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).Ĭonclusions. PTZ appears inferior to carbapenems for the treatment of ESBL bacteremia. One hundred three (48%) patients received PTZ empirically and 110 (52%) received carbapenems empirically. Results. A total of 331 unique patients with ESBL bacteremia were identified. We calculated overall hazard ratios for mortality censored at 14 days using Cox proportional hazards models on an IPW-adjusted cohort.
Propensity scores using inverse probability of exposure weighting (IPW) were used to estimate the probability that a patient would receive PTZ vs carbapenems empirically. The primary outcome was time to death from the first day of bacteremia. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. The primary exposure was empiric therapy, defined as antibiotic therapy administered to a patient before ESBL status was known. 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. Methods. Patients hospitalized between January 2007 and April 2014 with monomicrobial ESBL bacteremia were included. 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. Background. The effectiveness of piperacillin-tazobactam (PTZ) for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia is controversial.
0 kommentar(er)
