| Title: |
Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort. |
| Authors: |
Palacios-Baena, Zaira Raquel; Gutiérrez-Gutiérrez, Belén; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Peña, Carmen; Molina Gil-Bermejo, José; Hernández, Alicia; Venditti, Mario; Prim, Nuria; Bou, German; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Giamarellou, Helen; Almela, Manel; Pérez, Federico; Schwaber, Mitchell J; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po-Ren; Paño-Pardo, José Ramón; Torre-Cisneros, Julián; Souli, Maria; Bonomo, Robert A; Carmeli, Yehuda; Paterson, David L; Pascual, Álvaro; Rodríguez-Baño, Jesús; Spanish Network for Research in Infectious Diseases (REIPI)/European Study Group of Bloodstream Infections and Sepsis (ESGBIS)/INCREMENT Group |
| Publication Year: |
2017 |
| Collection: |
Sistema Sanitario Público de Andalucía (SSPA): Repositorio |
| Subject Terms: |
aminoglycosides; antimicrobial resistance; bloodstream infections; extended-spectrum β-lactamase–producing Enterobacteriaceae; therapy; Anti-Bacterial Agents; Bacteremia; Carbapenems; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; beta-Lactam Resistance; beta-Lactamases |
| Description: |
There is little information about the efficacy of active alternative drugs to carbapenems except β-lactam/β-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). The objective of this study was to assess the outcomes of patients with BSI due to ESBL-E who received empiric therapy with such drugs (other active drugs [OADs]) or carbapenems. A multinational retrospective cohort study of patients with BSI due to ESBL-E who received empiric treatment with OADs or carbapenems was performed. Cox regression including a propensity score for receiving OADs was performed to analyze 30-day all-cause mortality as main outcome. Clinical failure and length of stay were also analyzed. Overall, 335 patients were included; 249 received empiric carbapenems and 86 OADs. The most frequent OADs were aminoglycosides (43 patients) and fluoroquinolones (20 patients). Empiric therapy with OADs was not associated with mortality (hazard ratio [HR], 0.75; 95% confidence interval [CI], .38-1.48) in the Cox regression analysis. Propensity score-matched pairs, subgroups, and sensitivity analyses did not show different trends; specifically, the adjusted HR for aminoglycosides was 1.05 (95% CI, .51-2.16). OADs were neither associated with 14-day clinical failure (adjusted odds ratio, 0.62; 95% CI, .29-1.36) nor length of hospital stay. We were unable to show that empiric treatment with OAD was associated with a worse outcome compared with carbapenems. This information allows more options to be considered for empiric therapy, at least for some patients, depending on local susceptibility patterns of ESBL-E. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
1537-6591 |
| Relation: |
http://hdl.handle.net/10668/11669; PMC5849995; https://academic.oup.com/cid/article-pdf/65/10/1615/24266850/cix606.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849995/pdf |
| DOI: |
10.1093/cid/cix606 |
| Availability: |
http://hdl.handle.net/10668/11669; https://doi.org/10.1093/cid/cix606; https://academic.oup.com/cid/article-pdf/65/10/1615/24266850/cix606.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849995/pdf |
| Rights: |
open access |
| Accession Number: |
edsbas.5FD8DAC7 |
| Database: |
BASE |