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Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study

2017; Elsevier BV; Volume: 50; Issue: 5 Linguagem: Inglês

10.1016/j.ijantimicag.2017.08.005

1872-7913

Patrick N. A. Harris, Diletta Pezzani, Belén Gutiérrez‐Gutiérrez, Pierluigi Viale, Po‐Ren Hsueh, Patrícia Ruíz-Garbajosa, Mario Venditti, Mario Tumbarello, Carolina Navarro-San Francisco, Esther Calbo, Murat Akova, Helen Giamarellou, Antonio Oliver, Benito Almirante, Oriol Gasch, Luis Martı́nez-Martı́nez, Mitchell J. Schwaber, George L. Daikos, Johann Pitout, Carmen Peña, Alicia Hernández‐Torres, Yohei Doi, Federico Pérez, Felipe Francisco Tuon, Evelina Tacconelli, Yehuda Carmeli, Robert A. Bonomo, Álvaro Pascual, David L. Paterson, Jesús Rodríguez‐Baño, María Dolores del Toro, Juan Gálvez-Acebal, Marco Falcone, Alessandro Russo, Ilias Karaiskos, Enrico Maria Trecarichi, Angela Raffaella Losito, Elisa García‐Vázquez, J. Miguel Lobato Gómez, Emmanuel Roilides, Εlias Iosifidis, Spyros Pournaras, Núria Prim, Ferrán Navarro, Beatriz Mirelis, Julia Origüen, Rafael San Juan, Mario Fernández‐Ruiz, Manel Almela, Cristina de la Calle, José Antonio Martínez, Laura Morata, Nieves Larrosa, Mireia Puig‐Asensio, Germán Bou, José Luís Molina, V. González, Javier Bermejo, V. Rucci, E. Ruiz de Gopegui, C. Marinescu, M.C. Fariñas, M.E. Cano, Mónica Gozalo, J.R. Paño‐Pardo, Marta Mora-Rillo, Sílvia Gómez-Zorrilla, Fé Tubau, Athanassios Tsakris, Olympia Zarkotou, Anastasia Antoniadou, Garyphallia Poulakou, Maria Souli, Warren Lowman, Divya Virmani, Julián Torre-Cisneros, Isabel Machuca, Irene Gracia-Ahufinger, Özlem Kurt Azap, Özant Helvacı, Ahmet Şahin, Rafael Cantón, Vicente Pintado, Michele Bartoletti, Maddalena Giannella, Silke Peter, Axel Hamprecht, Cristina Badía, Mariona Xercavins, D. Fontanals, E. Jové,

Antibiotics Pharmacokinetics and Efficacy

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.