%0 Journal Article
%A Palacios-Baena, Zaira Raquel
%A Gutierrez-Gutierrez, Belen
%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 Gil-Bermejo, Jose
%A Hernandez, Alicia
%A Venditti, Mario
%A Prim, Nuria
%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, Joaquin
%A Lowman, Warren
%A Hsueh, Po-Ren
%A Paño-Pardo, Jose Ramon
%A Torre-Cisneros, Julian
%A Souli, Maria
%A Bonomo, Robert A
%A Carmeli, Yehuda
%A Paterson, David L
%A Pascual, Alvaro
%A Rodriguez-Baño, Jesus
%T Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort.
%D 2017
%U http://hdl.handle.net/10668/11669
%X 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.
%K Aminoglycosides
%K Antimicrobial resistance
%K Bloodstream infections
%K Extended-spectrum β-lactamase–producing Enterobacteriaceae
%K Therapy
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