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 HSUEHPa?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.2020-12-182020-12-1820171058-4838https://scholars.lib.ntu.edu.tw/handle/123456789/528229Background. 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.[SDGs]SDG3aminoglycoside; 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 Studiesjournal article10.1093/cid/cix606290202502-s2.0-85032746020