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 Hamprecht, Helen 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, Y Doi, F F Tuon, F Navarro, B Mirelis, JA 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, Ö K Azap, A Antoniadou, G Poulakou, D Virmani, Á Cano, I Machuca, Ö Helvaci, A O Sahin, P Ruiz-Garbajosa, M Bartoletti, M Giannella, S Peter, C Badia, M Xercavins, D Fontanals, E Jové

There is little information about the efficacy of active alternative drugs to carbapenems except β-lactam/β-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum β-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. 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. 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. 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.