Early Treatment Outcomes for Bloodstream Infections Caused by Potential AmpC Beta-Lactamase-Producing Enterobacterales with Focus on Piperacillin/Tazobactam: A Retrospective Cohort Study

Abstract

The Gram-negative bacilli Serratia spp., Providencia spp., Morganella morganii, Citrobacter freundii complex, Enterobacter spp. and Klebsiella aerogenes are common Enterobacterales that may harbor inducible chromosomal AmpC beta-lactamase genes. The purpose of the present study was to evaluate treatment outcomes and identify predictors of early treatment response in patients with bloodstream infection caused by potential AmpC beta-lactamase-producing Enterobacterales (SPICE-BSI). This cohort study included adult patients with SPICE-BSI hospitalized between 01/2011 and 02/2019. The primary outcome was early treatment response 72 h after the start of active treatment, defined as survival, hemodynamic stability, improved or stable SOFA score, resolution of fever and leukocytosis and microbiologic resolution. Among 295 included patients, the most common focus was the lower respiratory tract (27.8%), and Enterobacter spp. (n = 155) was the main pathogen. The early treatment response rate was significantly lower (p = 0.006) in the piperacillin/tazobactam group (17/81 patients, 21.0%) than in the carbapenem group (40/82 patients, 48.8%). Independent negative predictors of early treatment response (p < 0.02) included initial SOFA score, liver comorbidity and empiric piperacillin/tazobactam treatment. In vitro piperacillin/tazobactam resistance was detected in three patients with relapsed Enterobacter-BSI and initial treatment with piperacillin/tazobactam. In conclusion, our findings show that piperacillin/tazobactam might be associated with early treatment failure in patients with SPICE-BSI.

Kết Quả Điều Trị Của Piperacillin/Tazobactam Và Carbapenem Trong Nhiễm Khuẩn Có Cấy Máu Phân Lập Được Enterobacteriaceae Kháng Cephalosporin Thế Hệ Thứ 3 Tại Bệnh Viện Bệnh Nhiệt Đới Giai Đoạn 2017-2021

“…Đáp ứng điều trị sớm: Sau 72 giờ kháng sinh nghiên cứu, bệnh nhân còn sống, không sử dụng vận mạch, điểm SOFA giữ nguyên hoặc cải thiện, cắt sốt và bạch cầu máu < 12 k/uL [8] . Đặc điểm điều trị kháng sinh: Một nửa các trường hợp được chẩn đoán nhiễm khuẩn, carbapenem và piperacillin/tazobactam là các kháng sinh được lựa chọn ban đầu bởi các bác sĩ lâm sàng, trong đó piperacillin/tazobactam và ertapenem chiếm tỷ lệ cao nhất (21,4% và 20,9%).…”

Performance of the eazyplex® BloodScreen GN as a simple and rapid molecular test for identification of Gram-negative bacteria from positive blood cultures

“…or Acinetobacter spp. can be expected in most of the cases and escalation of the therapy to meropenem may be considered at least until the species is identified [13,14]. Clinical studies on the impact of rapid BC testing on patient outcome could demonstrate that the mortality risk and length of stay decreased when a molecular RDT is implemented in ABS [15][16][17].…”

“…or Acinetobacter spp. can be expected in most of the cases and escalation of the therapy to meropenem may be considered at least until the species is identified [ 13 , 14 ].…”