Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results from the INCREMENT Cohort

Zaira Raquel Palacios-Baena, Belén Gutiérrez-Gutiérrez, Esther Calbo, Benito Almirante, Pierluigi Viale, Antonio Oliver, Vicente Pintado, Oriol Gasch, Luis Martínez-Martínez, Johann Pitout, Murat Akova, Carmen Peña, José Molina Gil-Bermejo, Alicia Hernández, Mario Venditti, Nuria Prim, German Bou, Evelina Tacconelli, Mario Tumbarello, Axel HamprechtHelen Giamarellou, Manel Almela, Federico Pérez, Mitchell J. Schwaber, Joaquín Bermejo, Warren Lowman, Po Ren Hsueh, José Ramón Paño-Pardo, Julián Torre-Cisneros, Maria Souli, Robert A. Bonomo, Yehuda Carmeli, David L. Paterson, Álvaro Pascual, Jesús Rodríguez-Baño, J. Gálvez, M. Falcone, A. Russo, G. Daikos, E. M. Trecarichi, A. R. Losito, J. Gómez, E. Iosifidis, E. Roilides, I. Karaiskos, Yohei Doi, F. F. Tuon, F. Navarro, B. Mirelis, J. A. Martínez, C. De La Calle, L. Morata, R. San Juan, M. Fernández-Ruiz, N. Larrosa, M. Puig, J. Molina, V. González, V. Rucci, E. Ruiz De Gopegui, C. I. Marinescu, M. C. Fariñas, M. E. Cano, M. Gozalo, M. Mora-Rillo, S. Gómez-Zorrilla, F. Tubau, S. Pournaras, A. Tsakris, O. Zarkotou, K. Azap, A. Antoniadou, G. Poulakou, D. Virmani, Cano, I. Machuca, Helvaci, A. O. Sahin, P. Ruiz-Garbajosa, M. Bartoletti, M. Giannella, S. Peter, C. Badia, M. Xercavins, D. Fontanals, E. Jové

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1615-1623
Number of pages9
JournalClinical Infectious Diseases
Volume65
Issue number10
DOIs
Publication statusPublished - 15-11-2017

Fingerprint

Carbapenems
Enterobacteriaceae
Infection
Pharmaceutical Preparations
Therapeutics
Length of Stay
Propensity Score
Aminoglycosides
Confidence Intervals
Lactams
Mortality
Fluoroquinolones
Cohort Studies
Retrospective Studies
Odds Ratio
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Palacios-Baena, Zaira Raquel ; Gutiérrez-Gutiérrez, Belén ; Calbo, Esther ; Almirante, Benito ; Viale, Pierluigi ; Oliver, Antonio ; Pintado, Vicente ; Gasch, Oriol ; Martínez-Martínez, Luis ; Pitout, Johann ; Akova, Murat ; Peña, Carmen ; Molina Gil-Bermejo, José ; Hernández, Alicia ; Venditti, Mario ; Prim, Nuria ; Bou, German ; Tacconelli, Evelina ; Tumbarello, Mario ; Hamprecht, Axel ; Giamarellou, Helen ; Almela, Manel ; Pérez, Federico ; Schwaber, Mitchell J. ; Bermejo, Joaquín ; Lowman, Warren ; Hsueh, Po Ren ; Paño-Pardo, José Ramón ; Torre-Cisneros, Julián ; Souli, Maria ; Bonomo, Robert A. ; Carmeli, Yehuda ; Paterson, David L. ; Pascual, Álvaro ; Rodríguez-Baño, Jesús ; Gálvez, J. ; Falcone, M. ; Russo, A. ; Daikos, G. ; Trecarichi, E. M. ; Losito, A. R. ; Gómez, J. ; Iosifidis, E. ; Roilides, E. ; Karaiskos, I. ; Doi, Yohei ; Tuon, F. F. ; Navarro, F. ; Mirelis, B. ; Martínez, J. A. ; De La Calle, C. ; Morata, L. ; San Juan, R. ; Fernández-Ruiz, M. ; Larrosa, N. ; Puig, M. ; Molina, J. ; González, V. ; Rucci, V. ; Ruiz De Gopegui, E. ; Marinescu, C. I. ; Fariñas, M. C. ; Cano, M. E. ; Gozalo, M. ; Mora-Rillo, M. ; Gómez-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. ; Jové, E. / Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae : Results from the INCREMENT Cohort. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 10. pp. 1615-1623.
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title = "Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results from the INCREMENT Cohort",
abstract = "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.",
author = "Palacios-Baena, {Zaira Raquel} and Bel{\'e}n Guti{\'e}rrez-Guti{\'e}rrez and Esther Calbo and Benito Almirante and Pierluigi Viale and Antonio Oliver and Vicente Pintado and Oriol Gasch and Luis Mart{\'i}nez-Mart{\'i}nez and Johann Pitout and Murat Akova and Carmen Pe{\~n}a and {Molina Gil-Bermejo}, Jos{\'e} and Alicia Hern{\'a}ndez and Mario Venditti and Nuria Prim and German Bou and Evelina Tacconelli and Mario Tumbarello and Axel Hamprecht and Helen Giamarellou and Manel Almela and Federico P{\'e}rez and Schwaber, {Mitchell J.} and Joaqu{\'i}n Bermejo and Warren Lowman and Hsueh, {Po Ren} and Pa{\~n}o-Pardo, {Jos{\'e} Ram{\'o}n} and Juli{\'a}n Torre-Cisneros and Maria Souli and Bonomo, {Robert A.} and Yehuda Carmeli and Paterson, {David L.} and {\'A}lvaro Pascual and Jes{\'u}s Rodr{\'i}guez-Ba{\~n}o and J. G{\'a}lvez and M. Falcone and A. Russo and G. Daikos and Trecarichi, {E. M.} and Losito, {A. R.} and J. G{\'o}mez and E. Iosifidis and E. Roilides and I. Karaiskos and Yohei Doi and Tuon, {F. F.} and F. Navarro and B. Mirelis and Mart{\'i}nez, {J. A.} and {De La Calle}, C. and L. Morata and {San Juan}, R. and M. Fern{\'a}ndez-Ruiz and N. Larrosa and M. Puig and J. Molina and V. Gonz{\'a}lez and V. Rucci and {Ruiz De Gopegui}, E. and Marinescu, {C. I.} and Fari{\~n}as, {M. C.} and Cano, {M. E.} and M. Gozalo and M. Mora-Rillo and S. G{\'o}mez-Zorrilla and F. Tubau and S. Pournaras and A. Tsakris and O. Zarkotou and K. Azap and A. Antoniadou and G. Poulakou and D. Virmani and Cano and I. Machuca and Helvaci and Sahin, {A. O.} and P. Ruiz-Garbajosa and M. Bartoletti and M. Giannella and S. Peter and C. Badia and M. Xercavins and D. Fontanals and E. Jov{\'e}",
year = "2017",
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journal = "Clinical Infectious Diseases",
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Palacios-Baena, ZR, Gutiérrez-Gutiérrez, B, Calbo, E, Almirante, B, Viale, P, Oliver, A, Pintado, V, Gasch, O, Martínez-Martínez, L, Pitout, J, Akova, M, Peña, C, Molina Gil-Bermejo, J, Hernández, A, Venditti, M, Prim, N, Bou, G, Tacconelli, E, Tumbarello, M, Hamprecht, A, Giamarellou, H, Almela, M, Pérez, F, Schwaber, MJ, Bermejo, J, Lowman, W, Hsueh, PR, Paño-Pardo, JR, Torre-Cisneros, J, Souli, M, Bonomo, RA, Carmeli, Y, Paterson, DL, Pascual, Á, Rodríguez-Baño, J, Gálvez, J, Falcone, M, Russo, A, Daikos, G, Trecarichi, EM, Losito, AR, Gómez, J, Iosifidis, E, Roilides, E, Karaiskos, I, Doi, Y, Tuon, FF, Navarro, F, Mirelis, B, Martínez, JA, De La Calle, C, Morata, L, San Juan, R, Fernández-Ruiz, M, Larrosa, N, Puig, M, Molina, J, González, V, Rucci, V, Ruiz De Gopegui, E, Marinescu, CI, Fariñas, MC, Cano, ME, Gozalo, M, Mora-Rillo, M, Gómez-Zorrilla, S, Tubau, F, Pournaras, S, Tsakris, A, Zarkotou, O, Azap, K, Antoniadou, A, Poulakou, G, Virmani, D, Cano, Machuca, I, Helvaci, Sahin, AO, Ruiz-Garbajosa, P, Bartoletti, M, Giannella, M, Peter, S, Badia, C, Xercavins, M, Fontanals, D & Jové, E 2017, 'Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results from the INCREMENT Cohort', Clinical Infectious Diseases, vol. 65, no. 10, pp. 1615-1623. https://doi.org/10.1093/cid/cix606

Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae : Results from the INCREMENT Cohort. / Palacios-Baena, Zaira Raquel; Gutiérrez-Gutiérrez, Belén; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Peña, Carmen; Molina Gil-Bermejo, José; Hernández, Alicia; Venditti, Mario; Prim, Nuria; Bou, German; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Giamarellou, Helen; Almela, Manel; Pérez, Federico; Schwaber, Mitchell J.; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po Ren; Paño-Pardo, José Ramón; Torre-Cisneros, Julián; Souli, Maria; Bonomo, Robert A.; Carmeli, Yehuda; Paterson, David L.; Pascual, Álvaro; Rodríguez-Baño, Jesús; Gálvez, J.; Falcone, M.; Russo, A.; Daikos, G.; Trecarichi, E. M.; Losito, A. R.; Gómez, J.; Iosifidis, E.; Roilides, E.; Karaiskos, I.; Doi, Yohei; Tuon, F. F.; Navarro, F.; Mirelis, B.; Martínez, J. A.; De La Calle, C.; Morata, L.; San Juan, R.; Fernández-Ruiz, M.; Larrosa, N.; Puig, M.; Molina, J.; González, V.; Rucci, V.; Ruiz De Gopegui, E.; Marinescu, C. I.; Fariñas, M. C.; Cano, M. E.; Gozalo, M.; Mora-Rillo, M.; Gómez-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.; Jové, E.

In: Clinical Infectious Diseases, Vol. 65, No. 10, 15.11.2017, p. 1615-1623.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Empiric Therapy with Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae

T2 - Results from the INCREMENT Cohort

AU - Palacios-Baena, Zaira Raquel

AU - Gutiérrez-Gutiérrez, Belén

AU - Calbo, Esther

AU - Almirante, Benito

AU - Viale, Pierluigi

AU - Oliver, Antonio

AU - Pintado, Vicente

AU - Gasch, Oriol

AU - Martínez-Martínez, Luis

AU - Pitout, Johann

AU - Akova, Murat

AU - Peña, Carmen

AU - Molina Gil-Bermejo, José

AU - Hernández, Alicia

AU - Venditti, Mario

AU - Prim, Nuria

AU - Bou, German

AU - Tacconelli, Evelina

AU - Tumbarello, Mario

AU - Hamprecht, Axel

AU - Giamarellou, Helen

AU - Almela, Manel

AU - Pérez, Federico

AU - Schwaber, Mitchell J.

AU - Bermejo, Joaquín

AU - Lowman, Warren

AU - Hsueh, Po Ren

AU - Paño-Pardo, José Ramón

AU - Torre-Cisneros, Julián

AU - Souli, Maria

AU - Bonomo, Robert A.

AU - Carmeli, Yehuda

AU - Paterson, David L.

AU - Pascual, Álvaro

AU - Rodríguez-Baño, Jesús

AU - Gálvez, J.

AU - Falcone, M.

AU - Russo, A.

AU - Daikos, G.

AU - Trecarichi, E. M.

AU - Losito, A. R.

AU - Gómez, J.

AU - Iosifidis, E.

AU - Roilides, E.

AU - Karaiskos, I.

AU - Doi, Yohei

AU - Tuon, F. F.

AU - Navarro, F.

AU - Mirelis, B.

AU - Martínez, J. A.

AU - De La Calle, C.

AU - Morata, L.

AU - San Juan, R.

AU - Fernández-Ruiz, M.

AU - Larrosa, N.

AU - Puig, M.

AU - Molina, J.

AU - González, V.

AU - Rucci, V.

AU - Ruiz De Gopegui, E.

AU - Marinescu, C. I.

AU - Fariñas, M. C.

AU - Cano, M. E.

AU - Gozalo, M.

AU - Mora-Rillo, M.

AU - Gómez-Zorrilla, S.

AU - Tubau, F.

AU - Pournaras, S.

AU - Tsakris, A.

AU - Zarkotou, O.

AU - Azap, K.

AU - Antoniadou, A.

AU - Poulakou, G.

AU - Virmani, D.

AU - Cano,

AU - Machuca, I.

AU - Helvaci,

AU - Sahin, A. O.

AU - Ruiz-Garbajosa, P.

AU - Bartoletti, M.

AU - Giannella, M.

AU - Peter, S.

AU - Badia, C.

AU - Xercavins, M.

AU - Fontanals, D.

AU - Jové, E.

PY - 2017/11/15

Y1 - 2017/11/15

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85032746020&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032746020&partnerID=8YFLogxK

U2 - 10.1093/cid/cix606

DO - 10.1093/cid/cix606

M3 - Article

C2 - 29020250

AN - SCOPUS:85032746020

VL - 65

SP - 1615

EP - 1623

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 10

ER -