Piperacillin-tazobactam for the treatment of bloodstream infection caused by extended-spectrum-beta-lactamase-producing Enterobacteriaceae: a systematic review and meta-analysis

Objective To study the difference between piperacillin-tazobactam and other anti-infective agents in the treatment of blood stream infection caused by extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae by systematic review and meta-analysis. Methods PubMed, Cochrane library, Web of Science, CNKI, Weipu DATA, and CPVIP were systematically searched. Literatures were reviewed and data regarding mortality of mono-drug treatment with different antibiotics were collected. All data were pooled using the technique of meta-analysis by Revman 5.3, and heterogeneity tests were performed. Results Eleven articles containing 1620 patients were included. Escherichia coli and Klebsiella pneumonia were the main pathogens, and there were 31 cases caused by Enterobacter cloacae. There was no statistically significant difference in mortality between carbapenems and piperacillin-tazobactam mono-therapy for the empirical treatment (RR=0.86; 95% CI: 0.62-1.20, P>0.05) or for definitive treatment (RR=0.63; 95% CI: 0.20-1.97, P>0.05). Carbapenems were used as the main antibiotics for definitive treatment as well as empirical treatment. Conclusion Piperacillin-tazobactam treatment is not associated with increased mortality of the patients with ESBL-positive enterobacteria bloodstream infection, which can be used as an alternative antibiotics. Key words: Enterobacteriaceae infections; ESBL; Bloodstream infection; Piperacillin-tazobactam