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Int J Antimicrob Agents. 2019 Jul 15. pii: S0924-8579(19)30188-8. doi: 10.1016/j.ijantimicag.2019.07.008. [Epub ahead of print]

Clinical outcomes following treatment of Enterobacter species pneumonia with piperacillin/tazobactam compared to cefepime or ertapenem.

Author information

1
Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 West 10(th) Avenue, Columbus, Ohio 43210, United States of America.
2
Division of Infectious Diseases, The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
3
Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, 370 West 9(th) Avenue, Columbus, OH 43210, United States of America.
4
Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 West 10(th) Avenue, Columbus, Ohio 43210, United States of America. Electronic address: jessica.elefritz@osumc.edu.

Abstract

BACKGROUND:

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 desired. Cefepime has been shown to be non-inferior to carbapenems, but piperacillin/tazobactam has limited data to support its use. The objective of this study was to determine if piperacillin/tazobactam is non-inferior to cefepime or ertapenem for Enterobacter pneumonia treatment.

OBJECTIVES:

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.

METHODS:

Retrospective, single-center study.

RESULTS:

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). In multivariable logistic regression, treatment group was not associated with clinical cure when controlling for confounders (adjusted OR 0.59, 95% 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 were not different between the groups.

CONCLUSIONS:

In this retrospective study of patients with Enterobacter pneumonia, clinical cure with piperacillin/tazobactam was comparable to 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.

KEYWORDS:

AmpC; Cefepime; Enterobacter spp; Ertapenem; Piperacillin/tazobactam; Pneumonia

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