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...

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Authors: 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
Format: Article
Status:Published version
Publication date:2017
Country:España
Institution:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repository:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p6159
Online Access:https://i3pt.portalinvestigacion.com/publicaciones/6159
Access Level:Open access
Keyword:extended-spectrum beta-lactamase-producing Enterobacteriaceae
bloodstream infections
therapy
antimicrobial resistance
aminoglycosides
Summary: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.

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