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Association between Minimum Inhibitory Concentration, Beta-lactamase Genes and Mortality for Patients Treated with Piperacillin/Tazobactam or Meropenem from the MERINO Study
journal contribution
posted on 2021-12-01, 00:00 authored by A Henderson, D L Paterson, M D Chatfield, P A Tambyah, D C Lye, P P De, R T P Lin, K L Chew, M Yin, T H Lee, M Yilmaz, R Cakmak, T H Alenazi, Y M Arabi, M Falcone, M Bassetti, E Righi, B A Rogers, S S Kanj, H Bhally, J Iredell, M Mendelson, T H Boyles, D F M Looke, N J Runnegar, S Miyakis, G Walls, M A I Khamis, A Zikri, A Crowe, P R Ingram, N Daneman, P Griffin, Eugene AthanEugene Athan, L Roberts, S A Beatson, A Y Peleg, K Cottrell, M J Bauer, E Tan, K Chaw, G R Nimmo, T Harris-Brown, P N A HarrisAbstract
Introduction
This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.
Methods
Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.
Results
In total, 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam nonsusceptible breakpoint (MIC >16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% confidence interval [CI] 2.8–87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3%–15%) and 8% (95% CI 2%–15%) for the original PA population and the post hoc MA populations, which reduced to 5% (95% CI −1% to 10%) after excluding strains with piperacillin/tazobactam MIC values >16 mg/L. Isolates coharboring extended spectrum β-lactamase (ESBL) and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-day mortality of 14% (95% CI 2%–28%).
Conclusions
After excluding nonsusceptible strains, the 30-day mortality difference from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA coharboring ESBLs suggests that meropenem remains the preferred choice for definitive treatment of ceftriaxone nonsusceptible Escherichia coli and Klebsiella.
Introduction
This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.
Methods
Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.
Results
In total, 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam nonsusceptible breakpoint (MIC >16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% confidence interval [CI] 2.8–87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3%–15%) and 8% (95% CI 2%–15%) for the original PA population and the post hoc MA populations, which reduced to 5% (95% CI −1% to 10%) after excluding strains with piperacillin/tazobactam MIC values >16 mg/L. Isolates coharboring extended spectrum β-lactamase (ESBL) and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-day mortality of 14% (95% CI 2%–28%).
Conclusions
After excluding nonsusceptible strains, the 30-day mortality difference from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA coharboring ESBLs suggests that meropenem remains the preferred choice for definitive treatment of ceftriaxone nonsusceptible Escherichia coli and Klebsiella.
History
Journal
Clinical Infectious DiseasesVolume
73Issue
11Pagination
E3842 - E3850Publisher
OXFORD UNIV PRESS INCLocation
United StatesPublisher DOI
ISSN
1058-4838eISSN
1537-6591Language
EnglishPublication classification
C1 Refereed article in a scholarly journalUsage metrics
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No categories selectedKeywords
Science & TechnologyLife Sciences & BiomedicineImmunologyInfectious DiseasesMicrobiologypiperacillin-tazobactammeropenemextended spectrum beta-lactamasebloodstream infectionBLOOD-STREAM INFECTIONSESCHERICHIA-COLITAZOBACTAMBACTEREMIAENTEROBACTERIACEAEANTIBIOTICSRESISTANCEPHARMACOKINETICSCOMBINATIONSCARBAPENEMSIMPACTMERINO Trial Investigators and the Australasian Society for Infectious Disease Clinical Research Network (ASID-CRN)
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