β-Lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae: a multinational, pre-registered cohort study.
Antimicrob Agents Chemother. 2016 May 2;
Authors: Gutiérrez-Gutiérrez B, Pérez-Galera S, Salamanca E, de Cueto M, Calbo E, Almirante B, Viale P, Oliver A, Pintado V, Gasch O, Martínez-Martínez L, Pitout J, Akova M, Peña C, Molina J, Hernández A, Venditti M, Prim N, Origüen J, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Giamarellou H, Almela M, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Mora-Rillo M, Natera C, Souli M, Bonomo RA, Carmeli Y, Paterson DL, Pascual A, Rodríguez-Baño J, investigators from the REIPI/ESGBIS/INCREMENT Group
BACKGROUND: Spread of extended-spectrum β-lactamase-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 ESBL-E.
METHODS: A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI treated due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical therapy cohort (ETC; 365 patients), targeted therapy cohort (TTC; 601 patients) and global cohort (GC; 627 patients). 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.
RESULTS: Cure/improvement rates with BLBLI and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. 30-day mortality rates were 17.6% and 20% in the ETC, and 9.8% and 13.9% in the TTC, respectively. Adjusted OR (95% CI) for cure/improvement rate with ET with BLBLI was 1.37 (0.69-2.76); for TT was 1.61 (0.58-4.86). Regarding 30-day mortality, the adjusted OR (95% CI) were 0.55 (0.25-1.18) for ET, and 0.59 (0.19-1.71) for TT. The results were consistent in all subgroups studied, stratified analysis according to quartiles of PS, PS-matched cases, and in the GC.
CONCLUSIONS: BLBLI, if active in vitro, appear 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.
PMID: 27139473 [PubMed - as supplied by publisher]