Piperacillin/tazobactam versus imipenem: a double-blind, randomized formulary feasibility study at a major teaching hospital.


:With the introduction of piperacillin/tazobactam to the North American market, hospitals have been faced with the task of making a decision regarding its formulary role. In view of its broad spectrum of activity, piperacillin/tazobactam could be considered as a formulary alternative to imipenem. To evaluate the formulary feasibility of substituting piperacillin/tazobactam for imipenem, a comparative assessment of these agents in the empiric treatment of serious bacterial infections was undertaken at this tertiary care hospital. This trial was conducted as a randomized, double-blind, single-center study. Consenting adult patients (>16 years of age) who were prescribed imipenem were randomized to receive either 4 g of i.v. piperacillin/tazobactam or imipenem 500 mg of i.v. Q6H with or without concurrent antibiotics. Doses were adjusted according to renal function. There were no restrictions regarding the use of nonstudy antibiotics before and during the study period. Patients with beta-lactam allergies or meningitis or who had received greater than 72 h of previous imipenem therapy were excluded. Patients were evaluated at the end of treatment, at discharge, and at 30 days postdischarge. Endpoints included both clinical and microbiologic efficacy as well as drug toxicity. Over the 433-day study period, 360 imipenem treatment courses were initiated. Of these, 150 treatment courses (75 piperacillin/tazobactam courses and 75 imipenem courses) met study criteria and were subsequently randomized. The distribution of prescriber services for enrolled patients was similar to that for all patients receiving imipenem during the study period (p = 0.15). Also, there were no statistically significant differences in demographic parameters between enrolled and excluded patients. For those patients enrolled in the study, demographic characteristics, treatment course indication(s), and accompanying antibiotics were similar across treatment arms. The mean duration of study drug therapy was 7.7 days (SD, 6.2) for imipenem and 7.5 days (SD, 6.7)for piperacillin/tazobactam (p = 0.84). In the majority of cases, treatment discontinuation occurred as a result of a favorable treatment course outcome, stepdown to a narrower spectrum parenteral agent, or stepdown to an oral agent and did not differ between study drugs (p = 0.73). Clinical and microbiologic treatment course outcomes were also similar across treatment arms. Clinical outcome was deemed successful or improved for 68% of imipenem and 70% of the piperacillin/tazobactam treatment courses (p = 0.54). Fifty-three percent of treatment courses were microbiologically confirmed. Of the 58 courses that were assessed for microbiological outcome, 93% demonstrated successful eradication of the causative pathogens. There was no difference between study drugs (96% imipenem; 90% piperacillin/tazobactam; p = 0.61). The proportion of treatment courses with at least one adverse event was similar between the study drugs (p = 1.0). Nausea and/or vomiting were/was observed more commonly in the imipenem arm (p = 0.03). Discontinuation of therapy due to drug toxicity occurred in 16% of imipenem and 5% of piperacillin/tazobactam treatment courses (p = 0.06). There was no statistically significant difference between the mean treatment course cost for imipenem ($762; range, $55-$3192) versus piperacillin/tazobactam ($696; range, $79-$2967; p = 0.59). In summary, piperacillin/tazobactam seems to represent a suitable alternative to imipenem for several clinical indications including intraabdominal infections, pneumonia, febrile neutropenia, and skin/soft tissue infections in which the causative pathogens are susceptible. However, in view of the prevalence of multiresistant Gram-negative aerobic pathogens at this institution, we do not believe that imipenem can be removed from the drug formulary. In addition, at the currently studied dosing regimen, there seems to be no evidence of a direct cost advantage associated with


Marra F,Reynolds R,Stiver G,Bryce E,Sleigh K,Frighetto L,MacDougall C,Jewesson P




Has Abstract


1998-06-01 00:00:00














  • In vitro pharmacodynamic activity of gatifloxacin, gemifloxacin, moxifloxacin and levofloxacin against Streptococcus pneumoniae containing specific mutations in DNA gyrase and topoisomerase IV.

    abstract::An in vitro pharmacodynatnic modeling apparatus (PDMA) generated specific bacterial kill profiles for single-dose regimens of gatifloxacin (GT), gemifloxacin (GM), moxifloxacin (MX) and levofloxacin (LV) against isolates of Streptococcus pneumoniae with specific QRDR profiles: SP-WT (no modifications); SP-C (changes i...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Garrison MW,Schimmels JA,Madaras-Kelly KJ

    更新日期:2003-12-01 00:00:00

  • Copper-coated textiles: armor against MDR nosocomial pathogens.

    abstract::Soft surfaces in the health-care setting harbor potentially pathogenic bacteria and fungi that can be transferred to patients and personnel. We evaluated the in vitro antimicrobial efficacy of two types of innovative copper-coated textiles against a variety of nosocomial multi-drug resistant (MDR) pathogens. Five isol...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Irene G,Georgios P,Ioannis C,Anastasios T,Diamantis P,Marianthi C,Philippe W,Maria S

    更新日期:2016-06-01 00:00:00

  • Influenza B false-positive results by rapid molecular tests Alere™ i Influenza A&B 2 in France.

    abstract::The Alere-i™ Influenza A&B (Abbott), a nicking endonuclease amplification reaction test, has recently been improved in order to deliver results in a few minutes. Our field observation highlights two problems with this new version: improper interpretation of a test as valid despite improper reagent hydration and falsel...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Otto MP,Toyer AL,Poggi C,Janvier F

    更新日期:2019-08-01 00:00:00

  • Selection of Enterococcus faecium strains with stable and unstable resistance to the streptogramin RP 59500 using stepwise in vitro exposure.

    abstract::Therapy of vancomycin-resistant enterococcal infections is an increasing problem for many large medical centers. One promising agent for use against Enterococcus faecium is RP 59500 (Quinupristin/Dalfopristin). To assess the potential for emergence of resistant strains during clinical trials with this new compound, we...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Millichap J,Ristow TA,Noskin GA,Peterson LR

    更新日期:1996-05-01 00:00:00

  • Evaluation of the FiltraCheck-UTI for detection of bacteriuria.

    abstract::The FiltraCheck-UT1 (FC) is a disposable colorimetric urine screen for bacteriuria that requires less than 1 min to perform. The results of the FC and two other urine screens, the Bac-T-Screen (BTS) and the Chemstrip LN test strip (LN), were compared with quantitative culture method. A total of 551 urine specimens wer...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Stager CE,Davis JR

    更新日期:1990-07-01 00:00:00

  • Rapid identification of medically important Candida to species level by polymerase chain reaction and single-strand conformational polymorphism.

    abstract::Invasive fungal disease has taken a great toll on immunocompromised patients. With the emergence of fluconazole and amphotericin B resistance, the rapid identification of fungi to species level is of clinical relevance in guiding appropriate antifungal therapy. Among these opportunistic fungi, Candida species are the ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Hui M,Ip M,Chan PK,Chin ML,Cheng AF

    更新日期:2000-10-01 00:00:00

  • Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment.

    abstract::The indirect immunofluorescence assay (IFA) is considered the reference method for diagnosing Q fever, but serology is also performed by complement fixation assay (CFA) or enzyme-linked immunosorbent assay (ELISA). However, comparability between these assays is not clear, and therefore a quality assessment was perform...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Herremans T,Hogema BM,Nabuurs M,Peeters M,Wegdam-Blans M,Schneeberger P,Nijhuis C,Notermans DW,Galama J,Horrevorts A,van Loo IH,Vlaminckx B,Zaaijer HL,Koopmans MP,Berkhout H,Socolovschi C,Raoult D,Stenos J,Nicholson W

    更新日期:2013-01-01 00:00:00

  • Evaluation of two commercial microtiter cytotoxin assays for the detection of Clostridium difficile toxin B in stool specimens.

    abstract::Two commercial microtiter cytotoxin assays using a fibroblast cell line (Bartels, Baxter Diagnostics, Inc., Deerfield, IL) and an epithelial cell line (Cytotoxi Test, Advanced Clinical Diagnostics, Toledo, OH) were evaluated for their ability to detect Clostridium difficile toxin B in stool specimens. After 48 hours, ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Fedorko DP,Williams EC

    更新日期:1996-09-01 00:00:00

  • Analytical and clinical validation of novel real-time reverse transcriptase-polymerase chain reaction assays for the clinical detection of swine-origin H1N1 influenza viruses.

    abstract::During the early stages of the 2009/2010 swine-origin H1N1 influenza A (S-OIV H1N1 FluA) outbreak, the development and validation of sensitive and specific detection methods were a priority for rapid and accurate diagnosis. Between May and June 2009, 2 real-time reverse transcriptase-polymerase chain reaction (rRT-PCR...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Duncan C,Guthrie JL,Tijet N,Elgngihy N,Turenne C,Seah C,Lau R,McTaggart L,Mallo G,Perusini S,Rebbapragada A,Melano R,Low DE,Farrell D,Guyard C

    更新日期:2011-02-01 00:00:00

  • Are central venous catheter tip cultures reliable after 6-day refrigeration?

    abstract::Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be mean...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Bouza E,Guembe M,Gómez H,Martín-Rabadán P,Rivera M,Alcalá L

    更新日期:2009-07-01 00:00:00

  • Guidelines for serological testing in the diagnosis of acute hepatitis A and B.

    abstract::This study was performed to determine whether elevation of serum transaminases can be used to eliminate unnecessary serological tests to diagnose acute hepatitis A (HAV) and acute hepatitis B (HBV). Serum samples of 1226 patients were tested for HBsAg, anti-HBc (IgM), and anti-HAV (IgM). Acute hepatitis was diagnosed ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Chitkara YK,Fontes MD

    更新日期:1999-04-01 00:00:00

  • Determination of disk diffusion and MIC quality control guidelines for GSK2251052: a novel boron-containing antibacterial.

    abstract::GSK2251052 is a boron-containing antimicrobial agent in clinical development for the treatment of serious Gram-negative bacterial infections. These GSK2251052 quality control (QC) studies were performed to establish ranges for control strains (broth microdilution [BMD] MIC and disk diffusion zones) as follows: Pseudom...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Ross JE,Scangarella-Oman N,Jones RN

    更新日期:2013-04-01 00:00:00

  • In vitro antimicrobial synergy of colistin with rifampicin and carbapenems against colistin-resistant Acinetobacter baumannii clinical isolates.

    abstract::Increased use of colistin in a clinical setting had resulted in the emergence of colistin-resistant (CoR) Acinetobacter baumannii. Combination therapy has been studied as a new approach to treat infections caused by A. baumannii. Here, we investigated the in vitro antimicrobial synergistic activities of several antimi...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Hong DJ,Kim JO,Lee H,Yoon EJ,Jeong SH,Yong D,Lee K

    更新日期:2016-10-01 00:00:00

  • An evaluation of the Xpert MTB/RIF assay and detection of false-positive rifampicin resistance in Mycobacterium tuberculosis.

    abstract::Recent reports suggest that false-positive rifampicin resistance may be assigned by the Xpert MTB/RIF assay. We analysed 169 specimens using the MTB/RIF assay. Using culture as the gold standard, we found that the assay had 100% sensitivity and specificity for detecting M. tuberculosis. However, we found that the assa...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Williamson DA,Basu I,Bower J,Freeman JT,Henderson G,Roberts SA

    更新日期:2012-10-01 00:00:00

  • Evaluation of a new monoclonal antibody reagent for the detection of herpes simplex virus from clinical specimens.

    abstract::A reformulated fluorescein isothiocyanate conjugate-labeled monoclonal antibody typing reagent for herpes simplex virus (HSV) was compared for culture confirmation and typing with a similar commercially available HSV typing stain. There was complete agreement between the two stains in the confirmation of 240 cultures ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Johnston SL

    更新日期:1993-01-01 00:00:00

  • Vertebral osteomyelitis: nontypeable beta-lactamase-negative Haemophilus influenzae in an adult: case report.

    abstract::Adult pyogenic vertebral osteomyelitis due to Haemophilus influenzae is exceedingly rare. After a search of the literature, we deemed our case to be the seventh case of H. influenzae pyogenic osteomyelitis. Vertebral osteomyelitis in itself is a rarity. The most common organisms associated with vertebral osteomyelitis...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,评审


    authors: Personius CD,Camp CJ

    更新日期:1997-08-01 00:00:00

  • Prosthetic valve endocarditis caused by Bartonella quintana in a patient during immunosuppressive therapies for collagen vascular diseases.

    abstract::Bartonella quintana, known to cause various clinical symptoms, is increasingly recognized as one important cause of culture-negative endocarditis. We report a case of infectious endocarditis with B. quintana on the prosthetic valve, accompanied by proteinase 3-antineutrophil cytoplasmic antibody-positive collagen vasc...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Yamada Y,Ohkusu K,Yanagihara M,Tsuneoka H,Ezaki T,Tsuboi J,Okabayashi H,Suwabe A

    更新日期:2011-07-01 00:00:00

  • Genetic and phenotypic characterization of pyrazinamide-resistant mycobacterium tuberculosis complex isolates in Japan.

    abstract::The pncA gene mutations associated with pyrazinamide (PZA) resistance in Mycobacterium tuberculosis complex were determined in 26 PZA-resistant isolates in Japan. Of the 26 PZA-resistant isolates included, 21 were negative for pyrazinamidase (PZase). Of these, 20 isolates had various pncA mutations, resulting in alter...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Miyagi C,Yamane N,Yogesh B,Ano H,Takashima T

    更新日期:2004-02-01 00:00:00

  • Emergence of a multidrug-resistant clinical isolate of Escherichia coli ST8499 strain producing NDM-13 carbapenemase in the Republic of Korea.

    abstract::We described a carbapenem-resistant Escherichia coli ST8499 strain producing New Delhi metallo-β-lactamase-13 (NDM-13) from patient in Korea. The isolate exhibited multidrug resistance, but remained susceptible to colistin and tigecycline. The blaNDM-13 gene was located on a 130-kb self-transmissible plasmid. This is ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Kim JS,Jin YH,Park SH,Han S,Kim HS,Park JH,Gong Y,An JH,Jung SW,Kim S,Kim J,Kim DW,Hong CK,Lee JH,Kim IY,Jung K

    更新日期:2019-08-01 00:00:00

  • Ceftibuten: a new orally absorbed cephalosporin. In vitro activity against strains from the United Kingdom.

    abstract::The in vitro activity of ceftibuten was studied in 572 bacterial strains and was compared with the activity of other orally administered beta-lactams. Ceftibuten displayed high activity against the Enterobacteriaceae, generally being 16-fold more active than cefuroxime, cefaclor, cephalexin, or amoxicillin-clavulanic ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Wise R,Andrews JM,Ashby JP,Thornber D

    更新日期:1991-01-01 00:00:00

  • Antimicrobial resistance among uropathogens that cause acute uncomplicated cystitis in women in Hong Kong: a prospective multicenter study in 2006 to 2008.

    abstract::A prospective multicenter study was conducted to assess the epidemiology of antimicrobial resistance among uropathogens causing uncomplicated cystitis. Adult women with clinical diagnosis of uncomplicated cystitis were enrolled from 54 participating centers distributed all over Hong Kong during 2006 to 2008. A positiv...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,多中心研究


    authors: Ho PL,Yip KS,Chow KH,Lo JY,Que TL,Yuen KY

    更新日期:2010-01-01 00:00:00

  • Molecular characterization of Staphylococcus aureus isolates carrying the Panton-Valentine leukocidin genes from Rio de Janeiro hospitals.

    abstract::In a collection of 50 pvl-positive Staphylococcus aureus isolates from 10 Rio de Janeiro hospitals, 18 (36%) were from bloodstream infections, and 31 (62%) carried the SCCmec IV. Among 25 (50%) isolates of the USA1100/ST30/CC30 lineage present in 8 hospitals, 1 isolate was characterized as vancomycin-intermediate S. a...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Chamon RC,Iorio NL,da Silva Ribeiro S,Cavalcante FS,Dos Santos KR

    更新日期:2015-12-01 00:00:00

  • In vitro activity of ampicillin, amoxicillin, ampicillin-sulbactam, and amoxicillin-clavulanic acid against consecutive clinical isolates of Enterobacteriaceae.

    abstract::Ampicillin was generally twice as active as amoxicillin against 2440 consecutive isolates of Enterobacteriaceae from five medical centers. When beta-lactamase inhibitors were added to the penicillins, there was a significant increase in susceptibility. The magnitude of the increased susceptibility to ampicillin-sulbac...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Fuchs PC,Barry AL,Pfaller MA,Hardy DJ,McLaughlin JC,Gerlach EH

    更新日期:1993-08-01 00:00:00

  • Interferon gamma mRNA quantitative real-time polymerase chain reaction for the diagnosis of latent tuberculosis: a novel interferon gamma release assay.

    abstract::The interferon gamma (IFN-γ) release assay (IGRA) is widely used as a diagnostic method for latent tuberculosis infection (LTBI). The QuantiFERON-TB Gold and QuantiFERON-TB Gold In-tube (QFT-IT) tests measure plasma IFN-γ levels using enzyme-linked immunosorbent assay (ELISA), and T-SPOT.TB counts IFN-γ-producing cell...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Kim S,Kim YK,Lee H,Cho JE,Kim HY,Uh Y,Kim YM,Kim H,Cho SN,Jeon BY,Lee H

    更新日期:2013-01-01 00:00:00

  • Anti-Mycobacterium avium complex activity of clarithromycin, rifampin, rifabutin, and ethambutol in combination with adenosine 5'-triphosphate.

    abstract::We previously reported that adenosine 5'-triphosphate (ATP) inhibited the growth of various bacteria, including mycobacteria, Staphylococcus, and Pseudomonas, without damaging bacterial surface structures. Notably, ATP's antibacterial activity was found to be attributable to its iron-chelating ability. ATP exhibited c...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Tatano Y,Yamabe S,Sano C,Tomioka H

    更新日期:2017-07-01 00:00:00

  • Multicenter evaluation of the Verigene Gram-negative blood culture nucleic acid test for rapid detection of bacteria and resistance determinants in positive blood cultures.

    abstract::The Verigene Gram-Negative Blood Culture Nucleic Acid Test (BC-GN) is a microarray-based assay that enables rapid detection of 9 common Gram-negative bacteria and 6 resistance determinants directly from positive blood cultures. We compared the performance of BC-GN with currently used automated systems, testing 141 cli...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,多中心研究


    authors: Uno N,Suzuki H,Yamakawa H,Yamada M,Yaguchi Y,Notake S,Tamai K,Yanagisawa H,Misawa S,Yanagihara K

    更新日期:2015-12-01 00:00:00

  • Polymicrobial candidemia.

    abstract::We conducted a retrospective review of the clinical data on patients with polymicrobial candidemia during a nine-year period (1992-2000) at our tertiary care University Hospital. Also, the clinical features of patients with polymicrobial vs monomicrobial candidemia were compared. There were 16 (5.2%) patients with mul...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,评审


    authors: Pulimood S,Ganesan L,Alangaden G,Chandrasekar P

    更新日期:2002-12-01 00:00:00

  • Differentiation of mycobacteria in sputa by duplex polymerase chain reaction for mycobacterial hsp65 gene.

    abstract::Early differentiation of mycobacteria in sputa is crucial. This study was set to evaluate the usefulness of a newly developed duplex polymerase chain reaction (PCR) for hsp65 gene-based method in differentiating mycobacteria in sputum with a positive acid-fast bacilli (AFB) smear before culturing. One hundred forty-se...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Kim BJ,Park JH,Lee SA,Kim H,Cha CY,Kook YH,Kim EC,Joo SI,Lee JS,Yim JJ

    更新日期:2008-10-01 00:00:00

  • Diagnosis of pneumococcal empyema using immunochromatographic test on pleural fluid and serotype distribution in Korean children.

    abstract::To evaluate the diagnostic value of immunochromatographic test (ICT) on pleural fluid in diagnosing pneumococcal empyema in children and to determine pneumococcal serotypes, 62 exudative parapneumonic effusions from Korean children were tested with culture, ICT for S. pneumoniae, pneumococcal autolysin polymerase chai...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Lee JH,Kim SH,Lee J,Choi EH,Lee HJ

    更新日期:2012-02-01 00:00:00

  • Tn2008 is a major vehicle carrying bla(OXA-23) in Acinetobacter baumannii from China.

    abstract::bla(OXA-23) and bla(OXA-66) were detected in 49 Acinetobacter baumannii isolates. These isolates were assigned to 7 subtypes by enterobacterial repetitive intergenic consensus polymerase chain reaction and 7 representative isolates were of ST92 or ST75. In most cases, the ISAba1-bla(OXA-23)-ATPaseΔ structure was ident...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Wang X,Zong Z,Lü X

    更新日期:2011-02-01 00:00:00