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A multinational, preregistered cohort study of β-lactam/β-lactamase inhibitor combinations for treatment of bloodstream infections due to extended-spectrum-β-lactamase-producing enterobacteriaceae
Authors
B. Gutiérrez-Gutiérrez Pérez-Galera, S. Salamanca, E. De Cueto, M. Calbo, E. Almirante, B. Viale, P. Oliver, A. Pintado, V. Gasch, O. Martínez-Martínez, L. Pitout, J. Akova, M. Peña, C. Molina, J. Hernández, A. Venditti, M. Prim, N. Origüen, J. Bou, G. Tacconelli, E. Tumbarello, M. Hamprecht, A. Giamarellou, H. Almela, M. Pérez, F. Schwaber, M.J. Bermejo, J. Lowman, W. Hsueh, P.-R. Mora-Rillo, M. Natera, C. Souli, M. Bonomo, R.A. Carmeli, Y. Paterson, D.L. Pascual, A. Rodríguez-Baño, J. Gálvez, J. Del Toro, M.D. Retamar, P. Falcone, M. Russo, A. Daikos, G. Karaiskos, I. Trecarichi, E.M. Losito, A.R. García-Vázquez, E. Gómez, J. Roilides, E. Iosifidis, E. Doi, Y. Tuon, F.F. Navarro, F. Mirelis, B. San Juan, R. Fernández-Ruiz, M. Larrosa, N. Puig, M. Cisneros, J.M. González, V. Rucci, V. Ruiz De Gopegui, E. Marinescu, C.I. Fariñas, M.C. Cano, M.E. Gozalo, M. Paño-Pardo, J.R. Navarro-San Francisco, C. Gómez-Zorrilla, S. Tubau, F. Pournaras, S. Tsakris, A. Zarkotou, O. Azap, Ö.K. Antoniadou, A. Poulakou, G. Virmani, D. Torre-Cisneros, J. Pérez-Nadales, E. Gracia-Ahulfinger, I. Helvaci, Ö. Sahin, A.O. Cantón, R. Ruiz, P. Bartoletti, M. Giannella, M. Riemenschneider, F. Badia, C. Xercavins, M. Fontanals, D. Jové, E. REIPI/ESGBIS/INCREMENT Group
Publication date
1 January 2016
Publisher
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.) Copyright © 2016, American Society for Microbiology. All Rights Reserved
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Last time updated on 10/02/2023