Re-evaluation of cefepime or piperacillin/tazobactam to decrease use of carbapenems in ESBL-producing Enterobacterales urinary tract infections (REDUCE-UTI)

Alexander C Branton; Catherine H Vu; Veena Venugopalan; Barbara A Santevecchi; Kartikeya Cherabuddi; Reuben Ramphal; Tanvi Manohar; Kathryn E Desear

doi:10.1093/jacamr/dlad021

Re-evaluation of cefepime or piperacillin/tazobactam to decrease use of carbapenems in ESBL-producing Enterobacterales urinary tract infections (REDUCE-UTI)

JAC Antimicrob Resist. 2023 Mar 17;5(2):dlad021. doi: 10.1093/jacamr/dlad021. eCollection 2023 Apr.

Authors

Alexander C Branton¹, Catherine H Vu², Veena Venugopalan³, Barbara A Santevecchi³, Kartikeya Cherabuddi⁴, Reuben Ramphal⁴, Tanvi Manohar⁴, Kathryn E Desear⁵

Affiliations

¹ Department of Pharmacy, St. Anthony's Hospital, St. Petersburg, FL, USA.
² Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA.
³ Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA.
⁴ Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
⁵ Department of Pharmacy, University of Florida Shands Hospital, Gainesville, FL, USA.

Abstract

Objectives: To re-examine the use of non-carbapenems (NCBPs), specifically piperacillin/tazobactam and cefepime, for ESBL-producing Enterobacterales (ESBL-E) urinary tract infections (UTIs).

Patients: Retrospective cohort study of adults hospitalized between January 2016 and June 2020 with pyuria on urinalysis, a urine culture positive for ESBL-E treated with a study antibiotic (meropenem, ertapenem, cefepime or piperacillin/tazobactam) and did not meet criteria for study exclusion.

Methods: To compare carbapenems (CBPs) with cefepime or piperacillin/tazobactam for the treatment of ESBL-E UTI. The primary outcome was clinical cure, defined as complete resolution of signs and symptoms of infection. Secondary outcomes included in-hospital mortality, recurrence within 30 days and resistance emergence within 30 days.

Results: One-hundred and thirty-three patients were included, based on definitive therapy received; 69 (51.9%) received CBP and 64 (48.1%) received NCBP therapy. Of the total patient population, 17 (12.8%) were admitted to the ICU, 84 (63.1%) had a complicated UTI and 64 (48.1%) had pyelonephritis. There was no difference in clinical cure between the CBP and NCBP groups (95.7% versus 96.9%, P = 0.999). Additionally, no differences in secondary outcomes were observed.

Conclusions: When compared with CBPs, cefepime and piperacillin/tazobactam resulted in similar clinical cure, in-hospital mortality, recurrence and resistance emergence in the treatment of ESBL-E UTI.