title: Role of piperacillin/tazobactam as a carbapenem-sparing antibiotic for treatment of acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli.
abstract: Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a frequent cause of acute pyelonephritis (APN), requiring carbapenem therapy. However, alternatives to carbapenems are needed due to the emergence of carbapenemase-producing micro-organisms. The purpose of this study was to compare the clinical efficacy of piperacillin/tazobactam (TZP) versus ertapenem in the treatment of adult patients with APN caused by ESBL-Ec. A retrospective observational study of APN caused by ESBL-Ec susceptible to TZP was performed at a university-affiliated hospital in the Republic of Korea between February 2011 and June 2013. All adult patients initially treated with in vitro-active TZP were compared with those treated with ertapenem to evaluate antibiotic clinical efficacy. The primary endpoint was treatment failure, defined as a composite of in-hospital mortality, change of initial antibiotic regimen and microbiological eradication failure. During the study period, 68 patients prescribed TZP and 82 patients prescribed ertapenem were eligible for inclusion in the study. There was no significant difference between the two treatment groups in the occurrence of in-hospital mortality, change of initial antibiotic regimen or microbiological eradication failure. In the multivariate analyses, predictors associated with treatment failure included septic shock [odds ratio (OR) = 4.27, 95% confidence interval (CI) 1.66-10.99] and recent administration of immunosuppressive agents (OR = 2.84, 95% CI 1.02-7.91). However, the type of antibiotic was not associated with treatment failure. TZP could be an effective alternative to ertapenem for the treatment of APN caused by ESBL-Ec, sparing carbapenem consumption in the multidrug-resistant era.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Sook
authors.initials: KS
authors.lastname: Yang
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: macropha@korea.ac.kr.
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000077727:Ertapenem; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D056910:Republic of Korea; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D055815:Young Adult; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use*; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D065093:beta-Lactamase Inhibitors; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D001618:beta-Lactamases; D000077727:Ertapenem; D010878:Piperacillin
keywords: Acute pyelonephritis; ESBL; Ertapenem; Escherichia coli; Extended-spectrum β-lactamase; Piperacillin/tazobactam