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Title: Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study.
Authors: Harris, Patrick N A
Pezzani, M Diletta
Gutiérrez-Gutiérrez, Belén
Viale, Pierluigi
Hsueh, Po-Ren
Ruiz-Garbajosa, Patricia
Venditti, Mario
Tumbarello, Mario
Navarro-Francisco, Carolina
Calbo, Esther
Akova, Murat
Giamarellou, Helen
Oliver, Antonio
Almirante, Benito
Gasch, Oriol
Martínez-Martínez, Luis
Schwaber, Mitchell J
Daikos, George
Pitout, Johann
Peña, Carmen
Hernández-Torres, Alicia
Doi, Yohei
Pérez, Federico
Tuon, Felipe Francisco
Tacconelli, Evelina
Carmeli, Yehuda
Bonomo, Robert A
Pascual, Álvaro
Paterson, David L
Rodríguez-Baño, Jesús
Keywords: Carbapenemase;Carbapenems;Escherichia coli;Extended-spectrum β-lactamase;Klebsiella pneumoniae;β-Lactam/β-lactamase inhibitor
metadata.dc.subject.mesh: Adult
Aged, 80 and over
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae Infections
Global Health
Middle Aged
Retrospective Studies
beta-Lactamase Inhibitors
Issue Date: 3-Aug-2017
Abstract: We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14-0.81), Greece (aOR 0.49, 95% CI 0.26-0.94) and Canada (aOR 0.31, 95% CI 0.11-0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11-2.25) and Turkey (aOR 2.09, 95% CI 1.14-3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03-2.92) and USA (aOR 1.89, 95% CI 1.05-3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28-0.69) and Canada (aOR 0.10, 95% CI 0.01-0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts.
metadata.dc.identifier.doi: 10.1016/j.ijantimicag.2017.08.005
Appears in Collections:Producción 2020

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