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. 2024 Jun 4;4(1):e100.
doi: 10.1017/ash.2024.88. eCollection 2024.

Effectiveness of empiric carbapenem versus non-carbapenem therapy for extended-spectrum β-lactamase producing Enterobacterales infections in non-intensive care unit patients: a real-world investigation in a hospital with high-prevalence of extended-spectrum β-lactamase producing Enterobacterales

Amy Y Kang  1   2   3 , Mary Elkomos  1 , Danny Pham  4 , Michelle Guerrero  5 , Deborah Kupferwasser  3 , Loren G Miller  3   6
Affiliations

Effectiveness of empiric carbapenem versus non-carbapenem therapy for extended-spectrum β-lactamase producing Enterobacterales infections in non-intensive care unit patients: a real-world investigation in a hospital with high-prevalence of extended-spectrum β-lactamase producing Enterobacterales

Amy Y Kang et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: To investigate whether empiric carbapenem therapy, compared to empiric non-carbapenem therapy, was associated with improved clinical outcomes among hospitalized, non-intensive care unit (ICU) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections.

Methods: We performed a retrospective cohort study of adult, non-ICU patients admitted with ESBL-producing Enterobacterales infections. Primary outcome was time to clinical stability from the first empiric antibiotic dose. Secondary outcomes were early clinical response and 30-day all-cause hospital readmission. We used multivariate regression methods to examine time to clinical stability.

Results: Of the 142 patients, 59 (42%) received empiric carbapenems and 83 (58%) received empiric non-carbapenems, most commonly ceftriaxone (49/83, 59%). Median age was 59 years. The most common infection source was urinary (71%). The carbapenem group had a higher proportion of patients who received antibiotics within 6 months of admission (55% vs 28%, P < .01) and history of ESBL (57% vs 17%, P < .01). There were no significant differences in hours until clinical stability between the carbapenem and non-carbapenem groups (22 (IQR: 0, 85) vs 19 (IQR: 0, 69), P = .54). Early clinical response (88% vs 90%, P = .79) and 30-day all-cause hospital readmission (17% vs 8%, P = .13) were similar between groups.

Conclusion: Among hospitalized non-ICU patients with ESBL-producing Enterobacterales infection, we found no difference in time to clinical stability after the first empiric antibiotic dose between those receiving carbapenems and those who did not. Our data suggest that empiric carbapenem use may not be an important driver of clinical response in patients with less severe ESBL-producing Enterobacterales infection.

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Figures

Figure 1.
Figure 1.
Patient inclusion/exclusion and cohort allocation.
Figure 2.
Figure 2.
Empiric therapy for ESBL-producing Enterobacterales in non-ICU settings. Abbreviations: ESBL, extended-spectrum beta-lactamase; PTZ, piperacillin-tazobactam; FQ, fluoroquinolones; SMX/TMP, sulfamethoxazole-trimethoprim. Note that some patients received more than one antibiotic as empiric therapy.
Figure 3.
Figure 3.
Directed therapy. Abbreviations: FQ, fluoroquinolones; SMX/TMP, sulfamethoxazole-trimethoprim; PTZ, piperacillin-tazobactam.
Figure 4.
Figure 4.
Kaplan–Meier plot of the proportion of patients who presented clinically unstable.
See this image and copyright information in PMC

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References

    1. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304–377. doi: 10.1007/s00134-017-4683-6 - DOI - PubMed
    1. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–1596. doi: 10.1097/01.CCM.0000217961.75225.E9 - DOI - PubMed
    1. Teshome BF, Vouri SM, Hampton N, Kollef MH, Micek ST. Duration of exposure to antipseudomonal β-lactam antibiotics in the critically ill and development of new resistance. Pharmacotherapy 2019;39:261–270. doi: 10.1002/phar.2201 - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention (U.S.). Antibiotic Resistance Threats in the United States, 2019. Centers for Disease Control and Prevention (U.S.); 2019. doi: 10.15620/cdc:82532 - DOI
    1. Nordmann P, Poirel L. Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria. Clin Infect Dis. 2019;69:S521–S528. doi: 10.1093/cid/ciz824 - DOI - PMC - PubMed