@article{3108126,
    title = "Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results from the INCREMENT Cohort",
    author = "Palacios-Baena, Z.R. and Gutiérrez-Gutiérrez, B. and Calbo, E. and Almirante, B. and Viale, P. and Oliver, A. and Pintado, V. and Gasch, O. and Martínez-Martínez, L. and Pitout, J. and Akova, M. and Peña, C. and Molina Gil-Bermejo, J. and Hernández, A. and Venditti, M. and Prim, N. and Bou, G. and Tacconelli, E. and Tumbarello, M. and Hamprecht, A. and Giamarellou, H. and Almela, M. and Pérez, F. and Schwaber, M.J. and Bermejo, J. and Lowman, W. and Hsueh, P.-R. and Paño-Pardo, J.R. and Torre-Cisneros, J. and Souli, M. and Bonomo, R.A. and Carmeli, Y. and Paterson, D.L. and Pascual, Á. and Rodríguez-Baño, J. and Gálvez, J. and Falcone, M. and Russo, A. and Daikos, G. and Trecarichi, E.M. and Losito, A.R. and Gómez, J. and Iosifidis, E. and Roilides, E. and Karaiskos, I. and Doi, Y. and Tuon, F.F. and Navarro, F. and Mirelis, B. and Martínez, J.A. and De La Calle, C. and Morata, L. and San Juan, R. and Fernández-Ruiz, M. and Larrosa, N. and Puig, M. and Molina, J. and González, V. and Rucci, V. and Ruiz De Gopegui, E. and Marinescu, C.I. and Fariñas, M.C. and Cano, M.E. and Gozalo, M. and Mora-Rillo, M. and Gómez-Zorrilla, S. and Tubau, F. and Pournaras, S. and Tsakris, A. and Zarkotou, O. and Azap, Ö.K. and Antoniadou, A. and Poulakou, G. and Virmani, D. and Cano, Á. and Machuca, I. and Helvaci, Ö. and Sahin, A.O. and Ruiz-Garbajosa, P. and Bartoletti, M. and Giannella, M. and Peter, S. and Badia, C. and Xercavins, M. and Fontanals, D. and Jové, E.",
    journal = "Clinical Infectious Diseases",
    year = "2017",
    volume = "65",
    number = "10",
    pages = "1615-1623",
    publisher = "Oxford University Press",
    issn = "1058-4838, 1537-6591",
    doi = "10.1093/cid/cix606",
    keywords = "aminoglycoside;  aztreonam;  carbapenem;  cephalosporin derivative;  colistin;  cotrimoxazole;  doripenem;  ertapenem;  fosfomycin;  imipenem;  meropenem;  quinolone derivative;  tigecycline;  antiinfective agent;  beta lactamase;  carbapenem derivative, adult;  all cause mortality;  antibiotic therapy;  Article;  bloodstream infection;  clinical outcome;  cohort analysis;  Enterobacteriaceae infection;  extended spectrum beta lactamase producing Enterobacteriaceae;  female;  human;  length of stay;  major clinical study;  male;  mortality rate;  multicenter study;  priority journal;  retrospective study;  bacteremia;  beta-lactam resistance;  drug effect;  Enterobacteriaceae;  enzymology;  Kaplan Meier method;  microbiology;  middle aged, Anti-Bacterial Agents;  Bacteremia;  beta-Lactam Resistance;  beta-Lactamases;  Carbapenems;  Enterobacteriaceae;  Enterobacteriaceae Infections;  Female;  Humans;  Kaplan-Meier Estimate;  Male;  Middle Aged;  Retrospective Studies",
    abstract = "Background. There is little information about the efficacy of active alternative drugs to carbapenems except ?-lactam/?-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum ?-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. © The Author 2017."
}