Raquel Palacios-Baena, Zaira, Gutierrez-Gutierrez, Belen, Calbo, Esther, Almirante, Benito ORCID: 0000-0002-1189-2361, Viale, Pierluigi, Oliver, Antonio ORCID: 0000-0001-9327-1894, Pintado, Vicente, Gasch, Oriol, Martinez-Martinez, Luis, Pitout, Johann, Akova, Murat, Pena, Carmen, Molina Gil-Bermejo, Jose, Hernandez, Alicia, Venditti, Mario, Prim, Nuria, Bou, German, Tacconelli, Evelina, Tumbarello, Mario ORCID: 0000-0002-9519-8552, Hamprecht, Axel ORCID: 0000-0003-1449-5780, Giamarellou, Helen, Almela, Manel, Perez, Federico, Schwaber, Mitchell J., Bermejo, Joaquin, Lowman, Warren ORCID: 0000-0002-6981-389X, Hsueh, Po-Ren, Ramon Pano-Pardo, Jose, Torre-Cisneros, Julian, Souli, Maria, Bonomo, Robert A., Carmeli, Yehuda, Paterson, David L., Pascual, Alvaro ORCID: 0000-0002-8672-5891 and Rodriguez-Bano, Jesus ORCID: 0000-0001-6732-9001 (2017). Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort. Clin. Infect. Dis., 65 (10). S. 1615 - 1624. CARY: OXFORD UNIV PRESS INC. ISSN 1537-6591

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Raquel Palacios-Baena, ZairaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gutierrez-Gutierrez, BelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calbo, EstherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Almirante, BenitoUNSPECIFIEDorcid.org/0000-0002-1189-2361UNSPECIFIED
Viale, PierluigiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oliver, AntonioUNSPECIFIEDorcid.org/0000-0001-9327-1894UNSPECIFIED
Pintado, VicenteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gasch, OriolUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martinez-Martinez, LuisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pitout, JohannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akova, MuratUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pena, CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Molina Gil-Bermejo, JoseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hernandez, AliciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Venditti, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Prim, NuriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bou, GermanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tacconelli, EvelinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tumbarello, MarioUNSPECIFIEDorcid.org/0000-0002-9519-8552UNSPECIFIED
Hamprecht, AxelUNSPECIFIEDorcid.org/0000-0003-1449-5780UNSPECIFIED
Giamarellou, HelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Almela, ManelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perez, FedericoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwaber, Mitchell J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bermejo, JoaquinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lowman, WarrenUNSPECIFIEDorcid.org/0000-0002-6981-389XUNSPECIFIED
Hsueh, Po-RenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ramon Pano-Pardo, JoseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Torre-Cisneros, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Souli, MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonomo, Robert A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Carmeli, YehudaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paterson, David L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pascual, AlvaroUNSPECIFIEDorcid.org/0000-0002-8672-5891UNSPECIFIED
Rodriguez-Bano, JesusUNSPECIFIEDorcid.org/0000-0001-6732-9001UNSPECIFIED
URN: urn:nbn:de:hbz:38-211232
DOI: 10.1093/cid/cix606
Journal or Publication Title: Clin. Infect. Dis.
Volume: 65
Number: 10
Page Range: S. 1615 - 1624
Date: 2017
Publisher: OXFORD UNIV PRESS INC
Place of Publication: CARY
ISSN: 1537-6591
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
URINARY-TRACT-INFECTION; ESCHERICHIA-COLI; INHIBITOR COMBINATIONS; ANTIMICROBIAL AGENTS; BACTEREMIA; EFFICACYMultiple languages
Immunology; Infectious Diseases; MicrobiologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/21123

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