Gutierrez-Gutierrez, BelenPerez-Galera, SalvadorSalamanca, Elenade Cueto, MarinaCalbo, EstherAlmirante, BenitoViale, PierluigiOliver, AntonioPintado, VicenteGasch, OriolMartinez-Martinez, LuisPitout, JohannAkova, MuratPeña, CarmenMolina, JoseHernandez, AliciaVenditti, MarioPrim, NuriaOrigüen, JuliaBou, GermanTacconelli, EvelinaTumbarello, MarioHamprecht, AxelGiamarellou, HelenAlmela, ManelPerez, FedericoSchwaber, Mitchell JBermejo, JoaquínLowman, WarrenHsueh, Po-RenMora-Rillo, MartaNatera, ClaraSouli, MariaBonomo, Robert ACarmeli, YehudaPaterson, David LPascual, AlvaroRodriguez-Baño, Jesus2023-01-252023-01-252016-06-20Gutiérrez-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):4159-69http://hdl.handle.net/10668/10048The 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.enBacteremiaEnterobacteriaceaeMiddle agedRetrospective studiesbeta-lactamasesKaplan-Meier estimateAgedAnti-bacterial agentsCarbapenemsFemaleHumansMaleMultivariate analysisOdds ratiobeta-lactamase inhibitorsbeta-lactamsResearch article27139473Restricted AccessAntibacterianosAnálisis multivarianteCarbapenémicosEstimación de Kaplan-MeierInhibidores de beta-LactamasasOportunidad relativa10.1128/AAC.00365-161098-6596PMC4914653https://europepmc.org/articles/pmc4914653?pdf=renderhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914653/pdf