Temocillin versus piperacillin-tazobactam for ICU pneumonia caused by Enterobacterales: a Belgian single-centre...

The aim of this study was to explore the clinical outcomes of ICU patients with Enterobacterales pneumonia treated with temocillin or piperacillin-tazobactam.

This retrospective, single-centre study included ICU patients with culture-confirmed Enterobacterales pneumonia over 5 years. Only isolates susceptible to both study antibiotics were included. Patients were excluded if they received the study antibiotic for less than 48 h, had more than 72 h of prior empirical therapy, or required escalation to broad-spectrum antibiotics for a new infection. Primary outcomes were 28-day mortality and clinical failure, and secondary outcomes included ICU and hospital length of stay. Multivariable logistic regression analyses were performed to assess the association between treatment group and the primary outcomes.

167 ICU patients (66 temocillin, 101 piperacillin-tazobactam) were included. Baseline characteristics, comorbidities, and severity markers were largely comparable, although in the temocillin group pneumonia more often developed later during ICU stay and treatment was less frequently initiated empirically. 28-day mortality occurred in 23% and 29% of patients in the temocillin and piperacillin-tazobactam groups, respectively (p = 0.39), while clinical failure occurred in 47% and 46%, respectively (p = 0.86). In multivariable analysis, the adjusted OR for temocillin versus piperacillin-tazobactam was 0.931 (95% CI, 0.380-2.276; p = 0.87) for 28-day mortality and 1.224 (95% CI, 0.591-2.536; p = 0.59) for clinical failure.

Although the study was not designed to establish non-inferiority of temocillin and the sample size was limited, our findings raise the possibility that temocillin may be a viable treatment option for Enterobacterales-associated pneumonia. Prospective studies are needed to clarify its role.