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.
Infection. 2023 Dec;51(6):1749-1758. doi: 10.1007/s15010-023-02074-z. Epub 2023 Jul 18.
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.
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.
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.
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.
本研究旨在比较哌拉西林/他唑巴坦（PIP/TAZ）敏感的大肠埃希菌引起的血流感染（BSI）在三组患者中的治疗结果：氨苄西林/舒巴坦（AMP/SLB）耐药分离株用 PIP/TAZ 治疗、AMP/SLB 敏感分离株用 PIP/TAZ 治疗以及 AMP/SLB 耐药分离株用另一种单药治疗。
本回顾性研究在欧洲的两个学术中心进行。从 2014 年到 2020 年，筛选出患有大肠埃希菌 BSI 的成年患者。纳入标准为非 ESBL BSI 和初始单药治疗≥72 小时。为了减少患者组之间的预期偏差，进行了倾向评分匹配。主要结局为 72 小时后的早期治疗反应，需要在 ICU/IMC 患者中无 SOFA 评分增加，以及发热、白细胞增多和菌血症消退。
在筛选出的 1707 名患者中，有 315 名（18.5%）被纳入最终分析。尿路感染是 BSI 最常见的来源（54.9%）。除 PIP/TAZ 以外的单药治疗是头孢菌素（48.6%）、碳青霉烯类（34.3%）和喹诺酮类（17.1%）。与用 PIP/TAZ 治疗的患者相比（57.1%），用另一种单药治疗的 AMP/SLB 耐药分离株引起的 BSI 患者的早期治疗反应率（p=0.04）更高，这主要是由于头孢菌素和喹诺酮类药物的使用（p≤0.03）。各组之间的临床治愈率、28 天死亡率和复发性 BSI 率无显著差异。
我们的研究表明，与其他单药治疗相比，初始使用 PIP/TAZ 可能与 AMP/SLB 耐药分离株引起的大肠埃希菌 BSI 的早期治疗反应降低相关。
