%0 Journal Article
%A Gutierrez-Gutierrez, Belen
%A Perez-Galera, Salvador
%A Salamanca, Elena
%A de Cueto, Marina
%A Calbo, Esther
%A Almirante, Benito
%A Viale, Pierluigi
%A Oliver, Antonio
%A Pintado, Vicente
%A Gasch, Oriol
%A Martinez-Martinez, Luis
%A Pitout, Johann
%A Akova, Murat
%A Peña, Carmen
%A Molina, Jose
%A Hernandez, Alicia
%A Venditti, Mario
%A Prim, Nuria
%A Origüen, Julia
%A Bou, German
%A Tacconelli, Evelina
%A Tumbarello, Mario
%A Hamprecht, Axel
%A Giamarellou, Helen
%A Almela, Manel
%A Perez, Federico
%A Schwaber, Mitchell J
%A Bermejo, Joaquín
%A Lowman, Warren
%A Hsueh, Po-Ren
%A Mora-Rillo, Marta
%A Natera, Clara
%A Souli, Maria
%A Bonomo, Robert A
%A Carmeli, Yehuda
%A Paterson, David L
%A Pascual, Alvaro
%A Rodriguez-Baño, Jesus
%T A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae.
%D 2016
%U http://hdl.handle.net/10668/10048
%X The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems.
%K Bacteremia
%K Enterobacteriaceae
%K Middle aged
%K Retrospective studies
%K beta-lactamases
%K Kaplan-Meier estimate
%~