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Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae

Published online by Cambridge University Press:  20 May 2015

Hadas Ofer-Friedman
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Coral Shefler
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Sarit Sharma
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
Amit Tirosh
Affiliation:
Department of Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel
Ruthy Tal-Jasper
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Deepthi Kandipalli
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
Shruti Sharma
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
Pradeep Bathina
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
Tamir Kaplansky
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Moran Maskit
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Tal Azouri
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
Tsilia Lazarovitch
Affiliation:
Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel.
Ronit Zaidenstein
Affiliation:
Department of Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
Dror Marchaim*
Affiliation:
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
*
Address correspondence to Dror Marchaim, MD, Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, 70300, Israel (drormarchaim@gmail.com).

Abstract

A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.

Infect Control Hosp Epidemiol 2015;36(8):981–985

Type
Concise Communications
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Hadas Ofer-Friedman and Coral Shefler contributed equally to this publication.

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Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae
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