| description | ABSTRACT Although piperacillin-tazobactam (TZP) was shown to be less effective than carbapenems in treating bacteremia due to extended-spectrum β-lactamase-producing (ESBL)-producing organisms in a randomized controlled trial, the fact that many of the causative organisms co-produced inhibitor-resistant OXA-1 along with ESBLs may have influenced the results. In this study, we compared the therapeutic effectiveness of TZP and carbapenem in treating ESBL-producing Escherichia coli bacteremia in areas with low frequency of OXA-1 co-production. Forty patients, 14 in the TZP treatment group and 26 in the carbapenem treatment group, were included in the analysis. There were no significant differences in patient background between the two groups. Urinary tract infection or cholangitis was the source of bacteremia in 26 patients (65%), and the Pitt bacteremia score was zero or one in 35 patients (87.5%). Only four (11.4%) of the 35 causative isolates available for microbiological analysis harbored blaOXA-1, and only three (8.6%) were non-susceptible to TZP. Seventeen (48.6%) isolates carried blaCTX-M-27, none of which carried other β-lactamase genes. No significant difference in the frequency of treatment failure on day 14 of bacteremia was documented between the TZP and carbapenem treatment groups in both the crude analysis and the inverse probability of treatment weighting-adjusted analysis. This study demonstrates that TZP may be a treatment option for non-severe cases of ESBL-producing E. coli bacteremia in areas with low frequency of OXA-1 co-production. IMPORTANCE Although carbapenems are considered the drug of choice for severe infections caused by extended-spectrum β-lactamase-producing (ESBL)-producing organisms, other therapeutic options are being explored to avoid increasing the selective pressure for carbapenem-resistant organisms. In this study, it was suggested that piperacillin-tazobactam may be as effective as carbapenems for the treatment of mild bacteremia caused by ESBL-producing Escherichia coli in areas where OXA-1 co-production by ESBL-producing E. coli is rare. The genetic background of each regional epidemic clone differs even among multidrug-resistant bacteria classified under the same name (e.g., ESBL-producing organisms), resulting in possible differences in the efficacy of therapeutic agents. Exploration of treatment options for multidrug-resistant organisms according to local epidemiology is worthwhile from the perspective of antimicrobial stewardship. |
| first_indexed | 2024-04-12T06:05:18Z |
| format | Article |
| id | doaj.art-bc107a6909ad4cbebd77bd3fe770095a |
| institution | Directory Open Access Journal |
| issn | 2165-0497 |
| language | English |
| last_indexed | 2024-04-12T06:05:18Z |
| publishDate | 2022-08-01 |
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| series | Microbiology Spectrum |
| spelling | doaj.art-bc107a6909ad4cbebd77bd3fe770095a2022-12-22T03:44:53ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972022-08-0110410.1128/spectrum.02206-22Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary AnalysisKosuke Hoashi0Brian Hayama1Masahiro Suzuki2Aki Sakurai3Kazumi Takehana4Taisuke Enokida5Koichi Takeda6Daisuke Ohkushi7Yohei Doi8Sohei Harada9Department of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, JapanDepartment of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, JapanClinical Laboratory, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanDepartment of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, JapanDepartment of Infectious Diseases, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, JapanABSTRACT Although piperacillin-tazobactam (TZP) was shown to be less effective than carbapenems in treating bacteremia due to extended-spectrum β-lactamase-producing (ESBL)-producing organisms in a randomized controlled trial, the fact that many of the causative organisms co-produced inhibitor-resistant OXA-1 along with ESBLs may have influenced the results. In this study, we compared the therapeutic effectiveness of TZP and carbapenem in treating ESBL-producing Escherichia coli bacteremia in areas with low frequency of OXA-1 co-production. Forty patients, 14 in the TZP treatment group and 26 in the carbapenem treatment group, were included in the analysis. There were no significant differences in patient background between the two groups. Urinary tract infection or cholangitis was the source of bacteremia in 26 patients (65%), and the Pitt bacteremia score was zero or one in 35 patients (87.5%). Only four (11.4%) of the 35 causative isolates available for microbiological analysis harbored blaOXA-1, and only three (8.6%) were non-susceptible to TZP. Seventeen (48.6%) isolates carried blaCTX-M-27, none of which carried other β-lactamase genes. No significant difference in the frequency of treatment failure on day 14 of bacteremia was documented between the TZP and carbapenem treatment groups in both the crude analysis and the inverse probability of treatment weighting-adjusted analysis. This study demonstrates that TZP may be a treatment option for non-severe cases of ESBL-producing E. coli bacteremia in areas with low frequency of OXA-1 co-production. IMPORTANCE Although carbapenems are considered the drug of choice for severe infections caused by extended-spectrum β-lactamase-producing (ESBL)-producing organisms, other therapeutic options are being explored to avoid increasing the selective pressure for carbapenem-resistant organisms. In this study, it was suggested that piperacillin-tazobactam may be as effective as carbapenems for the treatment of mild bacteremia caused by ESBL-producing Escherichia coli in areas where OXA-1 co-production by ESBL-producing E. coli is rare. The genetic background of each regional epidemic clone differs even among multidrug-resistant bacteria classified under the same name (e.g., ESBL-producing organisms), resulting in possible differences in the efficacy of therapeutic agents. Exploration of treatment options for multidrug-resistant organisms according to local epidemiology is worthwhile from the perspective of antimicrobial stewardship.https://journals.asm.org/doi/10.1128/spectrum.02206-22ESBLEscherichia coliOXA-1carbapenemspiperacillin-tazobactam |
| spellingShingle | Kosuke Hoashi Brian Hayama Masahiro Suzuki Aki Sakurai Kazumi Takehana Taisuke Enokida Koichi Takeda Daisuke Ohkushi Yohei Doi Sohei Harada Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis Microbiology Spectrum ESBL Escherichia coli OXA-1 carbapenems piperacillin-tazobactam |
| title | Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis |
| title_full | Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis |
| title_fullStr | Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis |
| title_full_unstemmed | Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis |
| title_short | Comparison of the Treatment Outcome of Piperacillin-Tazobactam versus Carbapenems for Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in Areas with Low Frequency of Coproduction of OXA-1: a Preliminary Analysis |
| title_sort | comparison of the treatment outcome of piperacillin tazobactam versus carbapenems for patients with bacteremia caused by extended spectrum β lactamase producing escherichia coli in areas with low frequency of coproduction of oxa 1 a preliminary analysis |
| topic | ESBL Escherichia coli OXA-1 carbapenems piperacillin-tazobactam |
| url | https://journals.asm.org/doi/10.1128/spectrum.02206-22 |
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