RT Journal Article
T1 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.
A1 Gutierrez-Gutierrez, Belen
A1 Perez-Galera, Salvador
A1 Salamanca, Elena
A1 de Cueto, Marina
A1 Calbo, Esther
A1 Almirante, Benito
A1 Viale, Pierluigi
A1 Oliver, Antonio
A1 Pintado, Vicente
A1 Gasch, Oriol
A1 Martinez-Martinez, Luis
A1 Pitout, Johann
A1 Akova, Murat
A1 Peña, Carmen
A1 Molina, Jose
A1 Hernandez, Alicia
A1 Venditti, Mario
A1 Prim, Nuria
A1 Origüen, Julia
A1 Bou, German
A1 Tacconelli, Evelina
A1 Tumbarello, Mario
A1 Hamprecht, Axel
A1 Giamarellou, Helen
A1 Almela, Manel
A1 Perez, Federico
A1 Schwaber, Mitchell J
A1 Bermejo, Joaquín
A1 Lowman, Warren
A1 Hsueh, Po-Ren
A1 Mora-Rillo, Marta
A1 Natera, Clara
A1 Souli, Maria
A1 Bonomo, Robert A
A1 Carmeli, Yehuda
A1 Paterson, David L
A1 Pascual, Alvaro
A1 Rodriguez-Baño, Jesus
K1 Bacteremia
K1 Enterobacteriaceae
K1 Middle aged
K1 Retrospective studies
K1 beta-lactamases
K1 Kaplan-Meier estimate
AB 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.
PB American Society for Microbiology
YR 2016
FD 2016-06-20
LK http://hdl.handle.net/10668/10048
UL http://hdl.handle.net/10668/10048
LA en
NO Gutiérrez-Gutiérrez B, Pérez-Galera S, Salamanca E, de Cueto M, Calbo E, Almirante B, et al. 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. Antimicrob Agents Chemother. 2016 Jun 20;60(7):4159-69
DS RISalud
RD Apr 8, 2025