Carbapenems and piperacillin/tazobactam for the treatment of bacteremia caused by extended-spectrum β-lactamase-producing Proteus mirabilis
Journal
Diagnostic Microbiology and Infectious Disease
Journal Volume
80
Journal Issue
3
Pages
222-226
Date Issued
2014
Author(s)
Tsai H.-Y.
Chen Y.-H.
Tang H.-J.
Huang C.-C.
Liao C.-H.
Chu F.-Y.
Chuang Y.-C.
Ko W.-C.
Abstract
This study was intended to delineate the role of carbapenems and piperacillin/tazobactam in treating bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Proteus mirabilis. We performed a multicenter and retrospective study of the patients with ESBL-producing P. mirabilis bacteremia. The outcomes of the patients treated by piperacillin/tazobactam or a carbapenem for at least 48 hours and the MICs of the prescribed drugs for these isolates were analyzed. Forty-seven patients with available clinical data were included. The overall 30-day mortality rate was 29.8%. All available isolates (n = 44) were susceptible to ertapenem, meropenem, and doripenem, and 95.6% were susceptible to piperacillin/tazobactam; however, only 11.4% of the isolates were susceptible to imipenem. Among the 3 patients infected with isolates exhibiting non-susceptibility to imipenem (MIC ?2 mg/L) who were treated with imipenem, none died within 28 days. The 30-day (14.3% versus 23.1%, P = 0.65) or in-hospital (19.1% versus 30.8%, P = 0.68) mortality rate of 21 patients treated by a carbapenem was lower than that of 13 treated by piperacillin/tazobactam. However, among those treated by piperacillin/tazobactam, the mortality rate of those infected by the isolates with lower piperacillin/tazobactam MICs (?0.5/4 mg/L) was lower than that of the isolates with MICs of ?1/4 mg/L (0%, 0/7 versus 60%, 3/5; P = 0.045). ESBL-producing P. mirabilis bacteremia is associated with significant mortality, and carbapenem therapy could be regarded as the drugs of choice. The role of piperacillin/tazobactam, especially for the infections due to the isolates with an MIC ?0.5/4 mg/L, warrants more clinical studies. ? 2014 Elsevier Inc..
SDGs
Other Subjects
amikacin; amoxicillin plus clavulanic acid; aztreonam; carbapenem derivative; cefepime; ciprofloxacin; cotrimoxazole; doripenem; ertapenem; fosfomycin; gentamicin; imipenem; meropenem; piperacillin plus tazobactam; tigecycline; antiinfective agent; beta lactamase; carbapenem derivative; penicillanic acid; piperacillin; piperacillin, tazobactam drug combination; aged; antibiotic resistance; antibiotic sensitivity; Article; bacterium isolate; clinical article; controlled study; drug choice; extended spectrum beta lactamase producing Enterobacteriaceae; extended spectrum beta lactamase producing Proteus mirabilis; female; Gram negative sepsis; human; in vitro study; male; minimum inhibitory concentration; mortality; nonhuman; priority journal; retrospective study; treatment outcome; analogs and derivatives; bacteremia; clinical trial; drug effects; enzymology; isolation and purification; microbial sensitivity test; microbiology; middle aged; multicenter study; Proteus Infections; Proteus mirabilis; secretion (process); survival; very elderly; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Carbapenems; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillanic Acid; Piperacillin; Proteus Infections; Proteus mirabilis; Retrospective Studies; Survival Analysis; Treatment Outcome
Publisher
Elsevier Inc.
Type
journal article