Piperacillin/tazobactam vs carbapenems for patients with bacterial infection : Protocol for a systematic review
(2019) In Acta Anaesthesiologica Scandinavica 63(7). p.973-978- Abstract
INTRODUCTION: Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species. Whether these findings also apply to empirical piperacillin/tazobactam in patients with other severe infections, including sepsis, is unknown. We aim to assess the... (More)
INTRODUCTION: Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species. Whether these findings also apply to empirical piperacillin/tazobactam in patients with other severe infections, including sepsis, is unknown. We aim to assess the benefits and harms of empirical and definitive piperacillin/tazobactam vs carbapenems for patients with severe bacterial infections.
METHODS AND ANALYSIS: This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development, and Evaluation approach. We will include randomised clinical trials assessing piperacillin/tazobactam vs carbapenems in patients with severe bacterial infections of any origin. The primary outcome will be all-cause short-term mortality ≤ 90 days. Secondary outcomes will include all-cause long-term mortality > 90 days, adverse events, quality of life, use of life support, secondary infections, antibiotic resistance, and length of stay. We will conduct meta-analyses, including pre-planned subgroup and sensitivity analyses for all assessed outcomes. The risk of random errors in the meta-analyses will be assessed by trial sequential analysis.
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- author
- Petersen, Marie Warrer ; Perner, Anders ; Sjövall, Fredrik LU ; Jonsson, Andreas Bender ; Steensen, Morten ; Andersen, Jakob Steen ; Achiam, Michael Patrick ; Frimodt-Møller, Niels and Møller, Morten Hylander
- publishing date
- 2019-08
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 63
- issue
- 7
- pages
- 973 - 978
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85064919059
- pmid:31020663
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.13382
- language
- English
- LU publication?
- no
- additional info
- © 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
- id
- 9866a273-2e59-47c9-b99b-bf8961069bfc
- date added to LUP
- 2020-01-20 09:25:23
- date last changed
- 2024-10-02 20:01:54
@article{9866a273-2e59-47c9-b99b-bf8961069bfc, abstract = {{<p>INTRODUCTION: Early empirical broad-spectrum antimicrobial therapy is recommended for patients with severe infections, including sepsis. β-lactam/β-lactamase inhibitor combinations or carbapenems are often used to ensure coverage of likely pathogens. Piperacillin/tazobactam is proposed as a carbapenem-sparing agent to reduce the incidence of multidrug-resistant bacteria and superinfections. In the recently published MERINO trial, increased mortality from piperacillin/tazobactam was suggested in patients with bacteraemia with resistant Escherichia coli or Klebsiella species. Whether these findings also apply to empirical piperacillin/tazobactam in patients with other severe infections, including sepsis, is unknown. We aim to assess the benefits and harms of empirical and definitive piperacillin/tazobactam vs carbapenems for patients with severe bacterial infections.</p><p>METHODS AND ANALYSIS: This protocol has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development, and Evaluation approach. We will include randomised clinical trials assessing piperacillin/tazobactam vs carbapenems in patients with severe bacterial infections of any origin. The primary outcome will be all-cause short-term mortality ≤ 90 days. Secondary outcomes will include all-cause long-term mortality > 90 days, adverse events, quality of life, use of life support, secondary infections, antibiotic resistance, and length of stay. We will conduct meta-analyses, including pre-planned subgroup and sensitivity analyses for all assessed outcomes. The risk of random errors in the meta-analyses will be assessed by trial sequential analysis.</p>}}, author = {{Petersen, Marie Warrer and Perner, Anders and Sjövall, Fredrik and Jonsson, Andreas Bender and Steensen, Morten and Andersen, Jakob Steen and Achiam, Michael Patrick and Frimodt-Møller, Niels and Møller, Morten Hylander}}, issn = {{0001-5172}}, language = {{eng}}, number = {{7}}, pages = {{973--978}}, publisher = {{Wiley-Blackwell}}, series = {{Acta Anaesthesiologica Scandinavica}}, title = {{Piperacillin/tazobactam vs carbapenems for patients with bacterial infection : Protocol for a systematic review}}, url = {{http://dx.doi.org/10.1111/aas.13382}}, doi = {{10.1111/aas.13382}}, volume = {{63}}, year = {{2019}}, }