Re-evaluation of cefepime or piperacillin-tazobactam to decrease use of carbapenems in extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (REDUCE-BSI)

Catherine H Vu; Veena Venugopalan; Barbara A Santevecchi; Stacy A Voils; Reuben Ramphal; Kartikeya Cherabuddi; Kathryn DeSear

doi:10.1017/ash.2022.21

Re-evaluation of cefepime or piperacillin-tazobactam to decrease use of carbapenems in extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (REDUCE-BSI)

Antimicrob Steward Healthc Epidemiol. 2022 Mar 11;2(1):e39. doi: 10.1017/ash.2022.21. eCollection 2022.

Authors

Catherine H Vu¹, Veena Venugopalan², Barbara A Santevecchi², Stacy A Voils², Reuben Ramphal³, Kartikeya Cherabuddi³, Kathryn DeSear⁴

Affiliations

¹ Department of Pharmacy, University Medical Center New Orleans, New Orleans, Louisiana.
² Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida.
³ Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida.
⁴ Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, Florida.

Abstract

Objective: To re-examine the use of noncarbapenems (NCBPs), specifically piperacillin-tazobactam (PTZ) and cefepime (FEP), for extended-spectrum beta-lactamase-producing Enterobacterales bloodstream infections (ESBL-E BSIs).

Design: Retrospective cohort study.

Setting: Tertiary-care, academic medical center.

Patients: The study included patients hospitalized between May 2016 and May 2019 with a positive blood culture for ESBL-E. Patients were excluded if they received treatment with antibiotics other than meropenem, ertapenem, PTZ, or FEP. Patients were also excluded if they were aged <18 years, received antibiotics for <24 hours, were treated for polymicrobial BSI, or received concomitant antibiotic therapy for a separate gram-negative infection.

Methods: We compared CBPs with FEP or PTZ for the treatment of ESBL-E BSI. The primary outcome was in-hospital mortality. Secondary outcomes included clinical cure, microbiologic cure, infection recurrence, and resistance development.

Results: Data from 114 patients were collected and analyzed; 74 (65%) patients received carbapenem (CBP) therapy and 40 (35%) patients received a NCBP (30 received FEP and 10 received PTZ). The overall in-hospital mortality was 6% (N = 7), with a higher death rate in the CBP arm than in the N-CBP arm, (8% vs 3%; P = .42). No difference in mortality was detected between subgroups with Pitt bacteremia score ≥4, those requiring ICU admission, those whose infections were cause by a nongenitourinary source or causative organism (ie, 76 had Escherichia coli and 38 had Klebsiella spp). We detected no differences in secondary outcomes between the groups.

Conclusion: Compared to CBPs, FEP and PTZ did not result in greater mortality or decreased clinical efficacy for the treatment of ESBL-E BSI caused by susceptible organisms.