Role of piperacillin/tazobactam as a carbapenem-sparing antibiotic for treatment of acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli

Int J Antimicrob Agents. 2017 Apr;49(4):410-415. doi: 10.1016/j.ijantimicag.2016.12.017. Epub 2017 Mar 1.

Abstract

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a frequent cause of acute pyelonephritis (APN), requiring carbapenem therapy. However, alternatives to carbapenems are needed due to the emergence of carbapenemase-producing micro-organisms. The purpose of this study was to compare the clinical efficacy of piperacillin/tazobactam (TZP) versus ertapenem in the treatment of adult patients with APN caused by ESBL-Ec. A retrospective observational study of APN caused by ESBL-Ec susceptible to TZP was performed at a university-affiliated hospital in the Republic of Korea between February 2011 and June 2013. All adult patients initially treated with in vitro-active TZP were compared with those treated with ertapenem to evaluate antibiotic clinical efficacy. The primary endpoint was treatment failure, defined as a composite of in-hospital mortality, change of initial antibiotic regimen and microbiological eradication failure. During the study period, 68 patients prescribed TZP and 82 patients prescribed ertapenem were eligible for inclusion in the study. There was no significant difference between the two treatment groups in the occurrence of in-hospital mortality, change of initial antibiotic regimen or microbiological eradication failure. In the multivariate analyses, predictors associated with treatment failure included septic shock [odds ratio (OR) = 4.27, 95% confidence interval (CI) 1.66-10.99] and recent administration of immunosuppressive agents (OR = 2.84, 95% CI 1.02-7.91). However, the type of antibiotic was not associated with treatment failure. TZP could be an effective alternative to ertapenem for the treatment of APN caused by ESBL-Ec, sparing carbapenem consumption in the multidrug-resistant era.

Keywords: Acute pyelonephritis; ESBL; Ertapenem; Escherichia coli; Extended-spectrum β-lactamase; Piperacillin/tazobactam.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Ertapenem
  • Escherichia coli / enzymology*
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / microbiology
  • Female
  • Hospitals, University
  • Humans
  • Male
  • Middle Aged
  • Penicillanic Acid / analogs & derivatives*
  • Penicillanic Acid / therapeutic use
  • Piperacillin / therapeutic use
  • Piperacillin, Tazobactam Drug Combination
  • Pyelonephritis / drug therapy*
  • Pyelonephritis / microbiology
  • Republic of Korea
  • Retrospective Studies
  • Survival Analysis
  • Treatment Failure
  • Young Adult
  • beta-Lactamase Inhibitors / therapeutic use*
  • beta-Lactamases / metabolism*
  • beta-Lactams / therapeutic use

Substances

  • Anti-Bacterial Agents
  • beta-Lactamase Inhibitors
  • beta-Lactams
  • Piperacillin, Tazobactam Drug Combination
  • Penicillanic Acid
  • beta-Lactamases
  • Ertapenem
  • Piperacillin