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Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection

Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella... Opinion EDITORIAL Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection The Search Continues Mary K. Hayden, MD; Sarah Y. Won, MD, MPH Bloodstream infections due to Escherichia coli and Klebsiella single-center, retrospective cohort study of 331 patients with pneumoniae are associated with significant morbidity, mor- ESBL-producing bacteremia found that the risk of 14-day tality, and financial costs. Resistance to third-generation mortality was greater in patients treated empirically with cephalosporins is increasing in these species both in the com- piperacillin-tazobactam (17% mortality) compared with those munity and in health care treated with a carbapenem (8% mortality). Additional con- settings. The most common cerns from in vitro and animal models include the reduced Related article page 984 mechanism of third-genera- activity of piperacillin-tazobactam in the presence of higher 7,8 tion cephalosporin resistance is production of an extended- bacterial inoculums, as can be seen in infections such as spectrum β-lactamase (ESBL). These enzymes render E coli pneumonia. The discrepancies between outcomes of these and K pneumoniae nonsusceptible to nearly all cephalo- and other studies have led to debate about the appropriate sporins and penicillins. Carbapenems, such as meropenem, re- clinical uses of BLBLIs. main active and are considered http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection

Hayden, Mary K.; Won, Sarah Y.
JAMA , Volume 320 (10) – Sep 11, 2018
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References (15)

Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2018.12565
pmid
30208439
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Carbapenem-Sparing Therapy for Extended-Spectrum β-Lactamase–Producing E coli and Klebsiella pneumoniae Bloodstream Infection The Search Continues Mary K. Hayden, MD; Sarah Y. Won, MD, MPH Bloodstream infections due to Escherichia coli and Klebsiella single-center, retrospective cohort study of 331 patients with pneumoniae are associated with significant morbidity, mor- ESBL-producing bacteremia found that the risk of 14-day tality, and financial costs. Resistance to third-generation mortality was greater in patients treated empirically with cephalosporins is increasing in these species both in the com- piperacillin-tazobactam (17% mortality) compared with those munity and in health care treated with a carbapenem (8% mortality). Additional con- settings. The most common cerns from in vitro and animal models include the reduced Related article page 984 mechanism of third-genera- activity of piperacillin-tazobactam in the presence of higher 7,8 tion cephalosporin resistance is production of an extended- bacterial inoculums, as can be seen in infections such as spectrum β-lactamase (ESBL). These enzymes render E coli pneumonia. The discrepancies between outcomes of these and K pneumoniae nonsusceptible to nearly all cephalo- and other studies have led to debate about the appropriate sporins and penicillins. Carbapenems, such as meropenem, re- clinical uses of BLBLIs. main active and are considered

Journal

JAMA – American Medical Association

Published: Sep 11, 2018

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