Susceptibility to antibiotics of aerobic bacteria isolated from community acquired secondary peritonitis in children: therapeutic guidelines might not always fit with and everyday experience
Elio CastagnolaRoberto BandettiniFrancesca GinocchioMaddalena PerottiDaniela La MasaAntonella CiucciAnna LoyIlaria CavigliaRiccardo HauptEdoardo GuidaAlessio Pini PratoGirolamo MattioliPiero Buffa
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Abstract:
Appendicitis is a frequent clinical condition in normal children that may be complicated by community-acquired secondary peritonitis (CASP). We evaluated the potential efficacy of different drugs for initial treatment of this condition, as recommended by recent Consensus Conference and Guidelines for paediatric patients. Susceptibility to ampicillin-sulbactam, ertapenem, gentamycin, piperacillin, piperacillin-tazobactam, vancomycin, and teicoplanin was evaluated according to EUCST 2012 recommendations in aerobic bacteria isolated from peritoneal fluid in CASP diagnosed from 2005 to 2011 at 'Istituto Giannina Gaslini', Genoa, Italy. A total of 114 strains were analysed: 83 E. coli, 15 P. aeruginosa, 6 Enterococci, and 10 other Gram-negatives. Resistance to ampicillin-sulbactam was detected in 37% of strains, while ertapenem showed a potential resistance of 13% (all P. aeruginosa strains). However, the combination of these drugs with gentamicin would have been increased the efficacy of the treatment to 99 and 100%, respectively. Resistance to piperacillin-tazobactam was 3%, while no strain was resistant to meropenem. Our data suggest that monotherapy with ampicillin-sulbactam or ertapenem for community-acquired secondary peritonitis would present a non-negligible rate of failure, but the addition of gentamycin to these drugs could reset to zero this risk. On the contrary, monotherapy with piperacillin-tazobactam or meropenem is highly effective.Keywords:
Sulbactam
Ertapenem
Tazobactam
Piperacillin/tazobactam
Teicoplanin
To compare ertapenem therapy with piperacillin-tazobactam therapy for the management of acute pelvic infections.In a multicenter, double-blind study, 412 women with acute pelvic infection were assigned to one of two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then randomized to ertapenem, 1 g once a day, or piperacillin-tazobactam, 3.375 g every 6 hours, both administered intravenously.In total, 163 patients in the ertapenem group and 153 patients in the piperacillin-tazobactam group were clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common single pathogen was Escherichia coli. At the primary efficacy endpoint 2-4 weeks post therapy, 93.9% of patients who received ertapenem and 91.5% of those who received piperacillin-tazobactam were cured (95% confidence interval for the difference, adjusting for strata, -4% to 8.8%), indicating that cure rates for both treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both groups.In this study, ertapenem was as effective as piperacillin-tazobactam for the treatment of acute pelvic infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin-tazobactam.
Ertapenem
Piperacillin/tazobactam
Tazobactam
Multicenter trial
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Background: Complicated intra-abdominal infections are a common problem in surgical practice. This study compared the effectiveness of ertapenem (1 g qd) and piperacillin/tazobactam (3.375 g q6h) in the treatment of these infections. Methods: This was a multicenter, double-blinded, randomized study conducted in patients with complicated intra-abdominal infections. Of the 535 patients screened, 500 were stratified on the basis of disease severity (Acute Physiology and Chronic Health Evaluation [APACHE] II score ≤10 or >10), then randomized (1:1) to 4–14 days of treatment with one of the regimens and six weeks of followup. Nearly all patients (N = 494) were treated. The primary endpoint was the proportion of microbiologically evaluable patients with a favorable clinical response (cure) at two weeks. Non-inferiority of ertapenem was based on a difference in response rate of <15 percentage points compared with piperacillin/tazobactam (lower bound of the 95% CI > −15). Results: Of the 494 treated patients, 231 were microbiologically evaluable, with 123 and 108 patients in the ertapenem and piperacillin/tazobactam groups, respectively. Statistically similar cure rates were observed in the ertapenem (82.1%) and piperacillin/tazobactam (81.7%) groups (difference 0.3 [95% CI: −9.6, 10.5]). The pathogens isolated most frequently were Escherichia coli, Bacteroides fragilis, and Bacteroides thetaiotamicron, typical isolates associated with intra-abdominal infections. There were no statistical differences between the groups in serious drug-related clinical adverse events, drug-related clinical adverse experiences leading to study discontinuation, or mortality. Conclusions: Ertapenem was non-inferior to piperacillin/tazobactam in the cure of intra-abdominal infections caused by susceptible pathogens. Both study drugs generally were well tolerated.
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OBJECTIVE: The antibacterial activity in vitro of cefperazone/tazobactam was evaluated. METHODS: Cefperazone/tazobactam (4:1) against 601 clinical isolated strains was compared with cefperazone, tazobactam, cefperazone/sulbactam, piperacillinltazobactam and impipenenilceilastatin. Minimal inhibitory concentrations (MIC) were measured by agar dilution method and minimal bactericidal concentrations (MBC) were measured by broth dilution method. RESULTS: The antibacterial activity of cefperazone/tazobactam (4:1), the MIC50 and MIC90 against the strains producing extended spectrum b-lactamases (ESBLs) were 32-64 times and 16-32 times lower than cefperazone and were 2 times and 4 times lower than cefperazone/sulbactam and piperacillin/tazobactam. The bactericidal activity of cefperazone/tazobactam is better than cefperazone and similar as cefperazone/ sulbactam (1:1) and piperacillin/tazobactam (8:1). The inoculum size, pH and concentration of serum protein did not influence the in vitro the activity of cefperazone/tazobatam (4:1). CONCLUSION: Cefperazone/tazobactam (4:1) is an effective antibiotic containing β-lactamases inhibitor and valuable to be investigated.
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Tazobactam
Piperacillin/tazobactam
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ABSTRACTBackground: To analyze the results of the incidence of wound infection under 3 different antibiotics regiments. Methods:Between January, 1999 and December, 2004, 716 bariatric surgeries had been performed using the technique proposed byFobi/Capella. Three groups of patients had been compared, according to the antibiotic prophylaxys regimen: Group I: (n=185)ampicillin/sulbactam, 3g in two doses; Group II (n=280): ceftriaxone, 1g (single dose); and Group III: (n=251) ertapenem, 1g (single dose). Results: Our results demonstrate a rate of wound infection of 3.78% with ampicilina-sulbactam, 6.81% withceftriaxona and 1.99% in the ertapenem group. There was no significant differences between ampicilina/sulbactam or ceftriaxonain relation to the incidence of wound infection. However, there was a statistically significant difference between Group II(Ceftriaxona) and Group III (Ertapenem). Conclusion: The use of ertapenem as the antibiotic prophylaxis for the surgical ofmorbid obesity was associated to a lower incidence of wound infection than with the use of ceftriaxone, while being similar tha nampicillin/sulbactam.Key words: Surgical wound infection; Bariatric surgery; Infection; Antibiotic prophylaxis; Gastroplasty; Obesity, morbid.
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Tazobactam
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Cefoperazone-sulbactam (CS) and piperacillin-tazobactam (TZP) are used in the treatment of Gram-negative nosocomial infections (NIs). We aimed to compare the effects of these two antibiotics on mortality and treatment success. Patients treated with CS or TZP empirically for at least three days with suspicion of NI were included in this retrospective study. In total, 308 (154 patients in both treatment arms) patients were analyzed. Treatment success rate in CS and TZP group respectively (50% vs 51.2%, p = 0.18), 28-day mortality rate (46.1% vs 42.8%, p = 0.56) and antibiotic-related side effects (50.6% vs 46.1%, p = 0.42) were similar except prolonged prothrombin time (19.4% vs 6.4%; p = 0.001). According to this study results, CS and TZP have equal effectivity and safety for the empirical treatment of Gram-negative NIs. CS may be an appropriate alternative to TZP for antibiotic cycling or mixing strategy to reduce antibiotic resistance.
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Ertapenem
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Abstract Objectives Piperacillin/tazobactam combined with vancomycin has been associated with a decline in renal function when compared with monotherapy. Teicoplanin is a glycopeptide similar to vancomycin. We investigated whether piperacillin/tazobactam combined with teicoplanin is associated with a decline in renal function as well. Methods We conducted a single-centre retrospective cohort study with data from our electronic health records from 9 August 2013 to 15 November 2019, including all adult patients that received either piperacillin/tazobactam, teicoplanin or piperacillin/tazobactam + teicoplanin. The incidence of acute kidney injury (AKI) at 48–72 h served as the primary outcome, whereas change in serum creatinine served as a secondary outcome. Results Of the 4202 included patients, 3188 (75.9%) received piperacillin/tazobactam, 791 (18.8%) received teicoplanin and 223 (5.3%) received piperacillin/tazobactam + teicoplanin. The incidence of AKI at 48–72 h after commencement of antibiotic therapy was 5.4% for piperacillin/tazobactam, 3.4% for teicoplanin and 11.7% for piperacillin/tazobactam + teicoplanin (P < 0.001). However, mean serum creatinine at 48–72 h was slightly higher in the piperacillin/tazobactam + teicoplanin group therapy compared with baseline [+1.61% (95% CI –2.25 to 5.70)], indicating a slight decrease in renal function, and decreased for piperacillin/tazobactam [–1.98% (95% CI –2.73 to –1.22)] and teicoplanin [–8.01% (95% CI –9.54 to –6.45)]. After correcting for significant confounders in a multivariate linear regression analysis, these patterns remained. Conclusions Our study suggests that piperacillin/tazobactam + teicoplanin is associated with a higher prevalence of AKI compared with monotherapy. However, as the overall decline in renal function with piperacillin/tazobactam + teicoplanin is very small, its clinical relevance is likely limited. Therefore, piperacillin/tazobactam + teicoplanin can probably be safely combined.
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