Beta-lactam/ beta-lactamase inhibitors versus carbapenem for bloodstream infections due to extended spectrum beta-lactamase producing Enterobacteriaceae: Systematic review and meta-analysis.
Int J Antimicrob Agents. 2018 Aug 03;:
Authors: Sfeir M, Askin G, Christos P
BACKGROUND: Infections due to extended-spectrum beta-lactamases (ESBL)-producing Enterobacteriaceae pose a major public health threat due to poor outcomes and high mortality rates. We aimed to conduct a systematic review and meta-analysis to investigate the impact of intravenous beta-lactam/ beta-lactamase inhibitors (BL-BLI) including piperacillin-tazobactam (PTZ) on mortality of patients with ESBL- producing Enterobacteriaceae bloodstream infections compared to carbapenem.
METHODS: MEDLINE, EMBASE, and the Cochrane library were searched electronically for studies through June 15, 2017 that have provided data for mortality and addressed the terms "ESBL" and "PTZ or BL-BLI" and "carbapenem". Data extraction on study design, characteristics of the population, intervention, comparator, and outcomes was performed. A meta-analysis with a random-effects model was performed.
RESULTS: A total of 25 observational studies describing 3842 patients were included and analyzed. Within 30-day mortality of BL-BLI or PTZ for ESBL-producing Enterobacteriaceae bloodstream infections treatment was not statistically different from carbapenem [pooled odds ratios (OR): 1.07, 95% CI 0.81; 1.82 and 1.18, 95% CI 0.93; 1.5, respectively]. No statistically significant differences in mortality were found between BL-BLI or PTZ and carbapenem administered as definitive (OR: 0.96, 95% 0.59; 1.86 and 0.97, 95% CI 0.59; 1.6, respectively) or empirical (OR 1.13, 95% CI 0.87; 1.48 and 1.27, 95% CI 0.96; 1.66) treatment.
CONCLUSIONS: Our findings suggest that there is no significant difference in 30-day mortality between BL-BLI including PTZ and carbapenems in treating ESBL-producing Enterobacteriaceae bloodstream infections. Moreover, intravenous BL-BLI, especially PTZ, may be considered as an alternative treatment for ESBL-producing Enterobacteriaceae bloodstream infections. Future studies are needed to validate these findings.
PMID: 30081138 [PubMed - as supplied by publisher]