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Non-Carbapenem Antibiotics to Treat Severe Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae Infections in Intensive Care Unit Patients.
Int J Antimicrob Agents. 2019 Feb 08;:
Authors: Luyt CE, Faure M, Bonnet I, Besset S, Huang F, Junot H, Hékimian G, Schmidt M, Bréchot N, Combes A, Aubry A, Mayaux J, Chastre J
Abstract
PURPOSE: To evaluate the use of non-carbapenem antibiotics to treat severe extended-spectrum β-lactamase-producing Enterobacteriaceae infections in intensive care unit (ICU) patients.
METHODS: This retrospective observational study conducted in 2 ICUs compared outcomes of patients with extended-spectrum β-lactamase-producing Enterobacteriaceae infections administered a carbapenem or a non-carbapenem antibiotic as their definitive treatment. The primary outcome was treatment failure within 30 days, a composite endpoint of extended-spectrum β-lactamase-producing Enterobacteriaceae-infection recurrence and day-30 mortality. Secondary outcomes included day-30 and in-hospital mortality rates, extended-spectrum beta-lactamase-producing Enterobacteriaceae-infection recurrence, and infection(s) due to other pathogen(s).
RESULTS: Among the 107 patients included, 67 received a carbapenem and 40 a non-carbapenem antibiotic as their definitive treatment. Clinical characteristics of the 2 groups were similar. Comparing patients given a non-carbapenem antibiotic to those administered carbapenem, respectively, the former had similar day-30 treatment-failure (43% vs. 60%, P =0.06) and extended-spectrum β-lactamase-producing Enterobacteriaceae-infection-recurrence rates (25% vs. 22%, P = 0.8), but lower day-30 (23% vs. 45%, P = 0.02) and in-hospital (23% vs. 49%, P = 0.002) mortality rates. Secondary infection rates caused by other pathogen(s), including Clostridium difficile, were comparable. Outcomes were comparable regardless of whether or not patients received empirical carbapenem.
CONCLUSIONS: For ICU patients with severe extended-spectrum β-lactamase-producing Enterobacteriaceae infections, treatment with a non-carbapenem antibiotic was not associated with poorer outcome, compared to a carbapenem.
PMID: 30742956 [PubMed - as supplied by publisher]