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Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study

Tanya Babich 1 Pontus Naucler 2 John Karlsson Valik 2 Christian Giske 2 Natividad Benito 3 Ruben Cardona 4 Alba Rivera 4 Céline Pulcini 5, 6 Manal Abdel Fattah 5 Justine Haquin 5 Alasdair Macgowan 7 Sally Grier 7 Julie Gibbs 7 Bibiana Chazan 8 Anna Yanovskay 8 Ronen Ben Ami 1, 9 Michal Landes 9 Lior Nesher 10 Adi Zaidman-Shimshovitz 10 Kate Mccarthy 11 David Paterson 11 Evelina Tacconelli 12 Michael Buhl 12 Susanna Mauer 12 Jesús Rodríguez-Baño 13 Isabel Morales 13 Antonio Oliver 14 Enrique Ruiz de Gopegui 14 Angela Cano 15 Isabel Machuca 15 Monica Gozalo-Marguello 16 Luis Martinez Martinez 16 Eva Gonzalez-Barbera 17 Iris Gomez Alfaro 17 Miguel Salavert 18 Bojana Beovic 19 Andreja Saje 19 Manica Mueller-Premru 19 Leonardo Pagani 20 Virginie Vitrat 21 Diamantis Kofteridis 22 Maria Zacharioudaki 22 Sofia Maraki 22 Yulia Weissman 1 Mical Paul 23 Yaakov Dickstein 23 Leonard Leibovici 24 Dafna Yahav 24
Abstract : BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Though beta-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, carbapenems, and piperacillin-tazobactam as definitive monotherapy.METHODS: A multinational retrospective study (9 countries, 25 centers), including hospitalized patients with P . aeruginosa bacteremia treated with beta-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate analyses, including propensity adjusted analysis, were conducted introducing monotherapy type as an independent variable.RESULTS: We included 767 patients. Thirty-day mortality was 37/213 (17.4%) in the ceftazidime group; 42/210 (20%) in the carbapenem group, and 55/344 (16%) in the piperacillin-tazobactam group. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate or propensity adjusted analyses (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.52-2.46 for ceftazidime, OR 1.3, 95% CI 0.67-2.51 for piperacillin-tazobactam with carbapenems as reference in propensity adjusted multivariate analysis, 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequently with carbapenems (36/206, 17.5% versus ceftazidime 25/201, 12.4% and piperacillin-tazobactam 28/332, 8.4%, p=0.007).CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, carbapenems and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with carbapenems, along with the general preference for carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.
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Tanya Babich, Pontus Naucler, John Karlsson Valik, Christian Giske, Natividad Benito, et al.. Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study. Clinical Infectious Diseases, Oxford University Press (OUP), 2019, 70 (11), pp.2270-2280. ⟨10.1093/cid/ciz668⟩. ⟨hal-02459183⟩



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