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Title: Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort.
Authors: Palacios-Baena, Zaira Raquel
Gutiérrez-Gutiérrez, Belén
Calbo, Esther
Almirante, Benito
Viale, Pierluigi
Oliver, Antonio
Pintado, Vicente
Gasch, Oriol
Martínez-Martínez, Luis
Pitout, Johann
Akova, Murat
Peña, Carmen
Molina Gil-Bermejo, José
Hernández, Alicia
Venditti, Mario
Prim, Nuria
Bou, German
Tacconelli, Evelina
Tumbarello, Mario
Hamprecht, Axel
Giamarellou, Helen
Almela, Manel
Pérez, Federico
Schwaber, Mitchell J
Bermejo, Joaquín
Lowman, Warren
Hsueh, Po-Ren
Paño-Pardo, José Ramón
Torre-Cisneros, Julián
Souli, Maria
Bonomo, Robert A
Carmeli, Yehuda
Paterson, David L
Pascual, Álvaro
Rodríguez-Baño, Jesús
Spanish Network for Research in Infectious Diseases (REIPI)/European Study Group of Bloodstream Infections and Sepsis (ESGBIS)/INCREMENT Group
Keywords: aminoglycosides;antimicrobial resistance;bloodstream infections;extended-spectrum β-lactamase–producing Enterobacteriaceae;therapy
metadata.dc.subject.mesh: Anti-Bacterial Agents
Enterobacteriaceae Infections
Kaplan-Meier Estimate
Middle Aged
Retrospective Studies
beta-Lactam Resistance
Issue Date: 2017
Abstract: There is little information about the efficacy of active alternative drugs to carbapenems except β-lactam/β-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum β-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. 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. 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. 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.
metadata.dc.identifier.doi: 10.1093/cid/cix606
Appears in Collections:Producción 2020

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