Empirical piperacillin/tazobactam vs carbapenems to treat bloodstream infections due to ESBL enterobacterales: a propensity score-matched observational study conducted in an emergency department in Northern Italy.
Empirical piperacillin tazobactam vs carbapenems to treat bloodstream infections due to ESBL enterobacterales a propensity score-matched observationa.pdf
Sepsis; antibacterial drug resistance; beta-Lactams; enterobacteriaceae; septic shock
Abstract :
[en] [en] BACKGROUND: Piperacillin/tazobactam is frequently used empirically in patients subsequently diagnosed with bloodstream infections (BSIs) due to extended-spectrum β-lactamase (ESBL) Enterobacterales, yet its effectiveness remains uncertain.
OBJECTIVE: This study aimed to compare piperacillin/tazobactam with carbapenems as empirical therapy for BSIs caused by ESBL-Enterobacterales.
METHODS: A single-centre retrospective study was conducted at Niguarda Hospital in Milan,Italy, enrolling consecutive patients with BSIs caused by ESBL-Enterobacterales treated empirically with either piperacillin/tazobactam or carbapenems from January 2015 to December 2023. The primary outcome was in-hospital all-cause mortality. Propensity Score Matching(PSM) was employed to mitigate potential confounding factors when assessing the association between empirical therapy and mortality. A sensitivity analysis was performed to determine the role of definitive piperacillin/tazobactam or carbapenems on patient outcomes.
RESULTS: A total of 264 patients were included in the study, median age was 72[64-81], 64% were males, 66% had sepsis and 17% septic shock. Among them, 200(76%) received empirical piperacillin/tazobactam and 64(24%) received carbapenems. After PSM adjustment, baseline characteristics were well balanced between the groups. Patients who received empirical piperacillin/tazobactam had a higher in-hospital mortality compared to those receiving empirical carbapenems (14.3% vs 3.5%, adjusted Risk Difference: 10%;95%CI: 2-19%). No difference in in-hospital mortality was observed when comparing definitive piperacillin/tazobactam to definitive carbapenems (6% vs 9%, Risk Difference: -2.5%; 95%CI: -9.2 - 4.2).
CONCLUSION: Empirical piperacillin/tazobactam may be associated with higher mortality compared tocarbapenemswhen treating patients with BSI due to ESBL-Enterobacterales. Further larger studies are needed to confirm the results andto identify specific scenarios in which piperacillin/tazobactam may be safely used.
Disciplines :
Immunology & infectious disease
Author, co-author :
Capsoni, Nicolò ; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Bettina, Marco; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
Bellone, Beatrice; Department of Medicine and Surgery, University of Milan, Milano, Italy
Bossi, Ilaria Emanuela; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Cantù, Lisa; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
Rossmann, Marta; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
Scarnera, Marida; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
Serrai, Irene; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
Vergani, Silvia; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
PRIVITERA, Daniele ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education ; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca, Hospital, Milan, Italy
Bernasconi, Davide Paolo; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Department of Clinical Research and Innovation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Puoti, Massimo; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Merli, Marco; Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Galbiati, Filippo; Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Costantino, Giorgio; Department of Medicine and Surgery, University of Milan, Milano, Italy ; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Bombelli, Michele; School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Internal Medicine, Pio XI Hospital, Italy
Empirical piperacillin/tazobactam vs carbapenems to treat bloodstream infections due to ESBL enterobacterales: a propensity score-matched observational study conducted in an emergency department in Northern Italy.
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