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https://hdl.handle.net/2183/48060 Empiric therapy with Carbapenem-sparing regimens for bloodstream infections due to extended-spectrum β-Lactamase–producing Enterobacteriaceae: results from the INCREMENT cohort
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Palacios-Baena, Zaira R.
Gutiérrez-Gutiérrez, Belén
Calbo, Esther
Almirante, Benito
Viale, Pier-Luigy
Oliver, Antonio
Pintado, Vicente
Gasch Blasi, Oriol
Martínez-Martínez, Luis
Pitout, Johann
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Palacios-Baena ZR, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale P, Oliver A, Pintado V, Gasch O, Martínez-Martínez L, Pitout J, Akova M, Peña C, Molina Gil-Bermejo J, Hernández A, Venditti M, Prim N, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Giamarellou H, Almela M, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Paño-Pardo JR, Torre-Cisneros J, Souli M, Bonomo RA, Carmeli Y, Paterson DL, Pascual Á, Rodríguez-Baño J; Spanish Network for Research in Infectious Diseases (REIPI)/European Study Group of Bloodstream Infections and Sepsis (ESGBIS)/INCREMENT Group. Empiric therapy with Carbapenem-sparing regimens for bloodstream infections due to extended-spectrum β-Lactamase–producing Enterobacteriaceae: results from the INCREMENT cohort. Clin Infect Dis. 2017 Oct 30;65(10):1615-1623.
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Abstract
[Abstract] Background: 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.
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.
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This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record is available online at OUP website.