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














  • First report of qnrB-producing Enterobacter cloacae and qnrA-producing Acinetobacter baumannii recovered from Algerian hospitals.

    abstract::Two isolates of Enterobacter cloacae and 1 isolate of Acinetobacter baumannii showing a multidrug resistance phenotype including resistance to beta-lactams and fluoroquinolones were included in this study. By polymerase chain reaction amplification and sequencing, the 2 isolates of E. cloacae were found to produce Qnr...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Touati A,Brasme L,Benallaoua S,Gharout A,Madoux J,De Champs C

    更新日期:2008-03-01 00:00:00

  • Hemophilus aphrophilus vertebral osteomyelitis: a case report and literature review.

    abstract::We report a 60-yr-old diabetic female who developed vertebral osteomyelitis and discitis due to Hemophilus aphrophilus, and review three previously reported cases of this uncommon infection. Predisposing factors, clinical features, and treatment of H. aphrophilus vertebral osteomyelitis are discussed. ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,评审


    authors: Gribble MJ,Hunter T

    更新日期:1987-11-01 00:00:00

  • Host and microbiologic factors associated with mortality in Taiwanese children with invasive pneumococcal diseases, 2001 to 2006.

    abstract::We concurrently evaluated host- and organism-related factors in determining the outcomes of 160 invasive pneumococcal diseases episodes in 158 Taiwanese children during 2001 and 2006. Most (138/160, 86.2%) episodes occurred at age less than 60 months, and an underlying condition was present in 35 (22.2%) cases. Common...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Chen CJ,Lin CL,Chen YC,Wang CW,Chiu CH,Lin TY,Huang YC

    更新日期:2009-02-01 00:00:00

  • Surface-activated microtiter-plate microarray for simultaneous CRP quantification and viral antibody detection.

    abstract::Microarrays are widely used in high-throughput DNA and RNA hybridization tests and recently adopted to protein and small molecule interaction studies in basic research and diagnostics. Parallel detection of serum antibodies and antigens has several potential applications in epidemiologic research, vaccine development,...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Viitala SM,Jääskeläinen AJ,Kelo E,Sirola H,Moilanen K,Suni J,Vaheri A,Vapalahti O,Närvänen A

    更新日期:2013-02-01 00:00:00

  • Prevalence of beta-lactam nonsusceptible Gram-negative bacilli and use and interpretation of current susceptibility breakpoints: a survey of infectious disease physicians.

    abstract::Beta-lactam-resistant Enterobacteriaceae represent an important public health problem; however, questions exist about their prevalence and the impact of recent breakpoint changes on clinical practice. We surveyed infectious disease physicians to better understand these issues. Many reported encountering resistant Ente...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Kallen AJ,Beekmann SE,Limbago B,Lentnek AL,Polgreen PM,Patel J,Srinivasan A

    更新日期:2011-11-01 00:00:00

  • Microsatellite typing of Aspergillus fumigatus isolates recovered from deep organ samples of patients with invasive aspergillosis.

    abstract::Microsatellite typing was used to analyze 41 Aspergillus fumigatus isolates from 9 patients with proven invasive aspergillosis hospitalized in 2 different centers. No strains were shared between patients. For 8 of 9 patients, a single genotype was found for the isolates recovered from all anatomic sites involved. ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Vanhee LM,Symoens F,Nelis HJ,Coenye T

    更新日期:2008-09-01 00:00:00

  • Performance of a molecular viability assay for the diagnosis of Pneumocystis pneumonia in HIV-infected patients.

    abstract::Pneumocystis pneumonia (PCP), caused by infection with Pneumocystis jirovecii, remains an important opportunistic infection in humans. A reverse transcriptase polymerase chain reaction assay has been shown to specifically detect viable P. jirovecii organisms. In the current study, we evaluated this assay on different ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: de Oliveira A,Unnasch TR,Crothers K,Eiser S,Zucchi P,Moir J,Beard CB,Lawrence GG,Huang L

    更新日期:2007-02-01 00:00:00

  • MALDI-TOF MS identification of anaerobic bacteria: assessment of pre-analytical variables and specimen preparation techniques.

    abstract::Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has emerged as a tool for identifying clinically relevant anaerobes. We evaluated the analytical performance characteristics of the Bruker Microflex with Biotyper 3.0 software system for identification of anaerobes and examined...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Hsu YM,Burnham CA

    更新日期:2014-06-01 00:00:00

  • Comparison of a conventional and nested PCR for diagnostic confirmation and genotyping of Orientia tsutsugamushi.

    abstract::A nested polymerase chain reaction (PCR) targeting the 56-kDa antigen gene is currently the most commonly used molecular technique for confirmation of scrub typhus and genotyping of Orientia tsutsugamushi. In this study, we have compared the commonly used nested PCR (N-PCR) with a single-step conventional PCR (C-PCR) ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Janardhanan J,Prakash JA,Abraham OC,Varghese GM

    更新日期:2014-05-01 00:00:00

  • Linezolid-resistant Enterococcus faecium isolated from a patient without prior exposure to an oxazolidinone: report from the SENTRY Antimicrobial Surveillance Program.

    abstract::A patient case report describes an Enterococcus faecium strain isolated from a blood culture that was resistant to linezolid (MIC, 8 microg/mL; G2576U mutation of 23S rRNA). Co-resistances were identified for vancomycin, ampicillin, macrolides, fluoroquinolones, chloramphenicol, rifampin, gentamicin (high-level), nitr...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Jones RN,Della-Latta P,Lee LV,Biedenbach DJ

    更新日期:2002-02-01 00:00:00

  • Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole.

    abstract::Fusarium is an opportunistic fungal pathogen which is emerging as a significant cause of morbidity and mortality in immunocompromised hosts. We present a rare case of F. verticillioides fungemia that occurred in a patient who underwent a second orthotopic liver transplantation for chronic rejection and completely resp...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Cocchi S,Codeluppi M,Venturelli C,Bedini A,Grottola A,Gennari W,Cavrini F,Di Benedetto F,De Ruvo N,Rumpianesi F,Gerunda GE,Guaraldi G

    更新日期:2011-12-01 00:00:00

  • Characterization of Streptococcus pyogenes isolates responsible for adult meningitis in France from 2003 to 2013.

    abstract::Sixty-three cases of Streptococcus pyogenes meningitis in adults were studied. Three predominant emm types were associated with meningitis: emm1 (44%), emm3 (11%), and emm6 (11%). Streptococcal toxic shock syndrome and mortality rates were 40% and 38%, respectively. ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Plainvert C,Doloy A,Joubrel C,Maataoui N,Dmytruk N,Touak G,Collobert G,Fouet A,Poyart C,Loubinoux J

    更新日期:2016-04-01 00:00:00

  • In vitro activity of tigecycline against isolates collected from complicated skin and skin structure infections and intra-abdominal infections in Africa and Middle East countries: TEST 2007-2012.

    abstract::Complicated skin and skin structure infections (cSSSIs) and intra-abdominal infections (IAIs) are problematic due to decreasing therapeutic options available against multidrug-resistant pathogens common among these types of infections. A total of 2245 isolates from African and the Middle Eastern (AfME) countries were ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Renteria MI,Biedenbach DJ,Bouchillon SK,Hoban DJ,Raghubir N,Sajben P,Mokaddas E

    更新日期:2014-05-01 00:00:00

  • Coproduction of KPC-2 and QnrB19 in Klebsiella pneumoniae ST340 isolate in Brazil.

    abstract::Few reports described the presence of bla(KPC) and qnr genes in the same isolate. This study reports the combination of bla(KPC-2) and qnrB19 genes in Klebsiella pneumoniae ST340 isolate in Brazil. These findings draw attention to this combination in ST340 isolate, which is part of the CC258, disseminated in Latin Ame...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Martins WM,Almeida AC,Nicoletti AG,Cayô R,Gales AC,Alves LC,Brayner FB,Vilela MA,Morais MM

    更新日期:2015-12-01 00:00:00

  • Leukocytoclastic vasculitis complicating Klebsiella pneumoniae bacteremia.

    abstract::A 79-year old woman, with a history of hypertension, presented with clinical features of congestive heart failure, fever, a purpuric rash, and left lower quadrant abdominal tenderness. Contrast computed tomography scan of the abdomen showed features of acute diverticulitis, and blood culture was subsequently positive ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Lum PN,Woo PC,Wong SS,Yuen K

    更新日期:2000-08-01 00:00:00

  • Isolation of cholesterol-dependent Candida glabrata from clinical specimens.

    abstract::In the past few years, we have detected in the United Kingdom and in the United States several isolates of Candida glabrata that grew poorly unless bile was available. Cholesterol, a component of bile, stimulated equivalent growth of the bile-dependent isolates. The bile-dependent C. glabrata isolates appeared resista...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Hazen KC,Stei J,Darracott C,Breathnach A,May J,Howell SA

    更新日期:2005-05-01 00:00:00

  • Prediction of community-onset bacteremia among febrile adults visiting an emergency department: rigor matters.

    abstract:OBJECTIVES:Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. METHODS:During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to anal...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Lee CC,Wu CJ,Chi CH,Lee NY,Chen PL,Lee HC,Chang CM,Ko NY,Ko WC

    更新日期:2012-06-01 00:00:00

  • Change in the clinical antifungal sensitivity profile of Aspergillus flavus induced by azole and a benzimidazole fungicide exposure.

    abstract::The study evaluated the change in the clinical antifungal sensitivity profile of A. flavus strains after exposure to azole and benzimidazole fungicide. Exposure to fungicide altered the sensitivity profile for the antifungal itraconazole, voriconazole and posaconazole. This change was characterized by an increase in t...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Meireles LM,de Araujo ML,Endringer DC,Fronza M,Scherer R

    更新日期:2019-10-01 00:00:00

  • Isolation of agent associated with cat scratch disease bacillus from pretibial biopsy.

    abstract::We describe the isolation and cultural characteristics of a Gram-negative bacillus that is very similar to the presumed etiologic agent of cat scratch disease. The organism was isolated from a tibial lesion of a male patient who had been hospitalized for severe necrotizing pancreatitis. The significance of the isolate...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Hall GS,Pratt-Rippin K,Washington JA

    更新日期:1991-11-01 00:00:00

  • Case report: lymphogranuloma venereum proctitis-from rapid screening to molecular confirmation of a masked sexually transmitted disease.

    abstract::Proctitis caused by Chlamydia trachomatis L2b can manifest with very mild, nonspecific symptoms, and appropriate diagnostic evaluation is crucial. The case report demonstrates that rapid screening test, detection of specific antibodies in serum, and direct pathogen identification by PCR performed on tissue sample or r...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Markowicz M,Grilnberger E,Huber F,Leibl G,Abrahamian H,Gartner M,Huber M,Chott A,Reiter M,Stanek G

    更新日期:2013-08-01 00:00:00

  • Comparison of clindamycin, metronidazole, and penicillin for the treatment of experimental infections in mice caused by beta-lactamase-producing Bacteroides intermedius.

    abstract::Turbid saline suspensions (0.35 ml, approximately 10(9) organisms) of a strain of beta-lactamase-producing Bacteroides intermedius were injected subcutaneously into the right groin of ICR male mice. Therapeutic intraperitoneal doses of clindamycin, metronidazole, or penicillin were administered 4 hr later, and thereaf...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Cockerill FR 3rd,Rosenblatt JE,Lee DT,Gay JD

    更新日期:1986-05-01 00:00:00

  • Antigen-specific CD4- and CD8-positive signatures in different phases of Mycobacterium tuberculosis infection.

    abstract::Current diagnostic standards for Mycobacterium tuberculosis (MTB) infection do not distinguish between active and latent tuberculosis (TB). To identify specific biomarkers characterizing the different forms of TB infection, we investigated in parallel with the QuantiFERON -TB Gold In-Tube (QFT-IT) the use of flow cyto...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Nikolova M,Markova R,Drenska R,Muhtarova M,Todorova Y,Dimitrov V,Taskov H,Saltini C,Amicosante M

    更新日期:2013-03-01 00:00:00

  • Prevalence and risk factors for carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae among patients prior to bowel surgery.

    abstract::Prophylactic antibiotics are an important measure in preventing perioperative infection, Failure to cover multidrug-resistant pathogens may place carriers at increased risk of infection. We conducted a prospective, cross-sectional study in patients prior to bowel surgery to measure the carriage prevalence of extended-...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Pfeffer I,Zemel M,Kariv Y,Mishali H,Adler A,Braun T,Klein A,Matalon MK,Klausner J,Carmeli Y,Schwaber MJ

    更新日期:2016-07-01 00:00:00

  • Rotavirus in nasopharyngeal secretions of children with upper respiratory tract infections.

    abstract::Nasopharyngeal secretions from 30 infants and children presenting with respiratory tract infection, were tested for rotavirus antigen. Two of 30 children with signs and symptoms of seromucoid nasal secretions, cough, and low grade fever were positive for the antigen. Nasopharyngeal secretions may play a role in the sp...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Fragoso M,Kumar A,Murray DL

    更新日期:1986-01-01 00:00:00

  • In vitro activity of the combination of trovafloxacin and other antibiotics against enterococci.

    abstract::The activities of trovafloxacin and ciprofloxacin against 38 strains of non-beta-lactamase-producing enterococci, resistant to ampicillin, 34 strains susceptible to ampicillin, and 3 vancomycin-resistant enterococci were studied. Trovafloxacin was more active than ciprofloxacin against all the enterococci studied. The...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Schick DG,Canawati HN,Montgomerie JZ

    更新日期:1997-12-01 00:00:00

  • Risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa: clinical impact of bacterial virulence and strains on outcome.

    abstract::The incidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) bacteremia has increased in recent years, and infections caused by CRPA result in higher mortality than those caused by susceptible strains. This study was performed to evaluate the risk factors for mortality and to study the impact of virulence facto...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Jeong SJ,Yoon SS,Bae IK,Jeong SH,Kim JM,Lee K

    更新日期:2014-10-01 00:00:00

  • Comparative evaluation of etest for susceptibility testing Neisseria meningitidis with eight antimicrobial agents. An investigation using U.S. Food and Drug Administration regulatory criteria.

    abstract::Invasive infections caused by Neisseria meningitidis continue to be a serious clinical problem for therapy, epidemiology, and potential prophylaxis. Multiple antimicrobial resistances have emerged among meningococcal strains including elevated MICs to penicillin, sulfonamides, tetracyclines, and rifampin. Thus, the ne...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Marshall SA,Rhomberg PR,Jones RN

    更新日期:1997-03-01 00:00:00

  • Activity of a broad-spectrum cephalosporin (Ro 48-8391) alone and in combination with two novel beta-lactamase inhibitors (Ro 48-5545 and Ro 48-8724).

    abstract::The susceptibility of a group of beta-lactamase-producing and drug-resistant Gram-positive and Gram-negative organisms was tested against a novel cephalosporin (Ro 48-8391) alone and in combination with two bridged carbacephem beta-lactamase inhibitors (Ro 48-5545 or Ro 48-8724) and compared with that of ceftriaxone, ...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Jones RN,Marshall SA,Varnam DJ

    更新日期:1998-10-01 00:00:00

  • Haemophilus influenzae acute endometritis with bacteremia: case report and literature review.

    abstract::Haemophilus influenzae rarely causes acute endometritis and the few published cases have always been associated with intrauterine devices (IUD). A 48-year-old female presented to the emergency department with a 3-day history of lower abdominal pain and fever. On physical examination she was tachycardic, hypotensive an...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章,评审


    authors: Martin D,Dbouk RH,Deleon-Carnes M,del Rio C,Guarner J

    更新日期:2013-06-01 00:00:00

  • Metabolic interactions of ciprofloxacin.

    abstract::The mechanism and clinical relevance of the inhibitory effect of ciprofloxacin on the metabolism of selected drugs were studied in patients with bacterial infections. In study A, antipyrine tests were carried out in two groups of patients taking 1000 mg (group 1) and 250 mg (group 2) of oral ciprofloxacin for 7-10 day...

    journal_title:Diagnostic microbiology and infectious disease

    pub_type: 杂志文章


    authors: Ludwig E,Graber H,Székely E,Csiba A

    更新日期:1990-03-01 00:00:00