Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Piperacillin/tazobactam versus carbapenems for 30-day mortality in patients with ESBL-producing Enterobacterales bloodstream infections: a retrospective, multicenter, non-inferiority, cohort study,” published in the April 2025 issue of Infection by Månsson et al. 

Researchers conducted a retrospective study to assess whether piperacillin/tazobactam (PTZ) was non-inferior to carbapenems in terms of 30-day mortality among individuals with bloodstream infections (BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (EPE).  

They assessed individuals with BSIs induced with ESBL-producing EPE in southern Sweden from 2013 to 2022. Participants were grouped based on the first therapy who received 2 consecutive doses of (PTZ or a carbapenem). The primary outcome included 30-day all-cause mortality, estimated from the time of positive blood cultures. The absolute risk difference was calculated for all individuals and 2 propensity score (PS)-matched cohorts (empirical and effective) with delta limits of 5% and 2%, while the secondary outcomes were intensive care unit admission, early clinical response, superinfections, relapsed infections, and 1-year mortality.  

The results showed that 644 individuals were included, with 26 of 309 in the PTZ group and 27 of 335 in the carbapenem group meeting the primary outcome. The absolute risk difference was -0.4%, which was statistically significant in the PS-matched empirical cohort [1-sided 97.5% CI]: -∞ to 4.0, P = 0.008, and PTZ was non-inferior to carbapenems for all secondary outcomes, except for early clinical response.  

Investigators concluded that PTZ demonstrated non-inferiority to carbapenems for managing ESBL -producing EPE BSIs, given the acceptable 5% increase in 30-day mortality. 

Source: link.springer.com/article/10.1007/s15010-025-02496-x