Carbapenem versus Cefepime or Piperacillin-Tazobactam for the Empiric Treatment of Extended Spectrum {beta}-lactamase Producing Escherichia coli Bacteremia in Patients with Hematologic Malignancy [Clinical Therapeutics]

Infections with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are common in patients with hematologic malignancy. The utility of cefepime and piperacillin-tazobactam as empiric therapy for ESBL E. coli bacteremia in patients with hematologic malignancy is largely unknown. We conducted a single center, retrospective cohort review of 103 adult inpatients with leukemia and/or hematopoietic stem cell transplant (HCT) recipients with monomicrobial ESBL E. coli bacteremia. No association between increased fourteen-day mortality and empiric treatment with cefepime (8%) or piperacillin-tazobactam (0%) relative to carbapenems (19%) was observed (p = 0.19 and p = 0.04, respectively). This observation was consistent in multivariate Cox proportional hazards models adjusted for confounding and an inverse probability of treatment weighted (IPTW) Cox proportional hazards model. Fever and persistent bacteremia were both more common in patients treated empirically with cefepime or piperacillin-tazobactam. Empiric treatment with cefepime or piperacillin-tazobactam does not result in increased mortality relative to treatment with carbapenems in patients with hematologic malignancy and ESBL E. coli bacteremia, although most patients were changed to carbapenems early in treatment. However, due to prolonged fever and persistent bacteremia, their role may be limited in this patient population.

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