We previously reported the detection of Escherichia coli and Klebsiella pneumoniae that displayed in vitro piperacillin-tazobactam (TZP) resistance bu…

View abstract Objective:To evaluate whether a low-burden antimicrobial stewardship intervention, the 7-Day and 14-Day Antibiotic Time-Out Reminder Alert (TORA), was associated with changes in inpatient piperacillin-tazobactam (PIPC/TAZ) use.Design:Quasi-experimental interrupted time-series study.Setting:A tertiary-care teaching hospital in Japan.Participants:Inpatients in targeted departments, excluding hematology and transplant surgery.Methods:TORA was introduced on September 1, 2021, using day-7 and day-14 reminders for ongoing PIPC/TAZ therapy in the electronic medical record. The primary outcome was monthly PIPC/TAZ use as days of therapy (DOT) per 100 patient-days. Segmented regression analysis used generalized least squares with a first-order autoregressive correlation structure and month fixed effects. Balancing outcomes included carbapenems, antipseudomonal cephalosporins, and quinolones. Secondary outcomes included treatment episodes lasting ≥7 and ≥14 days and 30- and 90-day mortality.Results:TORA was associated with an immediate reduction in PIPC/TAZ use (level change, −1.021 DOT/100 patient-days; 95% CI, −1.783 to −0.259; P = .010) but no significant change in postintervention slope (−0.007 DOT/100 patient-days per month; 95% CI, −0.044 to 0.031; P = .724). Carbapenem and quinolone use showed no significant immediate or slope changes, whereas antipseudomonal cephalosporin use decreased immediately without slope changes. The proportions of treatment episodes lasting ≥7 and ≥14 days decreased significantly. Thirty- and 90-day mortality did not differ significantly before and after implementation.Conclusions:A low-burden TORA strategy was associated with an immediate reduction in inpatient PIPC/TAZ use and may offer a pragmatic stewardship approach where personnel-intensive interventions are difficult to sustain.

New data from the PETERPEN trial suggest that piperacillintazobactam may be noninferior to meropenem for early clinical outcomes in select patients with ESBL bloodstream infections, but carbapenems re...

Background Meropenem and piperacillin/tazobactam are commonly used empirical antibiotics in critically ill adults with sepsis, but whether one is superior to the other is uncertain. Methods The Emp...

View abstract Objective:To evaluate outcomes in patients with ceftriaxone-non-susceptible, non-extended-spectrum beta-lactamases (ESBL), Enterobacterales bacteremia treated with carbapenem and non-carbapenem treatment options.Methods:This pilot retrospective chart review evaluated adult patients admitted between January 2021 and November 2024 with a bacteremia caused by a non-ESBL, ceftriaxone-non-susceptible, piperacillin/tazobactam-sensitive, cefepime-sensitive, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, or Proteus mirabilis. Patients were stratified into 3 groups depending on the administered targeted treatment (cefepime or piperacillin/tazobactam vs carbapenem vs other).Results:Of the 76 patients who were screened, 40 patients were analyzed. There were 28 patients in the cefepime or piperacillin/tazobactam group, 8 patients in the carbapenem group, and 4 patients in the other antibiotics group. The median age of the cohort was 77 years, most patients were female, and 30% of patients were in septic shock. The most common source of infection was genitourinary (63%). Thirty-day mortality was 3.8% in the cefepime or piperacillin/tazobactam group, 14.3% in the carbapenem group, and 0% in the other antibiotic group (P = .611). There was no significant difference in any of the secondary outcomes.Conclusions:In this pilot retrospective chart review, there was no difference between carbapenem and non-carbapenem treatment for ceftriaxone-non-susceptible, non-ESBL Enterobacterales bacteremia. Better understanding of the resistance mechanisms and collaboration with other healthcare systems to increase sample size may help assess optimal treatment of these organisms.

Both piperacillin-tazobactam and cefepime are widely used for the treatment of pneumonia caused by Pseudomonas aeruginosa. Despite this, no studies have directly compared these agents for this purpose.MethodsWe performed a single-center retrospective cohort study of patients with pneumonia caused by P. aeruginosa treated with piperacillin-tazobactam or cefepime. The co-primary outcomes were 30-day mortality and a 30-day desirability of outcome ranking (DOOR) incorporating clinical failure, resistance, acute kidney injury (AKI), and recurrence. Overlap-weighted (OW) analyses were used to account for confounding.ResultsA total of 204 patients (piperacillin-tazobactam, n = 117; cefepime, n = 87) were included. Baseline characteristics were comparable between groups after OW. All-cause mortality occurred more frequently in patients who received piperacillin-tazobactam (23.1%) compared with those receiving cefepime (11.5%; p = 0.04, OW odds ratio 2.38, 95% CI 1.05–5.42). Conversely, no significant difference in the DOOR endpoint associated with receipt of piperacillin-tazobactam (46%, 95% CI 39% – 53%) was demonstrated. Rates of resistance development (12.0% vs 5.7%, p = 0.15; OW subhazard ratio 2.25, 95% CI 0.79–6.43), and clinical success (65% vs 70%; OW odds ratio 0.81, 95% CI 0.43–1.51) were similar amongst patients receiving piperacillin-tazobactam and cefepime, respectively. AKI incidence on study drug was likewise similar (7.0% vs 7.2%).ConclusionIn this comparative study of cefepime and piperacillin-tazobactam for P. aeruginosa pneumonia, increased risk of mortality was seen with piperacillin-tazobactam. No differences were seen in other key outcomes, although sample size limits interpretation. This finding warrants further investigation in larger studies.

This clinical trial compares the efficacy of continuous vs intermittent infusion of a β-lactam antibiotic (piperacillin-tazobactam or meropenem) in decreasing all-cause mortality at 90 days in critica...