title: Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.
abstract: A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.
authors.affiliation: 1Unit of Infectious Diseases,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Ofer-Friedman
authors.affiliation: 2Sackler School of Medicine,Tel-Aviv University,Tel-Aviv,Israel.
authors.forename: Coral
authors.initials: C
authors.lastname: Shefler
authors.affiliation: 3Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan,USA.
authors.forename: Sarit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: 4Department of Medicine A,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Tirosh
authors.affiliation: 2Sackler School of Medicine,Tel-Aviv University,Tel-Aviv,Israel.
authors.forename: Ruthy
authors.initials: R
authors.lastname: Tal-Jasper
authors.affiliation: 3Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan,USA.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Kandipalli
authors.affiliation: 3Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan,USA.
authors.forename: Shruti
authors.initials: S
authors.lastname: Sharma
authors.affiliation: 3Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan,USA.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bathina
authors.affiliation: 1Unit of Infectious Diseases,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Tamir
authors.initials: T
authors.lastname: Kaplansky
authors.affiliation: 1Unit of Infectious Diseases,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Maskit
authors.affiliation: 1Unit of Infectious Diseases,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Azouri
authors.affiliation: 5Clinical Microbiology Laboratory,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Tsilia
authors.initials: T
authors.lastname: Lazarovitch
authors.affiliation: 4Department of Medicine A,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Zaidenstein
authors.affiliation: 3Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan,USA.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: 1Unit of Infectious Diseases,Assaf Harofeh Medical Center,Zerifin,Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D015780:Carbapenems / Q000627:therapeutic use*; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D059413:Intraabdominal Infections / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D018410:Pneumonia, Bacterial / Q000150:complications; D017192:Skin Diseases, Bacterial / Q000150:complications; D018461:Soft Tissue Infections / Q000150:complications; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D001618:beta-Lactamases; D010878:Piperacillin