Effect of Meropenem-Vaborbactam vs. Piperacillin-Tazobactam
Piperacillin-tazobactam, a potentially "carbapenem-sparing" option for the treatment of bloodstream infections caused by ceftriaxone-resistant Escherichia coli or Klebsiella pneumoniae has a higher 30-day mortality rate than meropenem and should not be used as a substitute for these infections, the noninferiority MERINO trial indicates. The findings have been published recently in JAMA.

The research findings do not support piperacillin-tazobactam compared with meropenem in patients with bloodstream infections caused by ceftriaxone-resistant Escherichia coli or Klebsiella pneumoniae.

"In patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, noninferiority of piperacillin-tazobactam for the primary outcome of 30-day mortality could not be demonstrated when compared with meropenem. These findings do not support use of piperacillin-tazobactam in this setting" the authors conclude.

The MERINO study was an international, multicenter, randomized clinical trial comparing piperacillin-tazobactam with meropenem for the treatment of bloodstream inflections caused by ceftriaxone-resistant E coli or K pneumoniae in adults who had at least one positive blood culture for either species that were not susceptible to ceftriaxone or cefotaxime, both of which are third-generation cephalosporins.

As the authors explain, extended-spectrum β-lactamases enzymes confer resistance to third-generation cephalosporins in the setting of E coli and K pneumoniae.

Most of the bacteremia (86.2%) was caused by E coli, and 54.8% of the infections had a urinary tract source. The researchers randomly assigned patients to receive meropenem 1 g intravenously every 8 hours or piperacillin-tazobactam 4.5 g intravenously every 6 hours. Patients were assigned to the study drug within 72 hours of having a blood culture taken and were treated for a minimum of 4 days and a maximum of 14 days.

Read more here: https://pxmd.co/mqHLq

The original article can be read here: https://jamanetwork.com/journals/jama/article-abstract/2702145
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