Grant: Project Grant

Two bacteria, called E. coli and K. pneumoniae, are among the most common causes of blood infection in Canada. Unfortunately, they are becoming increasingly resistant to antibiotics with resistance to a class of medications called the third-generation cephalosporins ("ESBL") representing the fastest growing resistance problem in Canada. Most ESBL are also resistant to commonly used oral antibiotics such as ciprofloxacin. Therefore, doctors rely on drugs like meropenem or piperacillin-tazobactam ("PTZ"). A recent international trial suggests meropenem might be better than piperacillin-tazobactam; however, that trial had a number of potential flaws in the methods. Overuse of meropenem comes at a cost as it represents one of the last lines of defense against many other drug-resistant bacteria. Use of drugs like meropenem increases the risk of acquiring carbapenem-resistant bacteria in the future. Meropenem may also have a higher risk of C. difficile. Therefore, keeping an option like PTZ available is important to protect meropenem (and similar drugs) for the future. Along with international partners, we will conduct a randomized controlled trial which addresses the flaws in the previous trial and seeks to demonstrate whether piperacillin-tazobactam is non-inferior to meropenem for the treatment of blood infections due to ESBL E.coli and K. pneumoniae. Our Canadian team will make an important contribution to this international study.