Publication: Empiric therapy with Carbapenem-sparing regimens for bloodstream infections due to Extended-Spectrum β-Lactamase-producing Enterobacteriaceae: results from the INCREMENT cohort
Authors
Hernández Torres, Alicia ; 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 ; 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
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Publisher
Oxford University Press
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DOI
https://doi.org/10.1093/cid/cix606
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info:eu-repo/semantics/article
Description
Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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Citation
Clinical Infectious Diseases, Volume 65, Issue 10, 15 November 2017, Pages 1615–1623
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