Gutierrez-Gutierrez, Belen, Perez-Galera, Salvador ORCID: 0000-0002-3653-2717, Salamanca, Elena, de Cueto, Marina, Calbo, Esther ORCID: 0000-0001-7750-5347, Almirante, Benito ORCID: 0000-0002-1189-2361, Viale, Pierluigi, Oliver, Antonio ORCID: 0000-0001-9327-1894, Pintado, Vicente, Gasch, Oriol ORCID: 0000-0001-8518-458X, Martinez-Martinez, Luis, Pitout, Johann, Akova, Murat, Pena, Carmen, Molina, Jose, Hernandez, Alicia, Venditti, Mario, Prim, Nuria, Origuen, Julia ORCID: 0000-0002-6507-0363, Bou, German ORCID: 0000-0001-8837-0062, 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, Mora-Rillo, Marta ORCID: 0000-0002-2735-5931, Natera, Clara, 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 (2016). A Multinational, Preregistered Cohort Study of beta-Lactam/beta-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-beta-Lactamase-Producing Enterobacteriaceae. Antimicrob. Agents Chemother., 60 (7). S. 4159 - 4170. WASHINGTON: AMER SOC MICROBIOLOGY. ISSN 1098-6596

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Abstract

The spread of extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether beta-lactam/beta-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.)

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Gutierrez-Gutierrez, BelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perez-Galera, SalvadorUNSPECIFIEDorcid.org/0000-0002-3653-2717UNSPECIFIED
Salamanca, ElenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Cueto, MarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calbo, EstherUNSPECIFIEDorcid.org/0000-0001-7750-5347UNSPECIFIED
Almirante, BenitoUNSPECIFIEDorcid.org/0000-0002-1189-2361UNSPECIFIED
Viale, PierluigiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oliver, AntonioUNSPECIFIEDorcid.org/0000-0001-9327-1894UNSPECIFIED
Pintado, VicenteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gasch, OriolUNSPECIFIEDorcid.org/0000-0001-8518-458XUNSPECIFIED
Martinez-Martinez, LuisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pitout, JohannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akova, MuratUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pena, CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Molina, JoseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hernandez, AliciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Venditti, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Prim, NuriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Origuen, JuliaUNSPECIFIEDorcid.org/0000-0002-6507-0363UNSPECIFIED
Bou, GermanUNSPECIFIEDorcid.org/0000-0001-8837-0062UNSPECIFIED
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
Mora-Rillo, MartaUNSPECIFIEDorcid.org/0000-0002-2735-5931UNSPECIFIED
Natera, ClaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:38-271296
DOI: 10.1128/AAC.00365-16
Journal or Publication Title: Antimicrob. Agents Chemother.
Volume: 60
Number: 7
Page Range: S. 4159 - 4170
Date: 2016
Publisher: AMER SOC MICROBIOLOGY
Place of Publication: WASHINGTON
ISSN: 1098-6596
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PIPERACILLIN-TAZOBACTAM; ESCHERICHIA-COLI; INTRAABDOMINAL INFECTIONS; AMOXICILLIN-CLAVULANATE; KLEBSIELLA-PNEUMONIAE; BACTEREMIA; RESISTANCE; EFFICACIES; CARBAPENEMS; EMERGENCEMultiple languages
Microbiology; Pharmacology & PharmacyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/27129

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