KẾT QUẢ ĐIỀU TRỊ CỦA PIPERACILLIN/TAZOBACTAM VÀ CARBAPENEM TRONG NHIỄM KHUẨN CÓ CẤY MÁU PHÂN LẬP ĐƯỢC ENTEROBACTERIACEAE KHÁNG CEPHALOSPORIN THẾ HỆ THỨ 3 TẠI BỆNH VIỆN BỆNH NHIỆT ĐỚI GIAI ĐOẠN 2017-2021

Abstract

Objectives: Study aims to analyze the effect of piperacillin/tazobactam and carbapenem on the outcome of patients with bloodstream infection caused by the third generation cephalosporin - nonsusceptible Enterobacterales.

Methods: A case series study of adult patients having at least one positive blood with Enterobacterales that was nonsusceptible to the third generation cephalosporin, but remained susceptible to piperacillin/ tazobactam and carbapenem in Hospital for Tropical Disease from October 2017 to June 2021 and were treated by one in two above regimens.

Results: Overall, 211 patients were analyzed, with 60 received piperacillin/tazobactam and 115 received carbapenem. The median age was 58 years old and female/male ratio was 2/1. Almost patients (75.8%) had community-associated infection. Urinary tract was the most common source of bacteremia (64.8%). Among analyzed Enterobacterales in our study, E. coli was the most common organism (96.7%) and almost of these bacteria produced extended-spectrum β-lactamase (92.4%). No statistically significant difference between piperacillin/tazobactam and carbapenem about the time to resolution of fever (76 hour vs 64 hour, p = 0.077), the early treatment response rate (52.1% vs 52.7%, p = 0.946) and the 30-day mortality (5.0% vs 6.0%, p = 1).

Conclusions: In treatment of bloodstream infection due to Enterobacterales that are nonsusceptible to the third generation cephalosporin but remain susceptible to piperacillin/tazobactam, we suggest using piperacillin/tazobactam in order to reduce the use of carbapenem.