ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2015
Carbapenem therapy is associated with improved survival compared with piperacillin-tazobactam for patients with extended-spectrum β-lactamase bacteremia.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 146 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
146 citing papers in PubMed, 2 syntheses or guidelines pooled it, 318 citations in OpenAlex.
- Predictors of mortality from extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia.Emerging microbes & infections · 2023Pooled it
- Clinical practice guidelines for the provision of renal service in Hong Kong: Infection Control in Renal Service.Nephrology (Carlton, Vic.) · 2019Guideline
- Trial
- Trial
- Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli.BMC infectious diseases · 2017Trial
- ASP-COMPLEX: redefining antimicrobial stewardship to improve outcomes in high-risk patients with severe infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Real-world outcomes and safety of colistin therapy in children with multidrug-resistant gram-negative infections: a nine-year experience.European journal of pediatrics · 2026Article
- Critical threshold target attainment rates for tazobactam combined with piperacillin among patients admitted to the ICU with hospital-acquired pneumonia.Antimicrobial agents and chemotherapy · 2026Article
- Investigating the Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing Enterobacterales (ESBL-E) Among Patients Admitted to the Intensive Care Unit.Open forum infectious diseases · 2025Article
- Effect of Mutations on the Evolution of Extended Spectrum β-lactamases (ESBL).The protein journal · 2025Review
- In Vitro Activity of Cefaclor/Beta-Lactamases Inhibitors (Clavulanic Acid and Sulbactam) Combination Against Extended-Spectrum Beta-Lactamase Producing UropathogenicAntibiotics (Basel, Switzerland) · 2025Article
- Cefiderocol Resistance Conferred by Plasmid-Located Ferric Citrate Transport System in KPC-Producing Klebsiella pneumoniae.Emerging infectious diseases · 2025Article
- Effectiveness of Carbapenem-Sparing Antibiotics Versus Carbapenems for Treating Non-Bacteremic Extended-Spectrum Beta-Lactamase-Producing Enterobacterales Infections.Infection and drug resistance · 2025Article
- Infection Leading to Breast Abscess Formation in Pregnancy: A Case Report.International medical case reports journal · 2025Article
- β-Lactam/β-Lactamase Inhibitor Combinations Non-Susceptible ESBL-ProducingInfection and drug resistance · 2025Article
- Characterization of novel sequence type 12531 and O8:H7 serotype carbapenem-resistantAntimicrobial agents and chemotherapy · 2024Article
- Risk factors for positive follow-up blood cultures in critically ill adults with Gram-negative bacteraemia.JAC-antimicrobial resistance · 2024Article
- The role of early use of Carbapenems perioperatively for urolithiasis with ESBL-producing Escherichia coli.BMC urology · 2024Article
- Carbapenem use in extended-spectrum cephalosporin-resistant Enterobacterales infections in US hospitals and influence of IDSA guidance: a retrospective cohort study.The Lancet. Infectious diseases · 2024Article
- No improvement in mortality among critically ill patients with carbapenems as initial empirical therapy and more detection of multi-drug resistant pathogens associated with longer use: a post hoc analysis of a prospective cohort study.Microbiology spectrum · 2024Observational
86 more citing papers are in PubMed but not listed here.
Corrections and comments
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- Erratum issued
Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe effectiveness of piperacillin-tazobactam (PTZ) for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia is controversial. We compared 14-day mortality of PTZ vs carbapenems as empiric therapy in a cohort of patients with ESBL bacteremia who all received definitive therapy with a carbapenem.
methodsPatients hospitalized between January 2007 and April 2014 with monomicrobial ESBL bacteremia were included. A decrease of >3 doubling dilutions in the minimum inhibitory concentration for third-generation cephalosporins tested in combination with 4 µg/mL of clavulanic acid was used to confirm ESBL status. The primary exposure was empiric therapy, defined as antibiotic therapy administered to a patient before ESBL status was known. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. The primary outcome was time to death from the first day of bacteremia. Propensity scores using inverse probability of exposure weighting (IPW) were used to estimate the probability that a patient would receive PTZ vs carbapenems empirically. We calculated overall hazard ratios for mortality censored at 14 days using Cox proportional hazards models on an IPW-adjusted cohort.
resultsA total of 331 unique patients with ESBL bacteremia were identified. One hundred three (48%) patients received PTZ empirically and 110 (52%) received carbapenems empirically. The adjusted risk of death was 1.92 times higher for patients receiving empiric PTZ compared with empiric carbapenem therapy (95% confidence interval, 1.07-3.45).
conclusionsPTZ appears inferior to carbapenems for the treatment of ESBL bacteremia. For patients at high risk of invasive ESBL infections, early carbapenem therapy should be considered. Our findings should not be extended to β-lactam/β-lactamase inhibitor combinations in development, as limited clinical data are available for these agents.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.