Palacios-Baena, Zaira RaquelGutierrez-Gutierrez, BelenCalbo, EstherAlmirante, BenitoViale, PierluigiOliver, AntonioPintado, VicenteGasch, OriolMartinez-Martinez, LuisPitout, JohannAkova, MuratPeña, CarmenMolina Gil-Bermejo, JoseHernandez, AliciaVenditti, MarioPrim, NuriaBou, GermanTacconelli, EvelinaTumbarello, MarioHamprecht, AxelGiamarellou, HelenAlmela, ManelPerez, FedericoSchwaber, Mitchell JBermejo, JoaquinLowman, WarrenHsueh, Po-RenPaño-Pardo, Jose RamonTorre-Cisneros, JulianSouli, MariaBonomo, Robert ACarmeli, YehudaPaterson, David LPascual, AlvaroRodriguez-Baño, Jesus2023-01-252023-01-252017-07-13Palacios-Baena ZR, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale P, Oliver A, et al. Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort. Clin Infect Dis. 2017 Oct 30;65(10):1615-1623http://hdl.handle.net/10668/11669There 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.enAminoglycosidesAntimicrobial resistanceBloodstream infectionsExtended-spectrum β-lactamase–producing EnterobacteriaceaeTherapyAnti-bacterial agentsBacteremiaCarbapenemsEnterobacteriaceaeEnterobacteriaceae infectionsFemaleHumansKaplan-Meier estimateMaleMiddle agedRetrospective studiesbeta-Lactam resistancebeta-Lactamasesresearch article29020250open accessAntibacterianosCarbapenémicosEstimación de Kaplan-MeierInfecciones por EnterobacteriaceaeResistencia betalactámica10.1093/cid/cix6061537-6591PMC5849995https://academic.oup.com/cid/article-pdf/65/10/1615/24266850/cix606.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849995/pdf