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

Background. There is little information about the efficacy of active alternative drugs to carbapenems except beta-lactam/beta-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). The objective of this s...

Descripción completa

Detalles Bibliográficos
Autores: Palacios-Baena, ZR, Gutiérrez-Gutiérrez, B, Calbo, E, Almirante, B, Viale, P, Oliver, A, Pintado, V, Gasch, O, Martínez-Martínez, L, Pitout, J, Akova, M, Peña, C, Gil-Bermejo, JM, Hernández, A, Venditti, M, Prim, N, Bou, G, Tacconelli, E, Tumbarello, M, Hamprecht, A, Giamarellou, H, Almela, M, Pérez, F, Schwaber, MJ, Bermejo, J, Lowman, W, Hsueh, PR, Paño-Pardo, JR, Torre-Cisneros, J, Souli, M, Bonomo, RA, Carmeli, Y, Paterson, DL, Pascual, A, Rodríguez-Baño, J
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p6159
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/6159
Access Level:acceso abierto
Palabra clave:extended-spectrum beta-lactamase-producing Enterobacteriaceae
bloodstream infections
therapy
antimicrobial resistance
aminoglycosides
Descripción
Sumario:Background. There is little information about the efficacy of active alternative drugs to carbapenems except beta-lactam/beta-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum beta-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.

Similares en LA Referencia