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Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae: Results From the INCREMENT Cohort

2017; Oxford University Press; Volume: 65; Issue: 10 Linguagem: Inglês

10.1093/cid/cix606

1537-6591

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

Antibiotics Pharmacokinetics and Efficacy

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.