Are Carbapenems Better Than Piperacillin-Tazobactam for Bacteremia with ESBL-Producing Enterobacterales?

Antibiotic resistance among extended-spectrum beta-lactamase (ESBL)–producing Enterobacterales (including carbapenem-resistant organisms) is rapidly emerging worldwide. In the MERINO trial, patients having bloodstream infections with ESBL-producing Enterobacterales (EPE) had better outcomes with carbapenems than with piperacillin-tazobactam; nonetheless, antibiotic stewardship programs restrict carbapenem use to appropriate situations to reduce resistance. So, are carbapenems really better than piperacillin-tazobactam for EPE bacteremia?

Månsson and colleagues assessed 30-day all-cause mortality among 644 patients who received piperacillin-tazobactam or a carbapenem for EPE bacteremia at 9 Swedish hospitals from 2013 through 2022. Across the…