Use of β-Lactam/β-Lactamase Inhibitors for Extended-Spectrum-β-Lactamase Infections: Defining the Right Patient Population

Abstract

In a multicenter, multinational observational study that included neutropenic patients with bloodstream infections by extended-spectrum-␤-lactamase-producing species, Gudiol et al. (Antimicrob. Agents Chemother. 61:e00164-17, 2017, https://doi.org/10.1128/AAC.00164-17) demonstrated that ␤-lactam/␤-lactamase inhibitors are effective treatment options. A review of this work, however, reminds us that some lingering questions remain for specific high-risk subgroups.

Current trends in the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria

“…The mechanism of resistance in these isolates was an ESBL in about 85% and AmpC in about 10%. In contrast to some observational studies, the mortality in piperacillin/tazobactam-treated patients was significantly higher as compared with those treated with meropenem (12% versus 4%) 18, 19 . A total of 12 out of 379 patients had pneumonia as a source of BSI in this study.…”

Treatment of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLs) infections: what have we learned until now?

“…Although no difference between the two groups regarding subsequent infections of drug-resistant bacteria or C. difficile was reported, the 30-day mortality rate differed (12.3% for PTZ versus 3.7% for meropenem) 25 . In addition, it is of utmost importance to clearly define in future studies the specific subset of patients with ESBL-PE infections who could benefit from carbapenem-sparing treatments, especially regarding hematological patients with neutropenia 26 .…”

Evaluación de susceptibilidad y respuesta al tratamiento con piperacilina/tazobactam en pacientes con infecciones por Escherichia coli productoras de β-lactamasas de espectro extendido (BLEE) CTX-M

“…El uso de los antimicrobianos β-lactámicos/inhibidores de β-lactamasas versus carbapenémicos en el tratamiento de infecciones por enterobacterias productoras de BLEE ha conducido a varios debates y publicaciones, a favor o en contra en los últimos años [26][27][28][29][30][31][32][33] . Muchos de estos estudios concluyen que piperacilina/tazobactam podría entonces ser una opción terapéutica útil en estas infecciones, distinta al uso de carbapenémicos.…”

“…Muchos de estos estudios concluyen que piperacilina/tazobactam podría entonces ser una opción terapéutica útil en estas infecciones, distinta al uso de carbapenémicos. Su uso en escenarios con mejores resultados, como es el urinario, conduciría a usar menos carbapenémicos de amplio espectro, que seleccionan bacterias gramnegativas multi-resistentes como enterorabacterias con carbapenemasas, Pseudomonas aeruginosa y Acinetobacter baumannii [28][29][30][31][32] .…”