Please use this identifier to cite or link to this item: https://doi.org/10.1093/ofid/ofab387
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dc.titleMeropenem Versus Piperacillin-Tazobactam for Definitive Treatment of Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: A Pilot Multicenter Randomized Controlled Trial (MERINO-2)
dc.contributor.authorStewart, AG
dc.contributor.authorPaterson, DL
dc.contributor.authorYoung, B
dc.contributor.authorLye, DC
dc.contributor.authorDavis, JS
dc.contributor.authorSchneider, K
dc.contributor.authorYilmaz, M
dc.contributor.authorDinleyici, R
dc.contributor.authorRunnegar, N
dc.contributor.authorHenderson, A
dc.contributor.authorArchuleta, S
dc.contributor.authorKalimuddin, S
dc.contributor.authorForde, BM
dc.contributor.authorChatfield, MD
dc.contributor.authorBauer, MJ
dc.contributor.authorLipman, J
dc.contributor.authorHarris-Brown, T
dc.contributor.authorHarris, PNA
dc.date.accessioned2021-11-15T09:03:46Z
dc.date.available2021-11-15T09:03:46Z
dc.date.issued2021-08-01
dc.identifier.citationStewart, AG, Paterson, DL, Young, B, Lye, DC, Davis, JS, Schneider, K, Yilmaz, M, Dinleyici, R, Runnegar, N, Henderson, A, Archuleta, S, Kalimuddin, S, Forde, BM, Chatfield, MD, Bauer, MJ, Lipman, J, Harris-Brown, T, Harris, PNA (2021-08-01). Meropenem Versus Piperacillin-Tazobactam for Definitive Treatment of Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: A Pilot Multicenter Randomized Controlled Trial (MERINO-2). Open Forum Infectious Diseases 8 (8) : ofab387-. ScholarBank@NUS Repository. https://doi.org/10.1093/ofid/ofab387
dc.identifier.issn23288957
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/206194
dc.description.abstractBackground: Carbapenems are recommended treatment for serious infections caused by AmpC-producing gram-negative bacteria but can select for carbapenem resistance. Piperacillin-tazobactam may be a suitable alternative. Methods: We enrolled adult patients with bloodstream infection due to chromosomal AmpC producers in a multicenter randomized controlled trial. Patients were assigned 1:1 to receive piperacillin-tazobactam 4.5 g every 6 hours or meropenem 1 g every 8 hours. The primary efficacy outcome was a composite of death, clinical failure, microbiological failure, and microbiological relapse at 30 days. Results: Seventy-two patients underwent randomization and were included in the primary analysis population. Eleven of 38 patients (29%) randomized to piperacillin-tazobactam met the primary outcome compared with 7 of 34 patients (21%) in the meropenem group (risk difference, 8% [95% confidence interval {CI},-12% to 28%]). Effects were consistent in an analysis of the per-protocol population. Within the subcomponents of the primary outcome, 5 of 38 (13%) experienced microbiological failure in the piperacillin-tazobactam group compared to 0 of 34 patients (0%) in the meropenem group (risk difference, 13% [95% CI, 2% to 24%]). In contrast, 0% vs 9% of microbiological relapses were seen in the piperacillin-tazobactam and meropenem arms, respectively. Susceptibility to piperacillin-tazobactam and meropenem using broth microdilution was found in 96.5% and 100% of isolates, respectively. The most common AmpC β-lactamase genes identified were blaCMY-2, blaDHA-17, blaCMH-3, and blaACT-17. No ESBL, OXA, or other carbapenemase genes were identified. Conclusions: Among patients with bloodstream infection due to AmpC producers, piperacillin-tazobactam may lead to more microbiological failures, although fewer microbiological relapses were seen. Clinical Trials Registration: NCT02437045.
dc.publisherOxford University Press (OUP)
dc.sourceElements
dc.subjectEnterobacterales
dc.subjectampC β-lactamase
dc.subjectcarbapenem
dc.subjectclinical trial
dc.subjectpiperacillin-tazobactam
dc.typeArticle
dc.date.updated2021-11-11T06:10:17Z
dc.contributor.departmentMEDICINE
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.description.doi10.1093/ofid/ofab387
dc.description.sourcetitleOpen Forum Infectious Diseases
dc.description.volume8
dc.description.issue8
dc.description.pageofab387-
dc.published.statePublished
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