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Non-intravenous carbapenem-sparing antibiotics for definitive treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) or AmpC beta-lactamase: A propensity score study

AuthorsMeije, Yolanda; Pigrau, Carlos; Fernández-Hidalgo, N.; Clemente, Mercedes; Ortega, Lucía; Sanz, Xavier; Loureiro-Amigo, Jose; Sierra, Montserrat; Ayestarán, Ana; Morales-Cartagena, Alejandra; Ribera, A.; Duarte, Alejandra; Abelenda, Gabriela; Rodríguez-Baño, Jesús; Martínez-Montauti, Joaquim
KeywordsCarbapenem-sparing antibiotics
Enterobacteriaceae bacteraemia
Extended-spectrum β-lactamase
AmpC β-lactamase
Issue DateAug-2019
CitationInternational Journal of Antimicrobial Agents 54(2): 189-196 (2019)
AbstractCarbapenems are considered the treatment of choice for extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase-producing Enterobacteriaceae bacteraemia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. This study compared the 30-day mortality and clinical failure associated with the use of carbapenems versus alternative non-intravenous antibiotics for the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia. This 12-year retrospective study (2004–2015) included all patients with bacteraemia due to ESBL/AmpC-producing Enterobacteriaceae at a Spanish hospital. Given the lack of randomisation of initial therapies, a propensity score for receiving carbapenems was calculated. There were 1115 patients with a first episode of bacteraemia due to Escherichia coli or Klebsiella pneumoniae, of which 123 (11.0%) were ESBL/AmpC-positive. There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (trimethoprim/sulfamethoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared with the carbapenem group, patients treated with an alternative regimen had a shorter hospital stay [median (IQR) 7 (5–10) days vs. 12 (9–18) days; P < 0.001]. Use of an alternative non-intravenous therapy did not increase mortality (OR = 0.27, 95% CI 0.05–1.61; P = 0.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95 (95% CI 0.94–26.01; P = 0.059). Alternative non-intravenous carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia, allowing a reduction in carbapenem use. Use of trimethoprim/sulfamethoxazole in this series showed favourable results.
Publisher version (URL)http://dx.doi.org/10.1016/j.ijantimicag.2019.05.004
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