Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort
Por:
Palacios-Baena, ZR, Gutierrez-Gutierrez, B, Calbo, E, Almirante, B, Viale, P, Oliver, A, Pintado, V, Gasch, O, Martinez-Martinez, L, Pitout, J, Akova, M, Pena, C, Gil-Bermejo, JM, Hernandez, A, Venditti, M, Prim, N, Bou, G, Tacconelli, E, Tumbarello, M, Hamprecht, A, Giamarellou, H, Almela, M, Perez, F, Schwaber, MJ, Bermejo, J, Lowman, W, Hsueh, PR, Pano-Pardo, JR, Torre-Cisneros, J, Souli, M, Bonomo, RA, Carmeli, Y, Paterson, DL, Pascual, A, Rodriguez-Bano, J
Publicada:
15 nov 2017
Resumen:
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.
Filiaciones:
Palacios-Baena, ZR:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Gutierrez-Gutierrez, B:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Calbo, E:
Univ Int Catalunya, Hosp Univ Mutua Terrassa, Barcelona, Spain
Almirante, B:
Hosp Valle De Hebron, Barcelona, Spain
Viale, P:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Oliver, A:
Hosp Univ Son Espases, Mallorca, Spain
Pintado, V:
Hosp Ramon & Cajal, Madrid, Spain
Gasch, O:
Hosp Parc Tauli, Barcelona, Spain
Martinez-Martinez, L:
Hosp Univ M de Valdecilla IDIVAL, Santander, Spain
Pitout, J:
Univ Calgary, Calgary, AB, Canada
Akova, M:
Hacettepe Univ, Sch Med, Ankara, Turkey
Pena, C:
Hosp Bellvitge Princeps Espanya, Barcelona, Spain
Gil-Bermejo, JM:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Hernandez, A:
Hosp Virgen Arrixaca, Murcia, Spain
Venditti, M:
Policlin Umberto 1, Rome, Italy
Prim, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Bou, G:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Tacconelli, E:
Tubingen Univ Hosp, Tubingen, Germany
DZIF Partner Ctr, Braunschweig, Germany
Tumbarello, M:
Univ Cattolica Sacro Cuore, Rome, Italy
Hamprecht, A:
Univ Klilnikum Koln, Inst Mikrobiol Immunol & Hyg, Cologne, Germany
Giamarellou, H:
Hygeia Gen Hosp, Athens, Greece
Almela, M:
Hosp Clin Barcelona, Barcelona, Spain
Perez, F:
Case Western Reserve Univ, Louis Stokes Cleveland Veteran Affairs Med Ctr, Cleveland, OH 44106 USA
Schwaber, MJ:
Tel Aviv Univ, Tel Aviv Sourasky Med Ctr, Natl Ctr Infect Control, Israel Minist Hlth, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Bermejo, J:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Hosp Espanol, Rosario, Argentina
Lowman, W:
Wits Donald Gordon Med Ctr, Johannesburg, South Africa
Hsueh, PR:
Natl Taiwan Univ, Coll Med, Natl Taiwan Univ Hosp, Taipei, Taiwan
Pano-Pardo, JR:
Hosp Paz, Madrid, Spain
Torre-Cisneros, J:
Reina Sofia Univ Hosp, Unidades Gest Clin Enfermedades Infecciosas & Mic, Maimonides Biomed Res Inst Cordoba, Cordoba, Spain
Univ Cordoba, Cordoba, Spain
Souli, M:
Natl & Kapodistrian Univ Athens, Sch Med, Univ Gen Hosp Attikon, Athens, Greece
Bonomo, RA:
Case Western Reserve Univ, Sch Med, Res Serv, Louis Stokes Cleveland Vet Affairs Med Ctr, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Med, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Pharmacol, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Biochem, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Mol Biol & Microbiol, Cleveland, OH 44106 USA
Carmeli, Y:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Paterson, DL:
Univ Queensland, Clin Res Ctr, Brisbane, Qld, Australia
Pascual, A:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Rodriguez-Bano, J:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla, Unidad Gest Clin Enfermedades Infecciosas & Micro, Barcelona, Spain
Green Published, Bronze
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