https://scholars.lib.ntu.edu.tw/handle/123456789/528229
標題: | Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results from the INCREMENT Cohort | 作者: | Palacios-Baena Z.R. Guti?rrez-Guti?rrez B. Calbo E. Almirante B. Viale P. Oliver A. Pintado V. Gasch O. Mart?nez-Mart?nez L. Pitout J. Akova M. Pe?a C. Molina Gil-Bermejo J. Hern?ndez A. Venditti M. Prim N. Bou G. Tacconelli E. Tumbarello M. Hamprecht A. Giamarellou H. Almela M. P?rez F. Schwaber M.J. Bermejo J. Lowman W. PO-REN HSUEH Pa?o-Pardo J.R. Torre-Cisneros J. Souli M. Bonomo R.A. Carmeli Y. Paterson D.L. Pascual ?. Rodr?guez-Ba?o J. G?lvez J. Falcone M. Russo A. Daikos G. Trecarichi E.M. Losito A.R. G?mez J. Iosifidis E. Roilides E. Karaiskos I. Doi Y. Tuon F.F. Navarro F. Mirelis B. Mart?nez J.A. De La Calle C. Morata L. San Juan R. Fern?ndez-Ruiz M. Larrosa N. Puig M. Molina J. Gonz?lez V. Rucci V. Ruiz De Gopegui E. Marinescu C.I. Fari?as M.C. Cano M.E. Gozalo M. Mora-Rillo M. G?mez-Zorrilla S. Tubau F. Pournaras S. Tsakris A. Zarkotou O. Azap ?.K. Antoniadou A. Poulakou G. Virmani D. Cano ?. Machuca I. Helvaci ?. Sahin A.O. Ruiz-Garbajosa P. Bartoletti M. Giannella M. Peter S. Badia C. Xercavins M. Fontanals D. Jov? E. |
公開日期: | 2017 | 卷: | 65 | 期: | 10 | 起(迄)頁: | 1615-1623 | 來源出版物: | Clinical Infectious Diseases | 摘要: | 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. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/528229 | ISSN: | 1058-4838 | DOI: | 10.1093/cid/cix606 | SDG/關鍵字: | 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 |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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