Zaira Raquel Palacios-Baena1, Belén Gutiérrez-Gutiérrez1, Esther Calbo2, Benito Almirante3, Pierluigi Viale4, Antonio Oliver5, Vicente Pintado6, Oriol Gasch7, Luis Martínez-Martínez8, Johann Pitout9, Murat Akova10, Carmen Peña11, José Molina Gil-Bermejo1, Alicia Hernández12, Mario Venditti13, Nuria Prim14, German Bou15, Evelina Tacconelli16, Mario Tumbarello17, Axel Hamprecht18, Helen Giamarellou19, Manel Almela20, Federico Pérez21, Mitchell J Schwaber22, Joaquín Bermejo23, Warren Lowman24, Po-Ren Hsueh25, José Ramón Paño-Pardo26, Julián Torre-Cisneros27, Maria Souli28, Robert A Bonomo29, Yehuda Carmeli22, David L Paterson30, Álvaro Pascual1, Jesús Rodríguez-Baño1. 1. Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología/Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen Macarena/Universidad de Sevilla. 2. Hospital Universitari Mútua de Terrassa, Universitat Internacional de Catalunya. 3. Hospital Vall d'Hebrón, Barcelona, Spain. 4. Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy. 5. Hospital Universitario Son Espases, Mallorca. 6. Hospital Ramón y Cajal, Madrid. 7. Hospital Parc Taulí, Barcelona. 8. Hospital Universitario M. de Valdecilla-IDIVAL, Santander, Spain. 9. University of Calgary, Alberta, Canada. 10. Hacettepe University School of Medicine, Ankara, Turkey. 11. Hospital Bellvitge, Barcelona. 12. Hospital Virgen de la Arrixaca, Murcia, Spain. 13. Policlinico Umberto I, Rome, Italy. 14. Hospital de la Santa Creu i Sant Pau, Barcelona. 15. Complejo Hospitalario Universitario A Coruña, Spain. 16. Tübingen University Hospital and DZIF Partner Center, Germany. 17. Catholic University of the Sacred Heart, Rome, Italy. 18. Institut für Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Köln, Cologne, Germany. 19. Hygeia General Hospital, Athens, Greece. 20. Hospital Clinic, Barcelona, Spain. 21. Louis Stokes Cleveland Veteran Affairs Medical Center, Case Western Reserve University, Ohio. 22. Tel Aviv Sourasky Medical Center, National Center for Infection Control, Israel Ministry of Health, and Sackler Faculty of Medicine, Tel Aviv University. 23. Hospital Español, Rosario, Argentina. 24. Wits Donald Gordon Medical Centre, Johannesburg, South Africa. 25. National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei. 26. Hospital La Paz, Madrid. 27. Maimonides Biomedical Research Institute of Córdoba, Unidades de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Reina Sofia University Hospital and University of Córdoba, Spain. 28. National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Greece. 29. Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center and Departments of Medicine, Pharmacology, Biochemistry, and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Ohio. 30. University of Queensland Centre for Clinical Research, Herston, Brisbane, Australia.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: C Ruiz de Alegría; J Rodríguez-Baño; M E Cano; J R Hernández-Bello; J Calvo; E Román; M A Díaz; A Pascual; L Martínez-Martínez Journal: J Clin Microbiol Date: 2010-12-29 Impact factor: 5.948
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