@article{3108200,
    title = "Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study",
    author = "Harris, P.N.A. and Pezzani, M.D. and Gutiérrez-Gutiérrez, B. and Viale, P. and Hsueh, P.-R. and Ruiz-Garbajosa, P. and Venditti, M. and Tumbarello, M. and Navarro-Francisco, C. and Calbo, E. and Akova, M. and Giamarellou, H. and Oliver, A. and Almirante, B. and Gasch, O. and Martínez-Martínez, L. and Schwaber, M.J. and Daikos, G. and Pitout, J. and Peña, C. and Hernández-Torres, A. and Doi, Y. and Pérez, F. and Tuon, F.F. and Tacconelli, E. and Carmeli, Y. and Bonomo, R.A. and Pascual, Á. and Paterson, D.L. and Rodríguez-Baño, J. and del Toro, M.D. and Gálvez, J. and Falcone, M. and Russo, A. and Karaiskos, I. and Trecarichi, E.M. and Losito, A.R. and García-Vázquez, E. and Gómez, J. and Roilides, E. and Iosifidis, E. and Pournaras, S. and Prim, N. and Navarro, F. and Mirelis, B. and Origüen, J. and Juan, R.S. and Fernández-Ruiz, M. and Almela, M. and de la Calle, C. and Martínez, J.A. and Morata, L. and Larrosa, N. and Puig-Asensio, M. and Bou, G. and Molina, J. and González, V. and Bermejo, J. and Rucci, V. and de Gopegui, E.R. and Marinescu, C.I. and Fariñas, M.C. and Cano, M.E. and Gozalo, M. and Paño-Pardo, J.R. and Mora-Rillo, M. and Gómez-Zorrilla, S. and Tubau, F. and Tsakris, A. and Zarkotou, O. and Antoniadou, A. and Poulakou, G. and Souli, M. and Lowman, W. and Virmani, D. and Torre-Cisneros, J. and Machuca, I. and Gracia-Ahufinger, I. and Azap, Ö.K. and Helvaci, Ö. and Sahin, A.O. and Cantón, R. and Pintado, V. and Bartoletti, M. and Giannella, M. and Peter, S. and Hamprecht, A. and Badia, C. and Xercavins, M. and Fontanals, D. and Jové, E. and ESGBIS/REIPI/INCREMENT Group",
    journal = "International Journal of Antimicrobial Agents",
    year = "2017",
    volume = "50",
    number = "5",
    pages = "664-672",
    publisher = "Elsevier B.V.",
    issn = "0924-8579",
    doi = "10.1016/j.ijantimicag.2017.08.005",
    keywords = "amikacin;  amoxicillin plus clavulanic acid;  cefalotin;  cefepime;  cefixime;  cefotaxime;  ceftazidime;  ceftriaxone;  cefuroxime;  colistin;  doripenem;  ertapenem;  gentamicin;  imipenem;  meropenem;  piperacillin plus tazobactam;  sultamicillin;  tigecycline;  timentin;  tobramycin;  beta lactam;  beta lactamase inhibitor, adult;  aged;  antibiotic resistance;  antibiotic therapy;  Argentina;  Article;  bloodstream infection;  Brazil;  Canada;  carbapenemase producing Enterobacteriaceae;  clinical study;  cohort analysis;  controlled study;  Enterobacteriaceae infection;  extended spectrum beta lactamase producing Enterobacteriaceae;  female;  geographic distribution;  Germany;  Greece;  human;  Israel;  Italy;  major clinical study;  male;  multivariate logistic regression analysis;  observational study;  odds ratio;  post hoc analysis;  prevalence;  priority journal;  retrospective study;  Spain;  Taiwan;  Turkey (republic);  United States;  comparative study;  drug effect;  Enterobacteriaceae;  Enterobacteriaceae infection;  global health;  isolation and purification;  microbiology;  middle aged;  multidrug resistance;  sepsis;  very elderly, Adult;  Aged;  Aged, 80 and over;  beta-Lactamase Inhibitors;  beta-Lactams;  Drug Resistance, Multiple, Bacterial;  Enterobacteriaceae;  Enterobacteriaceae Infections;  Female;  Global Health;  Humans;  Male;  Middle Aged;  Retrospective Studies;  Sepsis",
    abstract = "We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14–0.81), Greece (aOR 0.49, 95% CI 0.26–0.94) and Canada (aOR 0.31, 95% CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11–2.25) and Turkey (aOR 2.09, 95% CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03–2.92) and USA (aOR 1.89, 95% CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28–0.69) and Canada (aOR 0.10, 95% CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts. © 2017 Elsevier B.V. and International Society of Chemotherapy"
}