TY - JOUR
T1 - Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae
T2 - a post-hoc analysis of the INCREMENT study
AU - ESGBIS/REIPI/INCREMENT Group
AU - Harris, Patrick N.A.
AU - Pezzani, M. Diletta
AU - Gutiérrez-Gutiérrez, Belén
AU - Viale, Pierluigi
AU - Hsueh, Po Ren
AU - Ruiz-Garbajosa, Patricia
AU - Venditti, Mario
AU - Tumbarello, Mario
AU - Navarro-Francisco, Carolina
AU - Calbo, Esther
AU - Akova, Murat
AU - Giamarellou, Helen
AU - Oliver, Antonio
AU - Almirante, Benito
AU - Gasch, Oriol
AU - Martínez-Martínez, Luis
AU - Schwaber, Mitchell J.
AU - Daikos, George
AU - Pitout, Johann
AU - Peña, Carmen
AU - Hernández-Torres, Alicia
AU - Doi, Yohei
AU - Pérez, Federico
AU - Tuon, Felipe Francisco
AU - Tacconelli, Evelina
AU - Carmeli, Yehuda
AU - Bonomo, Robert A.
AU - Pascual, Álvaro
AU - Paterson, David L.
AU - Rodríguez-Baño, Jesús
AU - del Toro, M. D.
AU - Gálvez, J.
AU - Falcone, M.
AU - Russo, A.
AU - Karaiskos, I.
AU - Trecarichi, E. M.
AU - Losito, A. R.
AU - García-Vázquez, E.
AU - Gómez, J.
AU - Roilides, E.
AU - Iosifidis, E.
AU - Pournaras, S.
AU - Prim, N.
AU - Navarro, F.
AU - Mirelis, B.
AU - Origüen, J.
AU - Juan, R. San
AU - Fernández-Ruiz, M.
AU - Almela, M.
AU - de la Calle, C.
N1 - Publisher Copyright:
© 2017 Elsevier B.V. and International Society of Chemotherapy
PY - 2017/11/1
Y1 - 2017/11/1
N2 - 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.
AB - 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.
KW - Carbapenemase
KW - Carbapenems
KW - Escherichia coli
KW - Extended-spectrum β-lactamase
KW - Klebsiella pneumoniae
KW - β-Lactam/β-lactamase inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85031115305&partnerID=8YFLogxK
U2 - 10.1016/j.ijantimicag.2017.08.005
DO - 10.1016/j.ijantimicag.2017.08.005
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C2 - 28782704
AN - SCOPUS:85031115305
SN - 0924-8579
VL - 50
SP - 664
EP - 672
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 5
ER -