Details

Autor(en) / Beteiligte

• 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
• Gil-Bermejo, José Molina
• 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

Titel

Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae: Results From the INCREMENT Cohort

Ist Teil von

• Clinical infectious diseases, 2017-11, Vol.65 (10), p.1615-1623

Ort / Verlag

United States: Oxford University Press

Erscheinungsjahr

2017

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• 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.