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
(17)
,
Bojana Beovic
(18)
,
Andreja Saje
(18)
,
Manica Mueller-Premru
(18)
,
Leonardo Pagani
(19)
,
Virginie Vitrat
(20)
,
Diamantis Kofteridis
(21)
,
Maria Zacharioudaki
(21)
,
Sofia Maraki
(21)
,
Yulia Weissman
(1)
,
Mical Paul
(22)
,
Yaakov Dickstein
(22)
,
Leonard Leibovici
(23)
,
Dafna Yahav
(23)
1
TAU -
Tel Aviv University
2 Karolinska University Hospital [Stockholm]
3 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
4 Hospital de la Santa Creu i Sant Pau
5 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
6 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
7 Southmead Hospital
8 Emek Medical Center
9 Tel Aviv Sourasky Medical Center [Tel Aviv]
10 Soroka University Medical Center [Beer Sheva, Israel]
11 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
12 University Hospital Tuebingen
13 University Hospital Virgen Macarena
14 Hospital Universitario Son Espases
15 Universidad de Córdoba = University of Córdoba [Córdoba]
16 Marqués de Valdecilla University Hospital
17 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
18 University of Ljubljana
19 Bolzano Central Hospital = Ospedale Provinciale di Bolzano
20 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
21 University Hospital of Heraklion
22 Rambam Health Care Campus
23 Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
2 Karolinska University Hospital [Stockholm]
3 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
4 Hospital de la Santa Creu i Sant Pau
5 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
6 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
7 Southmead Hospital
8 Emek Medical Center
9 Tel Aviv Sourasky Medical Center [Tel Aviv]
10 Soroka University Medical Center [Beer Sheva, Israel]
11 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
12 University Hospital Tuebingen
13 University Hospital Virgen Macarena
14 Hospital Universitario Son Espases
15 Universidad de Córdoba = University of Córdoba [Córdoba]
16 Marqués de Valdecilla University Hospital
17 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
18 University of Ljubljana
19 Bolzano Central Hospital = Ospedale Provinciale di Bolzano
20 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
21 University Hospital of Heraklion
22 Rambam Health Care Campus
23 Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
Natividad Benito
- Fonction : Auteur
- PersonId : 762350
- ORCID : 0000-0001-6410-013X
Antonio Oliver
- Fonction : Auteur
- PersonId : 763700
- ORCID : 0000-0001-9327-1894
Eva Gonzalez-Barbera
- Fonction : Auteur
- PersonId : 796723
- ORCID : 0000-0003-1674-1391
Leonardo Pagani
- Fonction : Auteur
- PersonId : 781948
- ORCID : 0000-0002-2553-9147
Diamantis Kofteridis
- Fonction : Auteur
- PersonId : 797153
- ORCID : 0000-0001-7603-2592
Résumé
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.