Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study
Por:
Harris, PNA, Pezzani, MD, Gutierrez-Gutierrez, B, Viale, P, Hsueh, PR, Ruiz-Garbajosa, P, Venditti, M, Tumbarello, M, Navarro-Francisco, C, Calbo, E, Akova, M, Giamarellou, H, Oliver, A, Almirante, B, Gasch, O, Martinez-Martinez, L, Schwaber, MJ, Daikos, G, Pitout, J, Pena, C, Hernandez-Torres, A, Doi, Y, Perez, F, Tuon, FF, Tacconelli, E, Carmeli, Y, Bonomo, RA, Pascual, A, Paterson, DL, Rodriguez-Bano, J, Prim N., Navarro F., Mirelis B., Jové, E.
Publicada:
1 nov 2017
Resumen:
We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum beta-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 beta-lactam/beta-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 1.053.39) 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. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Filiaciones:
Harris, PNA:
Univ Queensland, UQ Ctr Clin Res, Brisbane, Qld, Australia
Pezzani, MD:
Univ Milan, Div Malattie Infett 3, Dept Biomed & Clin Sci L Sacco, Milan, Italy
Gutierrez-Gutierrez, B:
Univ Seville, Inst Biomed Sevilla IBiS, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Viale, P:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Hsueh, PR:
Natl Taiwan Univ, Coll Med, Natl Taiwan Univ Hosp, Taipei, Taiwan
Ruiz-Garbajosa, P:
Hosp Ramon & Cajal, Madrid, Spain
Venditti, M:
Univ Roma La Sapienza, Policlin Umberto 1, Rome, Italy
Tumbarello, M:
Univ Cattolica Sacro Cuore, Rome, Italy
Navarro-Francisco, C:
Hosp Univ La Paz IdiPAZ, Madrid, Spain
Calbo, E:
Hosp Univ Mutua Terrassa, Barcelona, Spain
Univ Int Catalunya, Barcelona, Spain
Akova, M:
Hacettepe Univ, Sch Med, Ankara, Turkey
Giamarellou, H:
Hygeia Gen Hosp, Athens, Greece
Oliver, A:
Hosp Univ Son Espases, Inst Invest Sanitaria Palma IdISPa, Palma De Mallorca, Spain
Almirante, B:
Hosp Valle dHebron, Barcelona, Spain
Gasch, O:
Hosp Parc Tauli Sabadell, Barcelona, Spain
Martinez-Martinez, L:
Hosp Univ Marques Valdecilla IDIVAL, Santander, Spain
Schwaber, MJ:
Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
Israel Minist Hlth, Natl Ctr Infect Control, Tel Aviv, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Daikos, G:
Univ Athens, Laikon Gen Hosp, Athens, Greece
Pitout, J:
Univ Calgary, Dept Pathol & Lab Med, Calgary, AB, Canada
Pena, C:
Hosp Univ Bellvitge, Barcelona, Spain
Hernandez-Torres, A:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Doi, Y:
Univ Pittsburgh, Pittsburgh, PA USA
Perez, F:
Vet Affairs Med Ctr, Louis Stokes Cleveland Dept, Res Serv, Cleveland, OH 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
Tuon, FF:
Hosp Univ Fed Parana, Curitiba, Parana, Brazil
Tacconelli, E:
Tubingen Univ Hosp, Tubingen, Germany
Ctr Infect Res DZIF, Tubingen, Germany
Carmeli, Y:
Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
Bonomo, RA:
Vet Affairs Med Ctr, Louis Stokes Cleveland Dept, Res Serv, Cleveland, OH USA
Pascual, A:
Univ Seville, Inst Biomed Sevilla IBiS, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Paterson, DL:
Univ Queensland, UQ Ctr Clin Res, Brisbane, Qld, Australia
Wesley Hosp, Wesley Med Res, Brisbane, Qld, Australia
Rodriguez-Bano, J:
Univ Seville, Inst Biomed Sevilla IBiS, Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Prim N.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Navarro F.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Mirelis B.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Jové, E. :
Hospital Parc Taulí, Sabadell, Spain
Green Accepted
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