Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 West 10(th) Avenue, Columbus, Ohio 43210, United States of America.
Division of Infectious Diseases, The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
Int J Antimicrob Agents. 2019 Dec;54(6):824-828. doi: 10.1016/j.ijantimicag.2019.07.008. Epub 2019 Jul 15.
Enterobacter spp. are a common cause of nosocomial pneumonia and treatment can be complicated by AmpC resistance. Carbapenems are the treatment of choice; however, alternatives are needed. Cefepime has been shown to be non-inferior to carbapenems. There are limited data to support the use of piperacillin/tazobactam. The objective of this study was to determine if piperacillin/tazobactam is non-inferior to cefepime or ertapenem for Enterobacter pneumonia treatment.
To compare the rate of clinical cure in patients with Enterobacter pneumonia receiving definitive treatment with piperacillin/tazobactam, cefepime, or ertapenem. Secondary outcomes included hospital mortality, infection-related length of stay, duration of mechanical ventilation, recurrent pneumonia, and resistance.
Retrospective, single-center study.
Of 114 patients included, 59 received definitive treatment with piperacillin/tazobactam and 55 received cefepime or ertapenem. There was no difference in the proportion of patients who achieved clinical cure in the piperacillin/tazobactam group compared to the cefepime or ertapenem group (76.3% vs. 87.3%, P = 0.13). Treatment group was not associated with clinical cure when controlling for confounders in multivariable logistic regression (adjusted odds ratio [OR] 0.59, 95% confidence interval [CI] 0.15-2.37). The rate of recurrent pneumonia was 11.4% in the piperacillin/tazobactam group and 6.7% in the cefepime or ertapenem group (P = 0.48). Other secondary outcomes did not differ between the groups.
In this retrospective study of patients with Enterobacter pneumonia, clinical cure with piperacillin/tazobactam was comparable to that with cefepime or ertapenem; however, a prospective trial with a larger population is needed to determine if definitive treatment with piperacillin/tazobactam is non-inferior to definitive treatment with cefepime or ertapenem.
肠杆菌属是医院获得性肺炎的常见病因，治疗可能因 AmpC 耐药而变得复杂。碳青霉烯类是治疗的首选药物；然而，需要替代品。头孢吡肟已被证明不劣于碳青霉烯类药物。支持使用哌拉西林/他唑巴坦的数据有限。本研究的目的是确定哌拉西林/他唑巴坦是否不劣于头孢吡肟或厄他培南治疗肠杆菌肺炎。
比较接受哌拉西林/他唑巴坦、头孢吡肟或厄他培南确定性治疗的肠杆菌肺炎患者的临床治愈率。次要结局包括医院死亡率、感染相关住院时间、机械通气持续时间、复发性肺炎和耐药性。
回顾性单中心研究。
在 114 名患者中，59 名接受了哌拉西林/他唑巴坦的确定性治疗，55 名接受了头孢吡肟或厄他培南的治疗。哌拉西林/他唑巴坦组与头孢吡肟或厄他培南组患者达到临床治愈率的比例无差异（76.3%比 87.3%，P=0.13）。在多变量逻辑回归中控制混杂因素后，治疗组与临床治愈率无关（调整优势比[OR]0.59，95%置信区间[CI]0.15-2.37）。哌拉西林/他唑巴坦组复发性肺炎发生率为 11.4%，头孢吡肟或厄他培南组为 6.7%（P=0.48）。两组其他次要结局无差异。
在这项回顾性研究中，肠杆菌肺炎患者接受哌拉西林/他唑巴坦治疗的临床治愈率与头孢吡肟或厄他培南相当；然而，需要一项更大人群的前瞻性试验来确定哌拉西林/他唑巴坦的确定性治疗是否不劣于头孢吡肟或厄他培南的确定性治疗。
