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.
N1 - Funding Information:
Funding: PNAH is supported by an Australian Postgraduate Award from the University of Queensland (Brisbane, QLD, Australia). The study was funded by Planes Nacionales de I+D+i 2008-2011 / 2013-2016 and Instituto de Salud Carlos III , Subdirección General de Redes y Centros de Investigación Cooperativa , Ministerio de Economía, Industria y Competitividad,Spanish Network for Research in Infectious Diseases ( REIPI DR12/0015/0010 , RD16/0016/0001 , RD16/0016/0009 , RD12/0015/0001 , RD16/0016/0010 , RD12/0015/0013 , RD16/0016/0002 , RD12/0015/0009 , RD16/0016/0008 , RD12/0015/0002 , RD16/0016/0005 , RD12/0015/0008 , RD16/0016/0004 , RD12/0015/0006 , RD16/0016/0006 , RD12/0015/0014 , RD16/0016/0003 , RD12/0015/0003 , RD16/0016/0007 , RD12/0015/0019 , RD16/0016/0011 , RD12/0015/0004 , RD12/0015/0012 and RD16/0016/0014 ) ‐ cofinanced by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020. BG-G, JR-B, AP and YC also received funds from the COMBACTE-CARE project [grant agreement 115620 ], Innovative Medicines Initiative (IMI), the European Union's Seventh Framework Programme [ FP7/2007-2013 ] and in-kind contributions from EFPIA companies.
Funding Information:
Competing interests: JR-B reports personal fees from Merck, AstraZeneca and InfectoPharm and grants from Merck outside of the submitted work; AP reports personal fees from Merck, B. Braun and AstraZeneca and grants from B. Braun outside of the submitted work; RAB reports grants from Allergan, Merck, Entasis, the NIH and Merit Review VA outside of the submitted work; YD reports personal fees from Meiji, Shionogi, Tetraphase, Achaogen, Allergan, The Medicines Company, Curetis, Roche and Merck and grants from The Medicines Company and Merck outside of the submitted work; FP reports grants from Pfizer outside of the submitted work; FFT reports personal fees from AstraZeneca, Pfizer, TEVA, MSD and Bayer and grants from MSD during the conduct of the study; GD reports personal fees from Pfizer, Achaogen, MSD and REMPEX and grants from Pfizer and Gilead during the conduct of the study; DLP has received personal fees from Merck, grants from Merck and non-financial support from Allergen, Shionogi and Achaogen; PNAH has received travel and accommodation support to speak at an educational event sponsored by Pfizer. All other authors declare no competing interests.
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.
UR - http://www.scopus.com/inward/record.url?scp=85031115305&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031115305&partnerID=8YFLogxK
U2 - 10.1016/j.ijantimicag.2017.08.005
DO - 10.1016/j.ijantimicag.2017.08.005
M3 - Article
C2 - 28782704
AN - SCOPUS:85031115305
VL - 50
SP - 664
EP - 672
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
SN - 0924-8579
IS - 5
ER -