Περίληψη:
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.
Συγγραφείς:
Palacios-Baena, Z.R.
Gutiérrez-Gutiérrez, B.
Calbo, E.
Almirante, B.
Viale, P.
Oliver, A.
Pintado, V.
Gasch, O.
Martínez-Martínez, L.
Pitout, J.
Akova, M.
Peña, C.
Molina Gil-Bermejo, J.
Hernández, A.
Venditti, M.
Prim, N.
Bou, G.
Tacconelli, E.
Tumbarello, M.
Hamprecht, A.
Giamarellou, H.
Almela, M.
Pérez, F.
Schwaber, M.J.
Bermejo, J.
Lowman, W.
Hsueh, P.-R.
Paño-Pardo, J.R.
Torre-Cisneros, J.
Souli, M.
Bonomo, R.A.
Carmeli, Y.
Paterson, D.L.
Pascual, Á.
Rodríguez-Baño, J.
Gálvez, J.
Falcone, M.
Russo, A.
Daikos, G.
Trecarichi, E.M.
Losito, A.R.
Gómez, J.
Iosifidis, E.
Roilides, E.
Karaiskos, I.
Doi, Y.
Tuon, F.F.
Navarro, F.
Mirelis, B.
Martínez, J.A.
De La Calle, C.
Morata, L.
San Juan, R.
Fernández-Ruiz, M.
Larrosa, N.
Puig, M.
Molina, J.
González, V.
Rucci, V.
Ruiz De Gopegui, E.
Marinescu, C.I.
Fariñas, M.C.
Cano, M.E.
Gozalo, M.
Mora-Rillo, M.
Gómez-Zorrilla, S.
Tubau, F.
Pournaras, S.
Tsakris, A.
Zarkotou, O.
Azap, Ö.K.
Antoniadou, A.
Poulakou, G.
Virmani, D.
Cano, Á.
Machuca, I.
Helvaci, Ö.
Sahin, A.O.
Ruiz-Garbajosa, P.
Bartoletti, M.
Giannella, M.
Peter, S.
Badia, C.
Xercavins, M.
Fontanals, D.
Jové, E.
