Department of Pharmacy, Stanford Health Care, 300 Pasteur Drive, Stanford, CA 94305, USA.
Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, Stanford, CA, USA.
J Antimicrob Chemother. 2023 Apr 3;78(4):1009-1014. doi: 10.1093/jac/dkad037.
The role of piperacillin/tazobactam for treatment of serious infections due to AmpC-producing organisms remains debatable, particularly in immunocompromised patients.
This was a retrospective cohort study in immunocompromised patients that investigated the effect of definitive treatment with either piperacillin/tazobactam versus cefepime or carbapenems for bacteraemia caused by cefoxitin-non-susceptible Enterobacterales. The primary endpoint was a composite of clinical and microbiological failure. A logistic regression model was constructed to assess the impact of definitive treatment choice on the primary endpoint.
A total of 81 immunocompromised patients with blood cultures positive for cefoxitin-non-susceptible Enterobacterales were included for analysis. There was more microbiological failure in the piperacillin/tazobactam arm compared with the cefepime/carbapenem arm (11.4% versus 0.0%, P = 0.019). Definitive treatment with cefepime or a carbapenem was associated with a decreased odds of clinical or microbiological failure (OR 0.303, 95% CI 0.093-0.991, P = 0.048) when controlling for baseline characteristics.
In immunocompromised patients with bacteraemia due to cefoxitin-non-susceptible Enterobacterales, definitive treatment with piperacillin/tazobactam was associated with an increased risk of microbiological failure and higher odds of clinical or microbiological failure compared with cefepime or carbapenems.
对于产 AmpC 酶的生物体引起的严重感染，哌拉西林/他唑巴坦的治疗作用仍存在争议，尤其是在免疫功能低下的患者中。
这是一项回顾性队列研究，纳入了免疫功能低下的患者，旨在研究对于头孢西丁不敏感的肠杆菌科细菌引起的菌血症，采用哌拉西林/他唑巴坦与头孢吡肟或碳青霉烯类药物作为明确治疗方案的效果。主要终点是临床和微生物学失败的复合终点。构建了逻辑回归模型，以评估明确治疗方案选择对主要终点的影响。
共纳入 81 例头孢西丁不敏感的肠杆菌科细菌血培养阳性的免疫功能低下患者进行分析。哌拉西林/他唑巴坦组的微生物学失败率高于头孢吡肟/碳青霉烯类药物组（11.4%比 0.0%，P=0.019）。在控制基线特征后，采用头孢吡肟或碳青霉烯类药物作为明确治疗方案与临床或微生物学失败的可能性降低相关（OR 0.303，95%CI 0.093-0.991，P=0.048）。
在头孢西丁不敏感的肠杆菌科细菌引起菌血症的免疫功能低下患者中，与头孢吡肟或碳青霉烯类药物相比，采用哌拉西林/他唑巴坦作为明确治疗方案与微生物学失败风险增加以及临床或微生物学失败的可能性更高相关。
