TY - JOUR
T1 - 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
AU - REIPI/ESGBIS/INCREMENT Group
AU - Gutiérrez-Gutiérrez, Belén
AU - Pérez-Galera, Salvador
AU - Salamanca, Elena
AU - De Cueto, Marina
AU - Calbo, Esther
AU - Almirante, Benito
AU - Viale, Pierluigi
AU - Oliver, Antonio
AU - Pintado, Vicente
AU - Gasch, Oriol
AU - Martínez-Martínez, Luis
AU - Pitout, Johann
AU - Akova, Murat
AU - Peña, Carmen
AU - Molina, José
AU - Hernández, Alicia
AU - Venditti, Mario
AU - Prim, Nuria
AU - Origüen, Julia
AU - Bou, German
AU - Tacconelli, Evelina
AU - Tumbarello, Mario
AU - Hamprecht, Axel
AU - Giamarellou, Helen
AU - Almela, Manel
AU - Pérez, Federico
AU - Schwaber, Mitchell J.
AU - Bermejo, Joaquín
AU - Lowman, Warren
AU - Hsueh, Po Ren
AU - Mora-Rillo, Marta
AU - Natera, Clara
AU - Souli, Maria
AU - Bonomo, Robert A.
AU - Carmeli, Yehuda
AU - Paterson, David L.
AU - Pascual, Alvaro
AU - Rodríguez-Baño, Jesús
AU - Gálvez, J.
AU - Del Toro, M. D.
AU - Retamar, P.
AU - Falcone, M.
AU - Russo, A.
AU - Daikos, G.
AU - Karaiskos, I.
AU - Trecarichi, E. M.
AU - Losito, A. R.
AU - García-Vázquez, E.
AU - Gómez, J.
AU - Roilides, E.
N1 - Publisher Copyright:
Copyright © 2016, American Society for Microbiology. All Rights Reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.)
AB - 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.)
UR - http://www.scopus.com/inward/record.url?scp=84977072761&partnerID=8YFLogxK
U2 - 10.1128/AAC.00365-16
DO - 10.1128/AAC.00365-16
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C2 - 27139473
AN - SCOPUS:84977072761
SN - 0066-4804
VL - 60
SP - 4159
EP - 4169
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
IS - 7
ER -