BACKGROUND: Bacteroides fragilis is one of the most frequently isolated pathogenic anaerobic bacteria. Infections caused by B. fragilis are commonly treated with carbapenems or tazobactam/piperacillin. However, there is no evidence for the optimal antibiotic choice against infections caused by B. fragilis as an empirical therapy owing to its varied antibiotic resistance mechanisms. Hence, we compared the effectiveness of carbapenems and tazobactam/piperacillin as an antibiotic therapy in patients infected with B. fragilis. METHODS: We investigated mortality, clinical and antimicrobial efficacy, and the percentage of patients who switched to broad-spectrum antibiotics, such as carbapenems or tazobactam/piperacillin, due to the aggravated symptoms of infection in patients receiving carbapenems or tazobactam/piperacillin from 2019 to 2024. RESULTS: A total of 60 patients were included in the study
24 patients received carbapenems and 36 received tazobactam-piperacillin as an empirical treatment against B. fragilis infections. None of the patients in either group died. Compared to carbapenem treatment, tazobactam/piperacillin treatment significantly improved inflammatory markers, including body temperature and C-reactive protein (45.8 % vs. 72.2 %, p = 0.039 and 37.5 % vs. 63.4 %, p = 0.045, respectively
carbapenem vs. tazobactam/piperacillin). The percentage of patients switching from carbapenems to tazobactam/piperacillin or vice versa was significantly lower in the tazobactam/piperacillin group than in the carbapenem group (41.7 % vs. 11.1 %, p <
0.001). CONCLUSIONS: Our findings suggest that tazobactam/piperacillin can be used as the first-line empirical treatment for patients infected with B. fragilis.