RT Journal Article
T1 Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study.
A1 Harris, Patrick N A
A1 Pezzani, M Diletta
A1 Gutiérrez-Gutiérrez, Belén
A1 Viale, Pierluigi
A1 Hsueh, Po-Ren
A1 Ruiz-Garbajosa, Patricia
A1 Venditti, Mario
A1 Tumbarello, Mario
A1 Navarro-Francisco, Carolina
A1 Calbo, Esther
A1 Akova, Murat
A1 Giamarellou, Helen
A1 Oliver, Antonio
A1 Almirante, Benito
A1 Gasch, Oriol
A1 Martínez-Martínez, Luis
A1 Schwaber, Mitchell J
A1 Daikos, George
A1 Pitout, Johann
A1 Peña, Carmen
A1 Hernández-Torres, Alicia
A1 Doi, Yohei
A1 Pérez, Federico
A1 Tuon, Felipe Francisco
A1 Tacconelli, Evelina
A1 Carmeli, Yehuda
A1 Bonomo, Robert A
A1 Pascual, Álvaro
A1 Paterson, David L
A1 Rodríguez-Baño, Jesús
A1 ESGBIS/REIPI/INCREMENT Group, 
K1 Carbapenemase
K1 Carbapenems
K1 Escherichia coli
K1 Extended-spectrum β-lactamase
K1 Klebsiella pneumoniae
K1 β-Lactam/β-lactamase inhibitor
AB 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.
YR 2017
FD 2017-08-03
LK http://hdl.handle.net/10668/11482
UL http://hdl.handle.net/10668/11482
LA en
DS RISalud
RD Apr 8, 2025