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Objective <p>The rise in antimicrobial resistance among Gram-negative bacteria has highlighted the importance of optimizing the use of existing antibiotics. Rational use of piperacillin-tazobactam and cefepime, which are effective against Gram-negative organism, is particularly important for sparing carbapenems.</p> Methods <p>This retrospective study included pediatric patients aged 1 month to 18 years who developed monomicrobial bacteremia due to Gram-negative bacilli. Predictors of resistance to piperacillin-tazobactam (PTZ), cefepime (CEF), and both PTZ and CEF resistance (PTZ-CEF) were evaluated.</p> Results <p>A total of 249 episodes of Gram-negative bacteremia were identified. Resistance to PTZ was found to be 54%, CEF resistance was 63.9%, and PTZ-CEF resistance 50.6%. Previous use of carbapenems and colistin within the prior 3 months, as well as admission to the Pediatric Intensive Care Unit (PICU), were associated with resistance to piperacillin-tazobactam and/or cefepime.</p> Conclusion <p>As PTZ and CEF resistance exceeded 50%, making monotherapy with these agents generally unsuitable for empirical Gram-negative bacteremia treatment. Each healthcare center should conduct its own surveillance and tailor the empirical treatment of Gram-negative bacteremia based on its institutional data.</p>

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Risk Factors Influencing the Development of Piperacillin-tazobactam and Cefepime-Resistant Gram-Negative Bacteremia in Pediatric Patients

  • 期刊论文

  • 发表日期：

    2025年11月29日

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  • Gülsüm İclal Bayhan,
  • Zehra Nihan Coşkun,
  • Pınar Bayraktar,
  • Abdullah Demir,
  • Burcu Nur Demir,
  • Merve Keser,
  • Saliha Kanık-Yüksek,
  • Seval Özen,
  • Aslınur Özkaya Parlakay,
  • Bedia Dinç,
  • Belgin Gülhan

摘要

Objective

The rise in antimicrobial resistance among Gram-negative bacteria has highlighted the importance of optimizing the use of existing antibiotics. Rational use of piperacillin-tazobactam and cefepime, which are effective against Gram-negative organism, is particularly important for sparing carbapenems.

Methods

This retrospective study included pediatric patients aged 1 month to 18 years who developed monomicrobial bacteremia due to Gram-negative bacilli. Predictors of resistance to piperacillin-tazobactam (PTZ), cefepime (CEF), and both PTZ and CEF resistance (PTZ-CEF) were evaluated.

Results

A total of 249 episodes of Gram-negative bacteremia were identified. Resistance to PTZ was found to be 54%, CEF resistance was 63.9%, and PTZ-CEF resistance 50.6%. Previous use of carbapenems and colistin within the prior 3 months, as well as admission to the Pediatric Intensive Care Unit (PICU), were associated with resistance to piperacillin-tazobactam and/or cefepime.

Conclusion

As PTZ and CEF resistance exceeded 50%, making monotherapy with these agents generally unsuitable for empirical Gram-negative bacteremia treatment. Each healthcare center should conduct its own surveillance and tailor the empirical treatment of Gram-negative bacteremia based on its institutional data.