761. Piperacillin-tazobactam Versus Carbapenems for the Treatment of Urinary Tract Infections Caused by Extended-spectrum Beta-lactamase Producing Enterobacteriaceae
Session: Poster Abstract Session: Antimicrobials: Treatment of HAI and Resistant Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Zosyn-Carbapenem UTIs - Poster 2007 format FINAL POSTER ID WEEK.pdf (211.3 kB)
  • Background:

    Carbapenem antibiotics are considered the drugs of choice for the treatment of infections caused by extended-spectrum beta-lactamase (ESBL) producing enterobacteriaceae. However increased utilization of carbapenems is associated with the development of carbapenem-resistant organisms. ESBL-producing enterobacteriaceae generally shows in-vitro sensitivity to piperacillin-tazobactam, however, clinical efficacy data are limited. The objective of this study was to evaluate the efficacy of piperacillin-tazobactam (PTZ) compared with carbapenems for the treatment of urinary tract infections (UTIs) caused by ESBL-producing enterobacteriaceae.

    Methods:

    All patients with urine cultures positive for ESBL-producing enterobacteriaceae isolates from January 2008 to October 2012 were retrospectively evaluated. Patients were included if they were 18 years of age or older, received at least 48 hours of carbapenem or piperacillin-tazobactam therapy, and had a positive urine culture with an ESBL-producing organism (>105 cfu/mL with pyuria ≥10 WBC/HPF). Patients were excluded if there was documented resistance of the isolate to the treatment regimen. Electronic and paper-based medical records were reviewed and data was collected from patients meeting the selection criteria. The primary endpoint evaluated was microbiological clearance rates. Secondary endpoints included the patients’ length of hospital stay, duration of antibiotic treatment, and in-hospital mortality.

    Results:

    Of the 541 patients screened, 14 patients were included in the PTZ group and 45 patients were included in the carbapenem group.  In the evaluable patients, microbiological clearance was observed in 12 of 12 (100%) for the PTZ group compared with 27 of 31 (87.1%) in the carbapenem group (P=0.23). PTZ as compared with carbapenem treatment was not associated with significant differences in median length of hospital stay (17 days vs. 16 days, P=0.69), duration of antibiotic treatment (8.4 days vs. 8.2 days, P=0.92), or in-hospital mortality (7.1% vs. 13.3%, P =1.00).

    Conclusion:

    Piperacillin-tazobactam may be effective for the treatment of UTIs caused by ESBL-producing enterobacteriaceae.

    Steven Wang, Pharm.D.1, Gary Wu, Pharm.D.1, Nasser Saad, Pharm.D.1, Natalya Goldshteyn, MD2, Steven Colby, MD2 and Roseanni Andrescavage, B.S.3, (1)Pharmacy, New York Methodist Hospital, Brooklyn, NY, (2)Internal Medicine, New York Methodist Hospital, Brooklyn, NY, (3)Microbiology, New York Methodist Hospital, Brooklyn, NY

    Disclosures:

    S. Wang, None

    G. Wu, None

    N. Saad, None

    N. Goldshteyn, None

    S. Colby, None

    R. Andrescavage, None

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