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Tobudic S, Bahrs C, Schneider L, Paulussen E, Bartonickova L, Hagel S, Starzengruber P, Burgmann H, Pletz MW. Early treatment response to piperacillin/tazobactam in patients with bloodstream infections caused by non-ESBL ampicillin/sulbactam-resistant Escherichia coli: a binational cohort study. Infection 2023; 51:1749-1758. [PMID: 37462895 PMCID: PMC10665230 DOI: 10.1007/s15010-023-02074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/04/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE This study aimed to compare treatment outcomes for bloodstream infections (BSI) caused by a piperacillin/tazobactam (PIP/TAZ)-susceptible E. coli among three patient groups: BSI caused by ampicillin/sulbactam (AMP/SLB)-resistant isolates treated with PIP/TAZ, BSI caused by AMP/SLB-sensitive isolates treated with PIP/TAZ, and BSI caused by AMP/SLB-resistant isolates treated with another monotherapy. METHODS This retrospective study was conducted in two academic centres in Europe. Adult patients with E. coli BSI were screened from 2014 to 2020. Inclusion criteria were non-ESBL BSI and initial monotherapy for ≥ 72 h. To reduce the expected bias between the patient groups, propensity score matching was performed. The primary outcome was early treatment response after 72 h and required absence of SOFA score increase in ICU/IMC patients, as well as resolution of fever, leukocytosis, and bacteraemia. RESULTS Of the 1707 patients screened, 315 (18.5%) were included in the final analysis. Urinary tract infection was the most common source of BSI (54.9%). Monotherapies other than PIP/TAZ were cephalosporins (48.6%), carbapenems (34.3%), and quinolones (17.1%). Enhanced early treatment response rate was detected (p = 0.04) in patients with BSI caused by AMP/SLB-resistant isolates treated with another monotherapy (74.3%) compared to those treated with PIP/TAZ (57.1%), and was mainly driven by the use of cephalosporins and quinolones (p ≤ 0.03). Clinical success, 28-day mortality, and rate of relapsing BSI did not significantly differ between the groups. CONCLUSIONS Our study suggests that initial use of PIP/TAZ may be associated with reduced early treatment response in E. coli BSI caused by AMP/SLB-resistant isolates compared to alternative monotherapies.
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Affiliation(s)
- Selma Tobudic
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Christina Bahrs
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria.
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
| | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Emilia Paulussen
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Lucie Bartonickova
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Stefan Hagel
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Starzengruber
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Mathias W Pletz
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
- Center for Sepsis Care and Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
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Is Piperacillin-Tazobactam an Appropriate Empirical Agent for Hospital-Acquired Sepsis and Community-Acquired Septic Shock of Unknown Origin in Australia? Healthcare (Basel) 2022; 10:healthcare10050851. [PMID: 35627988 PMCID: PMC9142067 DOI: 10.3390/healthcare10050851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/17/2022] Open
Abstract
Early appropriate empirical antibiotics are critical for reducing mortality in sepsis. For hospital-acquired sepsis of unknown origin in Australia, piperacillin-tazobactam (TZP) is recommended as an empirical therapy. Anecdotally, some institutions also use TZP for community-acquired septic shock. This narrative review aimed to scrutinise the appropriateness of TZP as an empirical agent for undifferentiated hospital-acquired sepsis and community-acquired septic shock. An online database (Medline) was searched for relevant studies in adults published in the last 10 years. Studies were included if they addressed separately reported clinical outcomes related to a relevant aspect of TZP therapy in sepsis. Of 290 search results, no studies directly addressed the study aim. This review therefore explores several themes that emerged from the contemporary literature, all of which must be considered to fully interrogate the appropriateness of TZP use in this context. This review reveals the paucity and low quality of evidence available for TZP use in sepsis of unclear origin, while demonstrating the urgent need and equipoise for an Australian audit of TZP use in patients with sepsis of unknown origin.
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Powers CE, Bookstaver PB, Caulder C, Bouknight A, Justo JA, Kohn J, Winders HR, Al-Hasan MN. Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection. Infection 2022; 50:873-877. [PMID: 35044633 DOI: 10.1007/s15010-022-01754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Early clinical failure criteria (ECFC) were recently introduced to predict unfavorable outcomes in patients with Gram-negative bloodstream infections (BSI). ECFC include hypotension, tachycardia, tachypnea or mechanical ventilation, altered mental status, and leukocytosis evaluated at 72-96 h after BSI. The aim of this retrospective cohort study was to assess performance of ECFC in predicting 28-day mortality in Enterococcus species BSI. METHODS Hospitalized adults with Enterococcus species BSI at Prisma Health hospitals from 1 January 2015 to 31 July 2018 were identified. Multivariate logistic regression was used to determine the association between ECFC and 28-day mortality. Area under the receiver operating characteristic (AUROC) curve was used to measure model discrimination. RESULTS Among 157 patients, 28 (18%) died within 28 days of BSI. After adjustments in multivariate model, the risk of 28-day mortality increased in the presence of each additional ECFC (OR 1.6, 95% CI 1.2-2.3, p = 0.005). Infective endocarditis (OR 3.9, 95% CI 1.4-10.7, p = 0.01) was independently associated with 28-day mortality. AUROC curve of ECFC model in predicting 28-day mortality was 0.74 with ECFC of 2 identified as the best breakpoint. Mortality was 8% in patients with ECFC < 2 compared to 33% in those with ECFC ≥ 2 (p < 0.001). CONCLUSION ECFC had good discrimination in predicting 28-day mortality in patients with Enterococcus species BSI. These criteria may have utility in future clinical investigations.
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Affiliation(s)
- Caroline E Powers
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA. .,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - P Brandon Bookstaver
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Celeste Caulder
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Abigail Bouknight
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Julie Ann Justo
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA.,Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Joseph Kohn
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Hana Rac Winders
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, SC, USA
| | - Majdi N Al-Hasan
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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Bach K, Edel B, Höring S, Bartoničkova L, Glöckner S, Löffler B, Bahrs C, Rödel J. Performance of the eazyplex® BloodScreen GN as a simple and rapid molecular test for identification of Gram-negative bacteria from positive blood cultures. Eur J Clin Microbiol Infect Dis 2021; 41:489-494. [PMID: 34807364 PMCID: PMC8831353 DOI: 10.1007/s10096-021-04383-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
The LAMP-based eazyplex® BloodScreen GN was evaluated for the detection of frequent Gram-negatives directly from positive blood culture (BC) bottles. A total of 449 BCs were analyzed. Sensitivities and specificities were 100% and 100% for Escherichia coli, 95.7% and 100% for Klebsiella pneumoniae, 100% and 100% for blaCTX-M, 100% and 100% for Klebsiella oxytoca, 100% and 99% for Proteus mirabilis, and 100% and 99.8% for Pseudomonas aeruginosa, respectively. The time to result ranged from 8 to 16 min, plus about 6 min for sample preparation. The eazyplex® BloodScreen GN is a reliable molecular assay for rapid BC testing.
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Affiliation(s)
- Katharina Bach
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Birgit Edel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Steffen Höring
- Division of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany
| | - Lucie Bartoničkova
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Stefan Glöckner
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
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