| Literature DB >> 27139473 |
Belén Gutiérrez-Gutiérrez1, Salvador Pérez-Galera1, Elena Salamanca1, Marina de Cueto1, Esther Calbo2, Benito Almirante3, Pierluigi Viale4, Antonio Oliver5, Vicente Pintado6, Oriol Gasch7, Luis Martínez-Martínez8, Johann Pitout9, Murat Akova10, Carmen Peña11, José Molina1, Alicia Hernández12, Mario Venditti13, Nuria Prim14, Julia Origüen15, German Bou16, Evelina Tacconelli17, Mario Tumbarello18, Axel Hamprecht19, Helen Giamarellou20, Manel Almela21, Federico Pérez22, Mitchell J Schwaber23, Joaquín Bermejo24, Warren Lowman25, Po-Ren Hsueh26, Marta Mora-Rillo27, Clara Natera28, Maria Souli29, Robert A Bonomo30, Yehuda Carmeli23, David L Paterson31, Alvaro Pascual32, Jesús Rodríguez-Baño33.
Abstract
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. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.).Entities:
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Year: 2016 PMID： 27139473 PMCID： PMC4914653 DOI： 10.1128/AAC.00365-16
Source DB: PubMed Journal: Antimicrob Agents Chemother ISSN： 0066-4804 Impact factor: 5.191