Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct 30;65(10):1615-1623.
doi: 10.1093/cid/cix606.

Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort

Zaira Raquel Palacios-Baena  1 , Belén Gutiérrez-Gutiérrez  1 , Esther Calbo  2 , Benito Almirante  3 , Pierluigi Viale  4 , Antonio Oliver  5 , Vicente Pintado  6 , Oriol Gasch  7 , Luis Martínez-Martínez  8 , Johann Pitout  9 , Murat Akova  10 , Carmen Peña  11 , José Molina Gil-Bermejo  1 , Alicia Hernández  12 , Mario Venditti  13 , Nuria Prim  14 , German Bou  15 , Evelina Tacconelli  16 , Mario Tumbarello  17 , Axel Hamprecht  18 , Helen Giamarellou  19 , Manel Almela  20 , Federico Pérez  21 , Mitchell J Schwaber  22 , Joaquín Bermejo  23 , Warren Lowman  24 , Po-Ren Hsueh  25 , José Ramón Paño-Pardo  26 , Julián Torre-Cisneros  27 , Maria Souli  28 , Robert A Bonomo  29 , Yehuda Carmeli  22 , David L Paterson  30 , Álvaro Pascual  1 , Jesús Rodríguez-Baño  1 ; Spanish Network for Research in Infectious Diseases (REIPI)/European Study Group of Bloodstream Infections and Sepsis (ESGBIS)/INCREMENT Group
Collaborators, Affiliations

Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort

Zaira Raquel Palacios-Baena et al. Clin Infect Dis. .

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.

Keywords: aminoglycosides; antimicrobial resistance; bloodstream infections; extended-spectrum β-lactamase–producing Enterobacteriaceae; therapy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of included patients. Abbreviation: ESBL, extended-spectrum β-lactamase; OAD, other active drug.
Figure 2.
Figure 2.
Kaplan-Meier curves for mortality according to empiric therapy. A, Whole cohort. B, Patients with a high INCREMENT extended-spectrum β-lactamase (ESBL) mortality score (≥11 points). C, Patients with a low INCREMENT ESBL mortality score (<11 points).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005; 18:657–86. - PMC - PubMed
    1. Rodríguez-Baño J, Pascual A. Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther 2008; 6:671–83. - PubMed
    1. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008; 8:159–66. - PubMed
    1. Van Duin D, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence 2016; 11:1–10. - PMC - PubMed
    1. Rodríguez-Baño J, Navarro MD, Retamar P, Picón E, Pascual Á; Extended-Spectrum Beta-Lactamases–Red Española de Investigación en Patología Infecciosa/Grupo de Estudio de Infección Hospitalaria Group β-Lactam/β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts. Clin Infect Dis 2012; 54:167–74. - PubMed