Re-evaluation of cefepime or piperacillin/tazobactam to decrease use of carbapenems in ESBL-producing...

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Microbiology

Background:

• Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) are a growing cause of urinary tract infections (UTIs).
• Carbapenems (CBPs) are often the preferred treatment for ESBL-E UTIs, but concerns about resistance and availability exist.
• Non-carbapenem beta-lactams (NCBPs), such as piperacillin/tazobactam and cefepime, are potential alternatives.

Purpose of the Study:

• To compare the efficacy and safety of NCBPs (piperacillin/tazobactam, cefepime) versus CBPs for treating ESBL-E UTIs.
• To evaluate clinical cure, in-hospital mortality, recurrence, and resistance emergence.
• To inform antimicrobial stewardship strategies for ESBL-E UTIs.

Main Methods:

• Retrospective cohort study of adult patients hospitalized from January 2016 to June 2020.
• Included patients with ESBL-E UTI treated with meropenem, ertapenem, cefepime, or piperacillin/tazobactam.
• Compared outcomes between CBP and NCBP treatment groups.

Main Results:

• 133 patients were analyzed; 69 received CBP and 64 received NCBP therapy.
• Clinical cure rates were similar between CBP (95.7%) and NCBP (96.9%) groups (P=.999).
• No significant differences were observed in in-hospital mortality, 30-day recurrence, or 30-day resistance emergence.

Conclusions:

• Piperacillin/tazobactam and cefepime are effective alternatives to carbapenems for treating ESBL-E UTIs.
• NCBPs demonstrate comparable clinical outcomes to CBPs in this patient population.
• These findings support the judicious use of NCBPs to preserve carbapenem activity.