Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study

ESGBIS/REIPI/INCREMENT Group

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3 Citations (Scopus)

Abstract

We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14–0.81), Greece (aOR 0.49, 95% CI 0.26–0.94) and Canada (aOR 0.31, 95% CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11–2.25) and Turkey (aOR 2.09, 95% CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03–2.92) and USA (aOR 1.89, 95% CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28–0.69) and Canada (aOR 0.10, 95% CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts.

Original languageEnglish
Pages (from-to)664-672
Number of pages9
JournalInternational Journal of Antimicrobial Agents
Volume50
Issue number5
DOIs
Publication statusPublished - 01-11-2017

Fingerprint

Enterobacteriaceae
Infection
Carbapenems
Israel
Turkey
Taiwan
Italy
Therapeutics
Canada
Lactams
Greece
Spain
Observational Studies
Brazil
Logistic Models
Odds Ratio
carbapenemase

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

@article{881480519bd2419fb9adbf2932063620,
title = "Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study",
abstract = "We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95{\%} CI 0.14–0.81), Greece (aOR 0.49, 95{\%} CI 0.26–0.94) and Canada (aOR 0.31, 95{\%} CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95{\%} CI 1.11–2.25) and Turkey (aOR 2.09, 95{\%} CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95{\%} CI 1.03–2.92) and USA (aOR 1.89, 95{\%} CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95{\%} CI 0.28–0.69) and Canada (aOR 0.10, 95{\%} CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts.",
author = "{ESGBIS/REIPI/INCREMENT Group} and Harris, {Patrick N.A.} and Pezzani, {M. Diletta} and Bel{\'e}n Guti{\'e}rrez-Guti{\'e}rrez and Pierluigi Viale and Hsueh, {Po Ren} and Patricia Ruiz-Garbajosa and Mario Venditti and Mario Tumbarello and Carolina Navarro-Francisco and Esther Calbo and Murat Akova and Helen Giamarellou and Antonio Oliver and Benito Almirante and Oriol Gasch and Luis Mart{\'i}nez-Mart{\'i}nez and Schwaber, {Mitchell J.} and George Daikos and Johann Pitout and Carmen Pe{\~n}a and Alicia Hern{\'a}ndez-Torres and Yohei Doi and Federico P{\'e}rez and Tuon, {Felipe Francisco} and Evelina Tacconelli and Yehuda Carmeli and Bonomo, {Robert A.} and {\'A}lvaro Pascual and Paterson, {David L.} and Jes{\'u}s Rodr{\'i}guez-Ba{\~n}o and {del Toro}, {M. D.} and J. G{\'a}lvez and M. Falcone and A. Russo and I. Karaiskos and Trecarichi, {E. M.} and Losito, {A. R.} and E. Garc{\'i}a-V{\'a}zquez and J. G{\'o}mez and E. Roilides and E. Iosifidis and S. Pournaras and N. Prim and F. Navarro and B. Mirelis and J. Orig{\"u}en and Juan, {R. San} and M. Fern{\'a}ndez-Ruiz and M. Almela and {de la Calle}, C.",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/j.ijantimicag.2017.08.005",
language = "English",
volume = "50",
pages = "664--672",
journal = "International Journal of Antimicrobial Agents",
issn = "0924-8579",
publisher = "Elsevier",
number = "5",

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TY - JOUR

T1 - Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae

T2 - a post-hoc analysis of the INCREMENT study

AU - ESGBIS/REIPI/INCREMENT Group

AU - Harris, Patrick N.A.

AU - Pezzani, M. Diletta

AU - Gutiérrez-Gutiérrez, Belén

AU - Viale, Pierluigi

AU - Hsueh, Po Ren

AU - Ruiz-Garbajosa, Patricia

AU - Venditti, Mario

AU - Tumbarello, Mario

AU - Navarro-Francisco, Carolina

AU - Calbo, Esther

AU - Akova, Murat

AU - Giamarellou, Helen

AU - Oliver, Antonio

AU - Almirante, Benito

AU - Gasch, Oriol

AU - Martínez-Martínez, Luis

AU - Schwaber, Mitchell J.

AU - Daikos, George

AU - Pitout, Johann

AU - Peña, Carmen

AU - Hernández-Torres, Alicia

AU - Doi, Yohei

AU - Pérez, Federico

AU - Tuon, Felipe Francisco

AU - Tacconelli, Evelina

AU - Carmeli, Yehuda

AU - Bonomo, Robert A.

AU - Pascual, Álvaro

AU - Paterson, David L.

AU - Rodríguez-Baño, Jesús

AU - del Toro, M. D.

AU - Gálvez, J.

AU - Falcone, M.

AU - Russo, A.

AU - Karaiskos, I.

AU - Trecarichi, E. M.

AU - Losito, A. R.

AU - García-Vázquez, E.

AU - Gómez, J.

AU - Roilides, E.

AU - Iosifidis, E.

AU - Pournaras, S.

AU - Prim, N.

AU - Navarro, F.

AU - Mirelis, B.

AU - Origüen, J.

AU - Juan, R. San

AU - Fernández-Ruiz, M.

AU - Almela, M.

AU - de la Calle, C.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14–0.81), Greece (aOR 0.49, 95% CI 0.26–0.94) and Canada (aOR 0.31, 95% CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11–2.25) and Turkey (aOR 2.09, 95% CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03–2.92) and USA (aOR 1.89, 95% CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28–0.69) and Canada (aOR 0.10, 95% CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts.

AB - We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14–0.81), Greece (aOR 0.49, 95% CI 0.26–0.94) and Canada (aOR 0.31, 95% CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11–2.25) and Turkey (aOR 2.09, 95% CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03–2.92) and USA (aOR 1.89, 95% CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28–0.69) and Canada (aOR 0.10, 95% CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts.

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