Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low extended-spectrum beta-lactamase (ESBL) prevalence cohort

Sara Thønnings*, Filip Jansåker, Kim Oren Gradel, Bjarne Styrishave, Jenny Dahl Knudsen

*Corresponding author for this work

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Abstract

Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli. Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality. Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12–13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67–6.15), hospital-acquired infection (MRR 2,17, CI 1.02–4.62), admission at intensive care unit (MRR 20.45, 5.31–78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98–4.68). Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.

Original languageEnglish
JournalInfection and Drug Resistance
Volume12
Pages (from-to)1257-1264
ISSN1178-6973
DOIs
Publication statusPublished - 13. May 2019

Fingerprint

Cefuroxime
Denmark
Equidae
Proportional Hazards Models
Intensive Care Units
tazobactam drug combination piperacillin
Comorbidity
Cohort Studies
Retrospective Studies
Databases
Delivery of Health Care
Research

Keywords

  • Bacteremia
  • Cefuroxime
  • E. coli
  • Mortality
  • Piperacillin/tazobactam

Cite this

@article{26b9370071144eea89435d9faac4777a,
title = "Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low extended-spectrum beta-lactamase (ESBL) prevalence cohort",
abstract = "Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli. Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality. Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12–13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67–6.15), hospital-acquired infection (MRR 2,17, CI 1.02–4.62), admission at intensive care unit (MRR 20.45, 5.31–78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98–4.68). Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.",
keywords = "Bacteremia, Cefuroxime, E. coli, Mortality, Piperacillin/tazobactam",
author = "Sara Th{\o}nnings and Filip Jans{\aa}ker and Gradel, {Kim Oren} and Bjarne Styrishave and Knudsen, {Jenny Dahl}",
year = "2019",
month = "5",
day = "13",
doi = "10.2147/IDR.S197735",
language = "English",
volume = "12",
pages = "1257--1264",
journal = "Infection and Drug Resistance",
issn = "1178-6973",
publisher = "Dove Medical Press Ltd.(Dovepress)",

}

Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low extended-spectrum beta-lactamase (ESBL) prevalence cohort. / Thønnings, Sara; Jansåker, Filip; Gradel, Kim Oren; Styrishave, Bjarne; Knudsen, Jenny Dahl.

In: Infection and Drug Resistance, Vol. 12, 13.05.2019, p. 1257-1264.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Cefuroxime compared to piperacillin/tazobactam as empirical treatment of Escherichia coli bacteremia in a low extended-spectrum beta-lactamase (ESBL) prevalence cohort

AU - Thønnings, Sara

AU - Jansåker, Filip

AU - Gradel, Kim Oren

AU - Styrishave, Bjarne

AU - Knudsen, Jenny Dahl

PY - 2019/5/13

Y1 - 2019/5/13

N2 - Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli. Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality. Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12–13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67–6.15), hospital-acquired infection (MRR 2,17, CI 1.02–4.62), admission at intensive care unit (MRR 20.45, 5.31–78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98–4.68). Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.

AB - Objectives: On January 18, 2010, a part of the capital region of Denmark shifted the empirical treatment of febrile conditions from cefuroxime to piperacillin/tazobactam. We compare empirical treatment with piperacillin/tazobactam versus cefuroxime for Escherichia coli bacteremia with regard to 14 days mortality, in a low prevalence cohort of Extended-spectrum beta-lactamase-producing E. coli. Methods: From January 18, 2010 to December 31, 2012, we conducted a retrospective cohort study including patients with E. coli bacteremia from six university hospitals in Copenhagen, Denmark. Clinical and laboratory information was obtained from a bacteremia research database, including information on comorbidity, and we used Cox proportional hazard analysis to asses all-cause 14 days mortality. Results: A total of 568 patients receiving either cefuroxime (n=377) or piperacillin/tazobactam (n=191) as empirical therapy were included. In the Cox proportional hazard model, cefuroxime treatment was significantly associated with death (mortality rate ratio 3.95, CI 1.12–13.90). Other variables associated with death were health care related infection (MRR 3.20, CI 1.67–6.15), hospital-acquired infection (MRR 2,17, CI 1.02–4.62), admission at intensive care unit (MRR 20.45, 5.31–78.82), and combination therapy with ciprofloxacin (MRR 2.14, CI 0.98–4.68). Conclusion: Empiric cefuroxime treatment of E. coli bacteremia was significantly associated with higher 14 days mortality in comparison with piperacillin/tazobactam.

KW - Bacteremia

KW - Cefuroxime

KW - E. coli

KW - Mortality

KW - Piperacillin/tazobactam

U2 - 10.2147/IDR.S197735

DO - 10.2147/IDR.S197735

M3 - Journal article

C2 - 31190913

AN - SCOPUS:85066747167

VL - 12

SP - 1257

EP - 1264

JO - Infection and Drug Resistance

JF - Infection and Drug Resistance

SN - 1178-6973

ER -